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Home My Public Portal About10827 GRAND AVE_Electrical__I j DBS SA 25M SETS 7-47 ' APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ]ELECTRIC M. . FOX CHIEF ENGINEER a NAME - DISTRICT NO. GROUP ZONE PERMIT NO. ADDRESS NU CITY TEL.NO. RECEIVED By READY FOR DATE ISSUED FIRST INSPECTION J COUNTY IJ CERT.NO. % EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY DESCRIPTION OF WORD JOB -2- NUMBER OF OUTLETS ON CIRCUITS LOCALITY + LOCATION BY ROOMS NEAREST LIGHT OUTLETS JSW. PLUGS FIXT CROSS ST. CIRCUIT A B C D E F G H � NAME n Z MAIL ADDRESS , r O w CITY TEL.NO.,�,✓ P I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFIC^TION..' f ( ELF-- ICIAN. v 7 I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED 1 `1 ABOVE OWNER. CORRECTIONS J Q _Z L7 O / r TOTAL F f r E NO. OF OUTLETS ov' $ APPROVALS NO. OF FIXTURES a $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE $ �, UTILITY CO.NOTIFIED TOTAL FEE FINA � - COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN --f- IRE � RECEIVED BY READY FOR DATE ISSUED ADDRESS / FIRST INSPECTION CITY 1 TEL NO. COUNTY LICENSE NO. r,. -f EXPIRES BUILDING PERMIT FEES ADDRESS ------- - FEE ell NUMBER EACH LOCALITY .'"- LIGHT OUTLETS NEAREST CROSS ST. RECEPTACLES WALL SWITCHES OWNER TOTAL OUTLETS _ Sc S MAIL . ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 -- CITY TEL. NO. FIXTURES 5 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS _NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MvO. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY D ISED ABOVE. %2 6 LESS $ .2S SIGNATURE OF _ I/2 2 .50 PERMITTEE _ 2 5 1.00 INSPECTION RECORD _ 5 15 1.50 15 50 2.50 50 200 5.00 200 _ Soo 10.00 500 1000 15.00 Q Z OVER 1000 20.00 [7 M.G. SET/FREQ. CHANGER-HP IY WELDERS: AC-KVA GENERATORS - KW _ TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORI13.) MOVED MOTORS (75% Or ORIG.) _ MISC. S1ONS NO. NO.TRANS. APPROVALS NO. NO. LAMPS OATINSPECTOR'S NAME FOR EACH PERMIT? WIRING $1.00 CONDUIT ; WIRING L, FIXTURES $1.00 SUPPLEMENTARY ,50 FIXTURES POWER TOTAL FEE 1 !J UTILITY CO.NOTIFIED FINAL �f / >•"' .r'. 76A663 DBS#5A 4-52 ^ WORKERS'COMPENSATION DECLARATION , 19D�� APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent tq self (a-0060 Insure, or a . rt lflcate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a cr tIf11' thereof (Sec. 3800, Lab. C.) r R IZ L Y7S Company � moN-Var FOR APPLICANT TO FLU IN JOB Q 6 FI C' PolicNo Z7 GrAN y ertlfled copy Is hereby fumished. New Residential Bldgs. 8 Pools EA01 NO. FEE ADDRESS Certlfied copy Is filed with the county building Inspec- 1.8 2-Family, Sq. Ft. $ — ; L�L� C tion departmenT. " � Multl-famlly Sq.-Ft. C C6S T O Date '` xo"4\ ' Residential Swimming Pools CROSS Appllcdnt RM NAME L( CERTIFICATE OF EXEMPTION F4CM WORKERS' q MAIL COMPENSATION INSURANCE Outlets: Ref U ht�5w._ ' first 20 (This sectilon not be completed If tfw work Inv¢fvod by Total No. Additional CITY '�ifh a tC Tel. No. the permit Is for ono fiundrad dollart (;100)or loss.) I certify that In the performance of the work for Which this PLAN Cl-r� APPLICANT Workers'Gn. permit Is Issued, I shall not employ any person In any manner htln Fixtures Flat- ADDRESS so as to become subject to the Workers' LawP AdditionalTotal No. CITY Tel. No. Date ATx,llcant Fixed Appliances Not Over 1 HP PERMT NOTICE TO APPLICANT: If, after making this Certificate of Range— Heater—D.W. — APPLICATION QCA1D c.A Exemption, you should become subject to the Workers' nq Compensation provlslons of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS ZZ 46r. Kt with comply with such provisions or this permit shall be Top FAU —W.H- - deemed revoked. Hood Fan —Other— CITY ptf2A=A'O(A Tel. No.,qc17 67 6 LICENSED CONTRACTORS DECLARATION Dlsp. Room Air Cond. UC NOR $Z S-06 Clan.4c#–/O hereby affirm that I am licensed under provisions of Chapter 9 _ UMg� (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT ; PROT d and Professions Cotte,and my license Is In full farce and effect. Size 8 Type HP, KW, KVA, or KVAR 0 License Number- Llc. Clan �"�f Up to 1 Incl. FINAL 0 Contractor PUh "eVaLsc,te b�j0'70 Over 1 to 10 Incl. DATEOver0 �It� – Over 10 to 50 Incl. FINAL U I am exempt under Set Over 50 to 100 Inc. BY W B,BP.C. for this reason Over 100 A d Services, Swbd., MCC 8 Ponelboards f Z 0-200Amp. Under 600 V — . Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Req. Malnt. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances 2 HOME OWNER-BUILDER DECLARATION TMJ. I hereby affirm that I am exempt from the Contractor's License Sign with bnp Branch Circuit y Low for the following reason (Section 7031.5, Buslness and Additional Sign Branch Circuits 330731.0 01 Pr6fessions Code): 1 DUE Conduits 8 Conductors s ff ` ❑ as owner of the property will do the work and the Misc. TOTAL .' i- (30structure Is not Intended or offered for sale(Settlors 7044, Other (See Complete Fee Schedule)_ � - � Business and Professions Code). , UfCK 31.00 CONSTRUCTION LENDING AGENCY - 1 i hereby affirm that there Is a construction lending Nancy for the'performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.} PLAN CHECKING FEE 0004-"1 1/ 9/90 Lender's Name ■ ' PERMIT ISSUING FEE 3135 1 AM8•46 Lenders Address I certify that I have read this application and state that the TOTAL FEE above Information Is correct. I agree to comply with 911 County - ordinances and State laws regulating Electrical wiring, and hereby thorize representatives of this County to enter upon thea endo pro for Inspection purposes. SIM REVERSE FOR EXPLA ATO"LANGUAGE 1-9-90 Signatur Permittee Date �s