HomeMy Public PortalAbout10831 GRAND AVE_Electrical__ 76A66'3 DBS SA IT-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN
G-_
�_�1 RECEIVED BY READY FOR DATE ISSUED
ADDRESS Mvµ.. -.� FIRST INSPECTION t
CITY TEL. NO.7 J I C �< <� —17
COUNTY LICE O. ly EXPIRES BUILDING
PERMIT FEES ADDRESS j
�
NUMBERFEE I EACH LOCALITY
LIGHT OUTLETS NEAREST
ST.
RECEPTACLES CROSS
WALL SWITCHES OWNER
TOTAL OUTLETS Sc $ I MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
FIXTURES 5 CITY EL. NO. 0. 20.7
1 HEREBY AKNOWLED 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 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. HP OVER I INC.
EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/z 8 LESS $ .25 SIGNATURE OF
1A 2 .50 PERMITTEE.
2 5 1.00 INSPECTION RECORD
5 151.50
15 50 2.50
50 200 5.00
200 500 10.00 J
500 1000 15.00 Q
Z
OVER 1000 20.00
M. G. SET/FREQ. CHANGER-HP �
WELDERS: AC-KVA O
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%OF ORIG.)
MOVED MOTORS (75%of ORIG.)
MISC.
SIGNS
NO. NO. TRANS. APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.001 CONDUIT
_--�_��'c C
FIXTURES $1.00 WIRING
SUPPLEMENTARY 50 FIXTURES U -ti v (� N ✓
POWER
TOTAL FEE $ ® UTILITY CO. NOTIFIED
�7 �ICFINAL
f 7 "'
MW DESS SA 1T-46 APPLICATION FOR PERIM
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC
OF LOS ANGELES
WM. J. FOX CHIEF ENGINEER
NAME DISTRICT NO. GROUP ZONE PERMIT NO.
-7
� ADDRESS '
►' RECEIVED BY READY FOR DATE ISSUED
U CITY _ TEL.NO. / FIRST INSPECTION
J COUNTY
W CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
DESCRIPTION OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST .+
LIGHT OUTLETS I SW. PLUGS FIXT CROSS ST.
CIRCUIT A._..8_•. C D I E F I G I
W NAME
L 3 MAIL „
ADDRESS
I
CITY TEL.NO.
i1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIA..
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
CORRECTIONS
— a
z
Lo
0
TOTAL
NO. OF OUTLETS $ APPROVALS
NO. OF FIXTURESDATE INSPECTOR'S NAME
I NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ ELL
S
MISCELLANEOUS $
PERMIT FEE $ CO.NOTIFIED
TOTAL FEE
WORKERS'COMPENSATION DECLARATION 7e"°°3 10'B1
CE-8011GAPPLICATION FOR ELECTRICAL PERMIT Cr71
41q*rsby i fT m that I pave a oerttSbate of cornard to eeff insure. 7 )
or a owtfk;de of Vrbrk m' Corrpernffilon insurance, or a certt6ed COUNTY OF LOS ANGELES BUILDING AND SAFETY fu'
+}thereof(Sec.3600,L.eb.C.)
Poncy Ne Company FOR APPUCA r TO FILL IN JOB
❑ C tfk d bbPY b hereby th New Reaidwtfal Slope.S Pools EACH Na FEE ADDRESS
❑ Ce bw copy is flbd with the oounty bu8dng tiepection 1 8 2-Fernfly,Sq.Ft $ — S LOCALITY T
depertrnant. WMf-famy Sq Ft — WAFIEST
caos6 ST.
Date Ap~ ResidentialSwimming Pools QyyrEp oR
FIN NAME
CERTF"TE OF EXEMPTION FROM WORKERS' pig Rea_LJ�ht Sw. MAL
•COMPENSATION INSURANGE
(Thk section need not be comphbd If the work trwohad by the First 20
Pam* goo
for one hundred do4re(S 100)or law) Tbtal No. AddFdonel CffY Tel Na
b
I owtIty that h er
the pfortmanoe'o( the work for which this this perm PLAN CHECK
'APPL.ICdNf
Is issued,•I shall not employ any.person In.any marvner so as to
beoome eub)eot to the Workam'Corrp6nsatbn Laws. LU-Mng Ftxtvbe First 20 ADDRESS
Total'No. Addttk mel CffY Tel.No.
Data APAIlaa� Fixed Appkmcee Not Over 1 HP
NOTfCE -TO APPLICANT: M, after madV this C rfflo e of PST
Exw ptbn,you should beoome arbRxA to the Workws'Corpensarion Range— Heater—.D.W. T APPLYCdNT '
provisions of the Labor Code, you must for d wRh comply with such Oven — Dryer — W.M.— ADDRESS
provldons or this penrnit shall be deemed revokad. Top — FAU _ WR _ &rt21fd Ale
L)CENSED
W1-L —
LICENSED CONTRACTORS DECLARATION Hgod Fan — Other— GITY Tea.No.
L)CENSI hereby afrk that I am licensed under proviSkMa of Chapter 8 Dom. pin Alr Cond. RE(I NEER Ckwa
(comrrnndng with Section 7000) of Dlvblon 3 of the an4ves and
Profeeslone Co(*and my kwae is to fdl force and effect Pmw APparatire y Lame Appliances DOTRK7 Na /7 Pa0CEBSM BY
Stm S Type I-P,KW,KM,or KWR
License Number Lk__ Caws Up to 1 Incl. FINAL
Over 1 to 10 1noL ATE � �
DataOver 10 to 60 hid. b
❑ FINAL
I am exempt under Sec. Over 60 to 100 hhc. BY
BdP.0 f«this reason Over 100
Date Servloee.Swbd,MCC d Pane[boerrde , Z
0-200 Amp.Under 900 V
Signahue 201 - 1000 Arrp.Under 900 V
Over 1000 Amp.«Over 800 V
❑ Exemption f«Rep.Melmt.Elect.
SINGLE FAMILY Temp.Pch%w F*d Appurtenances 2
I hereby affimtttffii 1 am exarrpt�from the Cc s License Law CkARATION Signw One
wch M ACCT.i
for the fo0owlrq reason(Seddon 7031.6, BuMness and Profession Additional Sign Branoh C4mufta
Code): 3307 33.00
Mlao.CO0JURS a Conduotbre 1 ITEMS"
I, riot
owner d the property,,lull do the work and 4, sbwtBmirx ue Other(see Complete Fee sotieaute) TOTAL. 33- 00
b not Yhterded « bAered for sale (section 704-4, Budr>aea _ �
and Prvfeeef«,e Code).
CASH 33
CONSTRUCTION L ENDM AGENCYI i •LACI
I hereby m1ftm that there b a oonetniotbn lending agency for the # .
performanoe of the wok for which this permit is bared(Sea 3087, PERMIT FEE (Sub-Total)
Ctv.C.).
PLAN CHECKING FEE
Lender's Name
/� "' Ga00—Q�01 11I 9/Xi
Mff
Lenders Address PERISSUING FEE .7 r J0 1 4110:Q
I certtfy tfud I have read this appllbation and state that the above TOIL FEE 3 —
tnfom±torn Is correct I agree to comply with all County ordirnancee
end State kkws rsgubfing Electrics) wiring, and hereby euthortre
tprewrtattves of this County to enter upon the aboye-mentimeld
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sigrvature of Permittee Data
woRxERs COMPENSATION DEG AA/{1lON CW" 10/B1 APPLICATION FOR ELECTRICAL PERMIT
f.l hereby� m that I have a cute d consent to self Insure -Rosa .
ora oarml4a of Corrpersation Iraurence, or a certffied COUNTY OF LOS ANGELES BUILDING ANP SAFETY
wt,y thereof(SAa 380I7it-e1 eif
AAcy NQ. Comparry FbR APPL)C'AW TO RLL W JOB
❑ Cr-ertW copy Is Aeby fuR� - New Residential Bldgs,S Poore EACH NO. FEE �83
❑ c ertlneo ccpy Is Mod-watt, the county building InspeOt)on 1 d 2-FamHy,8%Ft $ — E LOCALrTy
dapartrnent Mu111-family Sq,Ft NEAREST LCr
aics3 8T.
Date Reeldentid Swtrvning Poois OKTEJT OR
FFrl t KkME !7
CERTF"TE OF EXEMPTION FROM WORKERS' Outlets:Re0—Light— SW. — MAL
COMPENSATION INSUIFANCE ADDRE88
C-rV4d 140-_
(Thls sactlon need nwork be oompWed tf the ork Involved by the First 20
permit Is for one hundred ddtsm($100)Or kmmL) Total No. Adder] CITY Tel.Na
I certify that In the per(ormanca of the work for which this perrnit PLAN CHECK
is.leaued, I Stall not eaploy any person in arty manner eo as to i 4 t 1 APPUQ T
becbme 9-blect to the Workers'Compermation Laws- Lighting Flch— Ffret 2CS ADDRESS
Tota]No. Addltlonal t Cf1Y Tel.Na
Date AopkwrtFixed Appfencee Not Over 1 HP
NOTICE TO APPLICANT: If, after making thio Certl5cafe of I PEFMT
Exertptlon,you Should become mp)&ct to the WbrKars' Range— Heater , D.W. _ ^PPUGwT
proviabrb,of the Labor Co* you must forthwtth Gornl4y wtth Such Oven _ Dryer _ WJvt_ ADDRESS
proyWons or thts peas t shag be deemed revoked. Top _ FAU _ WJ-L
LICENSECD ON-F ACTORS DECLARATION Hood — Fen _ Other_ OITY Tel.No,
I hereby atHrrn that I am Iicenaed under provWona of Chapter 9 Dk&A _ Room AIr CorKL LICENSE j�OR
(commencing wIth Secrion 7000) of'DMalon 3 df the BuetrreeS and
r\ 060A
Profeeslona Code,ard'rrry hoarse is In hurl force aro effect Pier APAerabus&Large APPS MTFSCTPROGE BY
Strb d Type HP,KW,KNA,or KWA J of
License Nrunber Uc.Clew Up to 1 lnol. FINAL
Date Over 1 to 10 hoL DATE NAr—DArrn u IX
❑ Over 10 to 60 Ind FINAL -
1 am exempt under Seo. Over 60 to 100 Inc. BY
B.BP.Q for this reason Over 100 O)
Servhcee,Swbd,MCC&Parslboerds IV ►
0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
Over 1000 Amp.or Over 800 V
❑ Exemptbn far Req•Malrrt.EJeaL
HOME OWNER BUILDER DECLARATION Sign
Power Pole 8 Appurtenances 3W7 31.00
1 hereby affrm'that I am ettanpLJ
t trcm the Contra"a oanae Law Sign with One Branch G rouft
for the followtV reason(Section 7031.6,Business and Profeesione .. SW B C4 1 ITEMS
code): TOTAL 31._00
El4 owner o(owof the property,wlu do the work and tha structure M1ea xf✓ftn Cord Conductors
Ib not hoarded or ofldred for Bale (SeOtlon 7044, Business Oth r(See Complete Fee Schedule) CASH 31.00
and Profese$One Code). .00
CONSTRUCTION LENDING AGF14CY
I hereby affirm that there Is a ooretruction ]ending agency for the f�
performance Of the work for which tie perml Is Issued(Sea 3097, PERWT FEE (Sub-Total) �-�1 5I25`
Uv.C.), C I
$ PLAN CHECK]N6 FEE 0940 1 AM 7:44
Lenders Neme LISP 11(G7 ri�7 /
Lenders Addreee PQ gO t `•els 67 � fT ISSUING FEE
I certify that 1 have read tis eppilct0on and state that the above 71AL FEE ,O
Infornstbn he correct. I agree to conply w tth all Count ordh ux)oa
and State Tawe reguVariig EkxArbal wirtng, and hereby authorize
repreeentattvee of tis County to enter upon the aboye-mantloned
PuaPceee, SEE REVERSE FOR EXPLAN/CTOR`!LANGUAGE
21L. ,
t 5
PbrTrrtttee Data _ ,
Wlfirm that
COMPENSATION DECLARATION 2&4.663 W 3!® APPLICATION FOR ELECTRICAL PERMIT O
� I hereby affirm that I have a certificate of consent to self ��pyp
Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof (Sec. 3800, Lab. C.)
PQf No Company FOR APPLICAW TO RL N JOB A
L Certlfled copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE
t O /"F g—
❑Certified copy Is flied with the county building Inspec- 1 8 2-Family, Sq. Ft. $ — $ LOCALITY
tion department. Multi-family Sq. Ft. NEAREST
ST .4
Date Applicant Residential $wlmming PoolsOR
RM NAME C � /`�
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
COMPENSATION INSURANCE Outleh: Re. LlghT Sw._ ADDRESS rcA ✓�
First 20
(This section rtMd not be completed H the work Invohrnd by Total No. Additional CITY Tel. No.
the permit Is for one hundred dollars ($100)or Ipn.) RAN CHECK
I certify that in the performance of the work for which this APPLCANT
permit Is Issued, I shall not employ any Person In any manner Lighting Fixtures First 20 ADDRESS
ompensation Laws.
to as to become subject to the Workers C
Additional
Total No. C1T`F Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION
Exemption, you should become subject to the Workers' Range— Heater—D.W. _
Compensation provisions of the Labor Code, you must forth. Oven — Dryer —W.M_— ADDRESS
with comply with such provisions or this, permit shall be Top — FAU —W.H. —
deemed revoked. Hood _ Fan —Othw— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Dlsp. — Room Air Cond. — LICENSE OR
1 hereby arm that I am Ilcerned undef provisions of Chapter 9 UMBER Class.
affirm
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. BY d
and Professions Code,and my license Is In full force and effect.
Size 8 Type HP, KW, KVA, or KVAR O
Ucense Number— Llc. Class T �Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DAA 9 VALIDATION 0
Contractor �+te Over 1Q to 50 Incl. O
FINAL 0
El I am exempt under Sec. Over 50 to 100 Inc. BY W
W
B.BP.C. for this reason Over 100 0-
Services,
Services, Swbd., MCC 8 Panelboards , U)
Date: Z
0-200 Amp. Under 600 V
Slgrature 201 - 1000 Amp. Under 600 V
ElExemption for Reg. Malnt. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 Appurtenanc*s
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Sign with One Branch Circuit ACCT.`
r
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits �J7 ?l1.00
Professions Code): J�J
I, as owner of the property will do the work and the WK' Conduits 8 Conductors 1 1TEPb
structure Is not Intended or offered for sale(Sectlon 7044, Other (See Complete Fee Schedule}_ , TOTAL 20 - oo
Business and Professions Code).
CONSTRUCTION LENDING AGENCY 2I.[CI
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. 307, Civ. C.).
PLAN CHECKING FEE
Lenders Name � 1 7/ 2/91
PERMIT ISSUING FEE
Lender's Address 711 1 AM 8:45
1 certify that I have read this application and state that the TOTAL FIE
above Information Is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
here authorize representatives of this County to enter upon
thea vo-me property fw Inspection purposes.
SEE REVEM FOR EXPLANATORY LANGUAGE
7--2,21 �s
Signature of Permittee Date