HomeMy Public PortalAbout5642 GRACEWOOD AVE_Electrical__ • COUNTY OF LOS ANa[Ln APPLICATION FOR PEHAEIT
r V ELECTRIC 1
,.- inow
DIVISION OF BUILDING � SAFETY
WILUAS I FOX. Couty ER�Imw
FOR APPLICANT TO FILL IN Dial l ICT NO. GROUP ZONA PERMIT NO.
ELECTRICIAN
ADDRESS - _ � Rm[IVm 1Y READY FOR DAT[ 10611.1-102
FIRST INSPECTION _
OI t TIL NO Is - 1%lss -
QOUjorNsic Imi DMIR-Ke ■UILDINO
PERMIT FEES ADDRna -
NUMMER [ADH F[[ LOOAUTY`
LIGHT OUTLETS NKAJt r
RLUKPTA3LES 0 OH
WALL SWITOH[S OWNER
TOTAL OUTLETS ■D MAIL
[LEO. RANGES sy ADDRE=
[LE0. HKAT[R1 316 CITY TIE L. N0.
Ffl(TURO A40
1 HERESY AOKNDWLEDO[ THAT I HAVE READ TH18
— APPLICATIONIL
AND STAT[ THAT THE ABOVE 12 CORRECT
HUMMER OF 1-101-17
OIROUITO AND ABRIT
E[ TO COMPLY WITH ALL DOUNTY ORDINAMOES
PD
NUMBER OF R[CETALI CIRCUITS AND STAT[ LAWS KWULATINB ELECTRICAL WIRING.
MOTORS I OKXTIFY THAT I POaE31Sl THE ABOVE VALID LDS
NUMBER HORSEPOWER FEE ANGELES ODLINTY LIC[NSI, OR 1 AM THE Li GAL OWNER
NEW Mw. HP DV[R INC. [AGH OF THE WKNIDKKTIAL_P PERTY D[SORIMED AS
A Lusa .25 ■IGNATUR[ OF
i .SO P[RMI
''O° INSPECHON RECORD
s IB 1.ao
TS Ba 31.50
SO 200 5.00
SOD 500 10.DO J
500 1COO IILDD
Z
OVER 10100 310.00
_MOVED MOTORS (75 Or DRi■
M.B. ■[T rw OHANmmm-Hr O
WELDIRStAC-KVA
GENERATORS - KW
TPtANSFORMKRE - KVA
OIONB
MO. MO.TRAMS
APPROVALS
FOR CA 3H PERMITI DAT[ INBPEOTORPE NAM[
WIRING 411.00 CONDUIT
Rq $1.00 WIRING
lKJPPl-9MKKTARY .00 F I1C111 REB
3 POWER �Z
TUTAL FEE UTILITYO0.NOTIFIm
h -
7--"- D=#&A ab 12-53 FINAL
WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-B06G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB t`
❑ Certified copy is herebyfurnished. EACH NO. FEE ADDRESS
New Residential Bldgs.&Pools
❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY
Certified copy is filed with the county building inspection
department. Multi-family Sq.Ft. — NEAREST
CROSS ST.
Date Applicant
Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' ; MAIL
COMPENSATION INSURANCE Outlets:Rec Light Sw. ADDRESS
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars($100)or less.)
Total No. Additional CITY Tel.No.
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
Total No. CITY Tel.No.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT
provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU W.H.
CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan Other_
I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR
(commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. d
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY U
Size& Type HP,KW,KVA,or KVAR Lv
License Number Lic.Class Up to 1 Incl. FINAL -�
Over 1 to 10 Incl. DATE V-
Contractor Date VALIDATION
❑ Over 10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY
B.&P.C.for this reason Over 100 d
Services,Swbd.,MCC&Panelboards ,
Date: 0-200 Amp.Under 600 V W
Signature 201 - 1000 Amp.Under 600 V H
❑
Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V
SINGLE FAMILY Temp.Power Pole& Appurtenances Ir
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit +'
I hereby affirm that I am exempt from the Contractor's License Law *
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits �+
Code): 1 ITEM
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 01C
and
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) t �" 1
and Professions Code). ,
84.0
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(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.). �"}j'
PLAN CHECKING FEE ""'
Lender's Name 1 WOOD%
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
information is correct. I agree to comply with all County ordinances
and State lawsr ting Electrical wiring, and hereby authorize
representative
of this County to enter upon the above-mentioned
property for inspection purpose
/`�° '� _ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date