HomeMy Public PortalAbout9407 GIDLEY ST_Electrical__ 76A663-CE606-7.56 APPLICATION FOR ELECTRIC PERMIT 1
BUILDING AND SAFETY DIVISION
Department of County Engineer BUILDING
County of Los Angeles ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY /p/Q7�,/�'/J11�/�,C�
FOR APPLICANT TO FILL IN CROSS ST C.-
PERMIT FEES
NUMBER OWNER
LIGHT OUTLETS MAIL -
ADDRESS
RECEPTACLES
b WALL SWITCHES FEE CITY TEL. NO.
-02 TOTAL OUTLETS @ 52 $ ELECTRICIA-!;-5-
ELEC. RANGES 25 ADDRESS �.S J^S
ELEC. HEATERS 25 CITY zte TEL. NO.
KW EA STATE
LICENSE
FIXTURES 5
MOTORS DISTRICT NO. ZONE READY FOR INSPECTION
NUMBER HORSEPOWER FEE 1GROUP1
`
NEW MVD. HP OVER INC. EACH
I�IN LESS $ .25 INSPECTION RECORD
�2 2 .50 -:�14',�i t 1 'n s 0"i�
2 5 1.00 C,s
5 15 1.50 t
15 50 2.50 �.l<�t'►OK pAytkn IN S At"L-L.
50 200 5.00
misc.
NO. SIGNS NO. TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING PERMIT $1.00
FIXTURE PERMIT $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE DATE INSPECTORS SIGNATURE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ICATION CONDUIT 11
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIRING 1 T7
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS A GEL OU �Y AND STATE OF POWER
CALIFORNIA OR THAT M T tL/Pll R OF THE ABOVE
DESCRIBED RESIDENTI ROP T UTILITY CO.NOTIFIED r
SIGNATURE
OF PERMITTEE FINAL U
JOHN A. LAMBIE. VkLIDATION ARTHUR C. VEIT.
COUNTY ENGINEER CK) MO CASH SUPERVISING ELECTRICAL ENGINEER
CK,
( -'Ico 6 5 1 3 MAR 2 7 2 . 5.0 D in
WORKERS'•cI have ATI°NDEte of consent -W6G, APPLICATION FOR ELECTRICAL PERMIT
I hereby Irm that I have a certificate of consent to self
�rtsure, o certificate ci Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
br a cert ped copy-thereof (Sec. 3WO, Lab. C.)
Policy No. Company K*APPLIC W TO KII IN D
Certifled copy Is hpreby furnished. New Residential Bldgs. d Pools EACH NO.
FE ADDRESS❑ Certified copy Is filed with the county building inspec- 1 8 2-Famlly, Sq. Ft. _ _ ; LOCALfTY
tion department. Multi-family Sq. Ft. NEAREST
RESTCROSS ST
Date Applicant Residential Swimming Pools OR
FIRM NAME
CERTIFICATE OF E)EMPTION FROM WORKERS' Outlets: Rec1T_Light_ ,Sw.1_ a
COMPENSATION INSURANCE . Flrn 20
(This sectkm nand not be completed rt the work Imrohred by Total No Additional City 771, Tel. No.
the permit Is for on*hundred dollars ($100)or lass.)
CHECY
I certify that In the performance 6f the work for which'this App
permit Is Issued, I shall not employ any p-erson In any manner
to as to become subject to the Workers Compensation Laws. Ughting Fixtures First 20 ADDRESS
Total No. -0- Additional CITY Tel N
Date Z/ licant NN Fixed Appliances Not Over 1 HP POM
NOTI TO CANT: If, after making this Certiflca f C
Exemption, you should become subject to the Workers' Range_ Heater D.W. APPLICANT
Compensation provl;lens of the Labor Code, you must forth- Oven _ Dryer. .W:(M. ADDRESS
with comply with such provisiohi or this permit shall be Top — FA T W.H. —
deemed revoked. Hood Fan Other CITY Tel. Ne.
LICENSED CONTRACTQREC
S DECLARATION . _ _ LK:E S OR
I hereby of Irm that I am licensed under provlsJons of Chapter 9 Disp. _ Room Air Cond. REG NUMBER Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. BY
off
and Professions Code,and my license Is in full force and eect. Power Apparatus-8 Large Appliances
Size $Type HP, KW,KVA, or KVAR'
License Number Llc. Class Up to 1 Incl. I FINAL 01U
Over 1 to 10 Incl. DAA V TFON
Contractor DmeOver 10 to 50 Incl.
❑ . FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY
BAP.C. for this reason Over 100
Services, Swbd., MCC 8 Panelboards 7 _
Date- 0 -200 Amp. Under 600 V
Signature r s 201 - 1000 Agip. Urldw 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Malnt. Elect.
:97950A '.
SINGLE FAMILY Temp. Power Pole d Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Clrtult # o • o'°•o Z
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Sectlon 7031.5, Business and ) 0 0 2 7,D,�
Professlons Code):
❑ I, as owner of the property, will do the work and the Mlsc. Conduits 8 Conductors o o.o 2 7,Q 0
p ed Other (See Complete Fee Schedule)_
structure Is riot Intended or offered for sale (Section ,
70..4, Business and Professloris Code) 9, 84' 87
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total)
(Sec. 3097, CNS. C.).
PLAN CHECKING FEE
Lenders Name
PERMIT ISSUING FEE
Lender',&Address
I certify that I have read this application and state that the TOTAL FEE , f!
above Information Is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property for Inspection purposes. SEE REVERSE FOR JEXPLANATORY LANGUAGE
cl—
n Ittae Date