HomeMy Public PortalAbout9414 GIDLEY ST_Electrical__ T5"a>I_Cff�� APPLICATION FOR ELECTRIC PERMIT ],
BUILDING AND SAFETY DriMON
Dep=bm@W of Ott Engiaew 7RM
^
C=2t1 of Los Angslm ZZ I
JOHN A. LAMBIR. COUNTY ENGINMMR
CAf1ATT D. GRIFFIN.Sur^r or Mu1LDi11•
FO�=PLICP.NT TO FILL IN �yE ST, ,
NUMBER g��� OWNER
LIGHT OUTLETS Idw'L
DR
R ECEPTACL.$D
WALL SWITCHES FEE C .
TOTAL OUTLsrs b ELECTRICIAN c,
ELEC. RANGES 213 ADDRXS- `L
ELEC. HEATERS 20 CITY
Kw EA STATIiK
LICENSE NO,
FIXTURES
MOTORS DISTRICT NO. GROUP1.ZON5 RLADT FOR I■SPXCTIOII
NUYm[R HORSEPOWER FEE
HimMvD. HP OV R INC. [AcFI
r LIM IF 2b INSPFd ON ESGOBD
2 .DO
2 D 1.00
e Ia. 1.50
IS. Ifo 9.150
DO . 200 5.00
� 418C.
NO.SIGNS NO.TRANS.
NO SIGNS NO. k-AMPS
FOR EACH PERMIT:
WIRING PERMIT $1.00
FIXTURE PERMIT 1.00
EUPPLILM ENTARY .150 APPHOVAIS
T T EDATE INSPECTOR D SIGNATURE
1 HERESY ACKNOWLEDGE THAT 1 HAVE READ,THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAMS REGULATING WIRING
ELECTRICAL MIRING. F1XTUkES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES.COUNTY AND &TATK OF POWTa
CALIFORNIA OR THAT I AN THE LEGAL ER OF THE ABOVE
DESCRIBED RESIDENT L• R P UTILITY CO.NOTA XD
H I O NATlf R E
OF PERMITTkX �Vj��T���� f*INAL 4
ARTHUR r—Y)EIT.
LINTYPHN NGINBCMRIE- �ATION SUP RVOLNG IILIDCT'RICAL ENGINM3M
/`ax// y0 CLASH
6995 APR 9 2 4.30 In
. V Tr . T
kJORmEth CI have cafti DECLARATION 2D-001764.66vovwJ/m APPLICATION FOR ELECTRICAL PERMIT
Thereby a�lrm that I have a certificate of coruent.to self CE-836G� O
Insure, or a certificate of Worker' Compensation Insurance, COUNTY OF LCIS ANGELES DEPT. OF PUBLIC WORKS
or a certlfle l copy thereof (Sec. 3800, Lab. C-)
Py�cy No. Company FOR/1Pt•LJUM TO FILL JOB
❑Certtfled copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
❑Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. $ ❑ $ LOCALITY
tion department. Multi-family Sq. Ft. at055 CROSS T
ST.
Date Applicant Resldentlal Swimming Pools py,�
-FiRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rer Llght Sw._ MAR
COMPENSATION INSURANCE ADDRESS
(This McHon need not be completed If the work Involved by First 20 OTY el. No.
the permM Is for one hundred dollars (:100) or Liss.) Total No. Additional
PLAN CHC{IC
I certify that In the performance of the work for which this APPUCANT
permit Is issued, I shall not employ any Person In any manner Lighting Fixtures FIM 20 ADDRESS
so as to become subject to the Workers Compensation Laws. r
Additional
' f Total No. C1 TY Tel. No.
Date �C —, ppllcont Fixed Appliances Not Ovef 1 HP PERMIT
NOTICE TO APPLICANT: If, after making thls Certlficat of APPUCATK)N
Exemption, you should become subject to the Workers' Range— Heater—D.W. —
Compensatlon provisions of the Labor Code, you must forth- Oven — Dryer —W.ML— ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITY Tel. No.
LICENSED CONTRACTORS DECLARATIONUc�NSE OR
Dlsp. — Room Air Cond. REG NUMBER Class.
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus R Large Appliances DISTRICT NO. SSM BY d
and Professions Code,and my license is In full force and effect.
Size 8 Type HP, KW, KVA, or KVAR D O
License Number Uc. Class Up to 1 Incl. FINAL / a U
Over 1 to 10 Incl. DATE l d— �G— l VALIDATION M
Confractor Dare Over 10 to 50 Incl. FINAL U
❑ I am exempt under Sec Over 50 to 100 Inc BY LU
B.BP.C_ for this reason Over 100 d
U)
Date: no
Services, Swbd., MCC 8 Panel boards , Z
0- 200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Cher 600 V
Exemption for Reg. Malnt. Elect. �
SINGLE FAMILY Temp. Power Pole 8 Appurtenances i
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit
T
Law for the following reason (Section 7031.5, Bwlness and Additional Sign Branch Circuits 7 31.[0
{Professions Code):
LJ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors 1 I
structure Is not Intended or offered forsale(Section 7044, Other (See Complete Fee Schedule. , TOTAL 3 1 - 00
Business and Professions Code). I`�{��( 1
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for
the pefformance of the work for which this permit Is Issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE L�—�1 11/27/91]
Lenders Name PERMIT ISSUING FEE J � �
Lender's Address 4113 1 AN 10-,[6
I certify that I have read this application and state that the TOTAL FEE
above Information Is correct. I agree to comply with all County
ordinances and State laws regulating Electrlcal wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property for Inspectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
'Srg to a of Perm ee Date
�� , a Q a , A P P L I C A T I O N F O R E L E C T R I C P E R M I T i
c o a x " o f 4 0 1 ; A x a
D E P A R T K M O F C O U N T ? M C M C M . B U I L D I N G
B U M D �� A N D S A F E T Y D M R O N D R E 6 E
J O H N A . L A M B I E _ C o u x r r B r v G L N K t
C A S S A T T D . G I R I W O f L D I M a L O C A L I T Y
F O R A P P L I C A N T T O F I L L L N q W " S I P E B M T +
E M S O W N R
u a r m X K C a T A C L [ 1 B v r " c t i [ s
u I T z m M A I L
A D b R E "
T O T A L O U T L E T S . 1 0
u i c , w O a , �%A T X R �%[ A T X R S , Q T T Y
a U T w D R Y K M C X
R U C .
B u n D o E L E C T R I C I A N
' c . ��r A t i n , f T 1 r T . C O q [ -
I n g D i r n , a A ��l A 6 l D I S F 0 2 1 l l . A D D R H B D
" T o 1 ��i i i n M W A S N i l
L I G H T I N G F [ I T U Y n . 1 0 C r T - Y T S L N O .
a O T O R S L I A T E C E N S E
E N N O
H O R S E P O W E R
H . t ' O V L I I N C . T u A D T r o a n i l ��c n o i
a L i l a . 2 5
2 . 5 0 I N S P E C T I O N S E C O N D
5 1 . 0 0
5 1 5 1 . 5 0 V
1 5 5 0 2 . 5 0
5 0 2 0 0 5 . 0 0 _
8 1 G N d N O . T R A N S
N O . L A . i [ T f
B R R V I C E O - Q O O V 1 . 0 0
6 E R V i C R O V E R 6 0 O V 5 . 0 0
W I R I N G P I S R M I T 1 . 0 0
F I X T U R E P E R M I T 1 . 0 0
S U P P L E M E N T A R Y F E R M I T . 5 0 A M O V A M
T O T A L F E E
I H E R E B T A C K N O W L E D G E T H A T I k A V E R E A D T H I S O M D A T E I N S P E C T O R ' S S I G K A T U R E
A N D S T A T E T H A T T H E A B O Y E I S C O R K q T A N D A G R E E T C O N P L T C O N D U I T
W I T H A L L C O U R T T O R D I N A N C E S A N D S T A T E L A W S R E G U L A T I N G
E L E C T R I C A L W I R I N G . W I R I N G
I H E R E R T C E R T I F T T H A T I A N P R O P E R L T R E G I S T E R E D A A ! ! ( ( D / O R p I X T U R S b
L C E M B E D A S R E Q U I R E D B T L A S A N G E L E S C O U N T T A N D S 7 A Y E O F
C A L I F O R N I A O R D W I A l T H L E G A L O W N E R O F T H E A B O V E p O V y ��
D E S C R I B E D R E S I D E l h [ L L L P 2 0 P
S I G N A T U R E U T I L I T Y C O . N O T I F I E D
O F P E 3 1 N M : 1
J O H N A B I E . { % M A T I O N 9 U p K R V C . 1 ��f ,
u N T Y o l l x r a e o z x o a w a r e U P [ R V L p N Q i C { A L Q t i G l W l f l O R
4 . G 4 6 8 3 , - , t m v 2 9 2 5 5 . 0 0 L
- v t Z ��v
WORKDRS'CibMPENSATTON DECLARATION 75A"3
'► CE-806G (2-80) APPLICATION .FOR ELECTRICAL PERMIT
,-
I hereby affirm that I have a certificate of consent to .elf COUNTY OF 40S ANGELS NG AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab.C.)
FOR APPLICANT Tp.FILl, IN ,JOB
I� Policy No. Company EACH NO. FfE ASD 8&
Sf{ New Residential Bldgs.&Poole
Certified copy Is hereby furnished. 1 &2-Famlly,Sq. Ft._ s LOCALITY
n, Certlifled copy Is filedesId with the county building Inspection RfamHy wFt. CROSS ST
¢apartment. esldeptlal Swimming Poole OWNER OR
( FIRM NAME
Data Appucarit Outlets: Rec._Ligi-t Sw. ADI L S`8 /•
T�arst 2a
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CIT Tal o.
COMPENSATION INSURANCE
� PLA E
(This section -need not be letad if the work hmtved APPLI A 8
by the permit is for ope hundred•doilm ($100) or lar.) Lighting Fixtures Flrrt 20 AD-DRESS.
Total Nd, Additional
I I certify that in the performance of the work for which this Fixed Appllances Not Over 1 HP CITY tel No. O
I permit is issued, 1&hail not employ any person in any►gannetU
PERMJT {� W
so•as to bectlrrla subject to the Workers' Compensation Laws. Range— Heater_D.W. _ PP ANT �l a
IOven _ Dryer•__,-W.M. A4DRE88 Z
Date(Applicant Top _fAU T W.H.
Hood Fen ,_Other— CITY Tal N
NOTICE TO APPLICANT": If, after making this eta of Dlrp. Room Air Cond` REO.NUMBER Class
Exemption, you should become subject to thb Workers'
Compensation provisions of the Labor Code, you mwt forth- power Apparaw a& Large App,Warw-m DISTRICT NO. P CE ED BY
with comply with such provisions or this permit /hall be
deemed revoked. Size&Type HP,KW, KVA,or KVA
J Up to 1 Incl.
' FINAL
Over 1 to 10 Incl. DATE �Z., � VALE DATION.
:LICENSED CONTRACTORS DE"ARATION � Over 10 to 60 Incl. 44 4�;9
I hereby afftrm that I ani licensed under provisions of Chapter Over 60 to 100 Inc. FINAL r '
9 (commencinJj with Settlors 7000) of Dtrialo❑ � of the Bust- Over 100 BY
-
neu and Prbfeaalonz.,Coda, and my license is in AM forte and.
t effdct. / Services
License Number Lic.Class / O 0-200 Amp. Under 800,V f• fat
p
�ig201 rl 000 Amp,'Under 600 V
Coptracto ate ----7-- d f Oyer 1D00 Amp.or Over 600 V-
HOME FR 11 ILDER DECLARATION Temp. Power Pole&Appurtenances
I hareby affirm that T am exempt.from the ContrActdr's Sign wlthiOne Brancb Clrchlt
License Law for the following reawn- (Se -tloo 7031.5, Buri- Addltionar Sign Branch Clrcults
new and.ProfeWons"de):
Mlac.Conduits&Conductors
❑ I, as owner of the property, will do the work and the Other{See Complete Fee Schedule►—
5 1 .a O
structure is not intended or offered for sale (Section # 0`0 0 2
7044, Business and Trofeadons Code). -
CONSTRUCTION LENDING AGENCY 2 0 0 0 0 3 2 O O
I hereby affirm, that there Is a construction lending sgapcy
for the performance of fhe work for,which this'permit Is PERMIT'FEE (Sub-Total)
iuLked'(Sec. 3097,Civ.C_.). o 0 0 3 2 O O T3
Lander'sName PLAN CHEOKING FE-E (One-Fourth Permit Fee) 0 S.07-81
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TQTAL FEE
above information Is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
'hereby authorize represe4tatives of the Co nXy to entgrLpbn
the ab-ova- onad property;or IM purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signa turd of "goDate .