HomeMy Public PortalAbout5646 GRACEWOOD AVE_Electrical__ D13S 5-A 12-44 "PUCATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ��������
COUNTY OF LOS ANGELES
wM. J. FOX CHIEF ENGINEER
a _NAMEDISTRICT NO. GROUP ZONE PERMIT NO.
Olt
U ADDRESS ♦ "'
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F RECEIVED BY READY FOR DATE ISSUED
W CITY FIRST INSPECTION
J COU TY ♦ Y,
W CERT.NO. Q// EXPIRES t '
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB I
DESCRIPTION OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS lsw.I PLUGS FIXT CROSS ST.
CIRCUIT /A B C � D E F G H m NAME
Z MAIL
3 ADDRESS
0
CITY TEL.NO. JA
I AM THE LF_GAL POSSESSO�. OF THE AANGELES COUNTY CERTIFIC T OF QUALIFICELECTR
I AN THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
CORRECTIONS
J
Q
Z
O
R
I
TOTAL,
NO. OF OUTLETS - $ APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
'7
NO. OF SIGNS TRANS. $ WIRING
NO. OF OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $
UTILITY CO.NOTIFIED
TOTAL FEE 41 F FINAL `'�
VAX*CER'S COMPENSATJON DECLARATION 20-0019 DPW 9/89
hereby affirm that I have a certificate of consent to .elf Insure, '°"°°' APPLICATION FOR ELECTRICAL PERMIT
or ■oerttfloate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIY.
copy thereof(Sec.3800 Lab. C.)
0 No. Company FOR APPLMAN17 TO FLl N A�D0RE88
CmtW copy In hereby wdontlel ed• New ResiBldgs.8 Pools EACH NO. FES
❑ LOCALITY
Car~copy Is Mad with the county bdkWQ Inspection 1 8 2-Family,Sq.Ft TY
� — $ LOCALIr
department MultNamily Sq.Ft- — CF1068 ST.
Datert Fleeiderrtld 8wtmrrling Pool AOR
YAP BOOK PAGE PAFICE-
CMT1F1CATE OF EXEPIPTION FROM WORJ(EFS' OutMlb:Rao. tight Sw.M ~FIFN On /
COMPENSATION INSUFLANCE
(This,swtlon need not be oompleted tf the work Involved by the -fk3t 20
Total No. Additional ADOFtEsenotr
permtt to fpr oos hundred doIlam(5100)or lose.)
I certify that In the performance of the work for which this permit CITY TOL /
Is Issued, I shall not employ any person In any manner so as to
become subject to the Workers'Compensation Laws.' Ugh*Q Rldurse Rrat 20 PLAN
APPLICANT
Total No Addttlonal
ADDRESS
Data Appkarrt 16 OR 20A,120V BRANCii aFowrB
NOTICE TO APPLICANT: If,!after making this Certificate of CITY Td.Na
Exemption,you should become sub)ect to the Workers'Compensatlon 1 TO 10 MLL0VE EACH
provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PETMTAPPUCANT
provisions or this permit shall be deemed revpked. 41 OR MORE BRANCH CIACUTB EACH }
LfC0481�D CONTRACTORS DECLAMT1ON ADORE88 O_
I hereby affirm that I em licensed under provisions of Chapter 9 16 OR 20A 206Y TO 2T/V IJCi}iT1Tif3 EACH O
(oommenoing with Section 7800) of D"lon 3 of the Business and GIT' Ts+-Na U
Professions Code,and my license Is In full force and effectP R A DENTALS UP TO 314PnOR � cc
O
license Number L.b.C1eee Stze 8 Type HP,KW,KVA,or'KVAR DteTACT NO. ev V
Up to 3 Ind. ( - cWj
a
Over 3 to 10 Ind. FiZE
Contractor Over
❑ I em exempt under Sec. cele Over 60 to 00 1nnol. �� �y � VAIJDATFON Z
B.BP.C.for this reason Over 100 a uL
Services,& 4CC.8 Peneboerds
°"D o- under eco v
Slgnall.ee 201 -1000 Amp.Under 000 V
Over 1000 Amp.or Over 600 V
EJ Exemption for Reg.Melnt Elect - _
HOME OWNER-8UILDER64NGLE FAM ILDEC ARAT10N Temp Power Pole 8 Appurterrnces rT.;
L t
I hereby affirm that I am exempt from the Contractor's with One Branch Circ tt
e License Lew
for the following reason (Seotion 7031.6, Business and Prpfeesions A&IIdonal Sign Branch'Circutts
Cods): 1 ITEM,
I,as owner of the r Mlsc-Condutb 8 Conductor
property,will do the work end the stru qtu ro n l ��y �r
Is not Intended or offered for sale (Section 7044, Bualnees Other(See Comch
Complete Fee Sedule) TOTAL . -
and Professlons Code).
CONSTRUCTION LENDING AGENCY FTL I
I hereby affirm that there is a conatruotlon lending agency for the
performance of the work for which this permit Is Issued (Seo. 3097, PERMIT FEE (Sub-Tota
Ctv. C.)
PLAN CHECKING FEE 0-M-i303J 1 6/10/92
Lender.Name PERMIT ISSUING FEF a� 1 1 Ni 7:�f,
Lenders Address
I certify that I have rend this appllontlon and state that the above TOTAL FEE 5
Information Is correct. I agree to comply with all County ordinances
and State Tawe regulating Electrical wiring, and hereby authorize
repreeentattves of this County to enter upon the *bovs-mentioned
prgpeq for Inspection purposes.
SEE RAE FOR EXPLANATORY LANCKAOE
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