HomeMy Public PortalAbout10144 GREEN ST_Electrical__ 79"93-CS&Oe.10-.. APPLICATION FOR ELECTRIC PERMIT
BUa.DING AND "=Y DrVIMON
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CkIqmtr OI Low Anovim JOHN A. IM COUNTY ENGINmiS'CAIRSATT D, GRIFFM. BUF'T OF BUILDING E
FOR APP I O FILL IN
OWNER
LIGHTSRIOZFTAX*+n rwaaHn
Y XACH FIDE WAIL
ADDRi88 /a A/
TOTAL OUTLETS .10 j
[LRC LAMM •AT11 0[AT[1/, CI N
CLOTALl DaT"s -50 ELECTRICIAN
X rC 1PAC[ NZAT12 , [TAT'T. C001-
11. IT1, .A11Ai[ 1111POVM. ADDRWAS .
ALTO u;AIl1 DI1RWA"" .SiS
LIGHTING FDTURES .10 CITY NO.
MOTORS STAT[
LIZIENOR NQ.
HORB113�0AER
1 R
H.P. mV1D\ 1X0. ■[ADT PON 1[1P1CT1011
ya r lilt .III1
1 .50 INSPEOnON RECORD
Z 5 1.00
5 — r5 1.150
15 50 1.150
50 Yoo 5.00
SIGNa XD.TPANA .
XO.LAMM
SERVICE O-a00V 1.00
GIERVICI OVER COOV 5.00
WIRING P IT 1.00 "►
FIXTURE PERMIT 1.00
SUP ENTARY PERMIT .50 APP$OVAM
TOTAL F E DATE IXSP OR s M MAT11
1 HEREBY A XOIILEDOE THAT I HAVII READ THID ICATIOM _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .CONDUIT
WITH ALL COUNTY ORDINANCES AMD STATE LAWS REGULATING Z.
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PRQPE Y REGI AMD/bR FIXTURES
LICENSED AS REQUIRED BY W"E MD STATEOF
CALIFORNIA OR THAT 1 AOF THE ABOVE poWMR
DESCRIBED RESIDENTIAL
810NATURE UTILITY CO. NOTIFIIED
OF PERMITTEE FINAL
JOHN A MHIE ATION 9 TMIRauvC' ELrr'
COUNTY�NGINKKR - K YO CASH U a KCTRICAL ]ENGINMaI
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0627� x- 25 2 2.90 In
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76AS63 DBS SA 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES E L E CT R I 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE P
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDRESS FIRST INSPECTION
CITY _ TEL. NO.
COUNTY LICENSE NO. EXPIRES BUILDING
PERMIT FEES ADDRESS
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS \- NEAREST
CROSS ST,
RECEPTACLES
WALL SWITCHES OWNER
TOTAL OUTLETS - , 5C $ MAIL
ELEC. RANGES 25 ADDRESS ..
ELEC. HEATERS - 25 CITY TEL. NO.
FIXTURES 5
I HEREBY ACKNOWLEDGE THAT 1 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 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER
ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER
FEE R INC.
EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
1/2 a LESS $ .25 °'`- SIGNATURE OF
1/2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 15 1.501 J
15 50 2.50
50 200 5.00
200 Boo 10.00 J
500 1000 15.00 Q
Z
OVER 1000 20.00 F3
M. G. SET/FREQ. CHANGER-HP it
WELDERS: AC-KVA I I O
GENERATORS-KW I�
TRANSFORMERS-KVA
TEMP. MOTORS (75%oFOR1G.)
MOVED MOTORS (75%OF ORIG.)
MISC.
SIGNS
No. NO. TRANS. APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
CONDUIT
WIRING $1.00
WIRING
FIXTURES $1.00
SUPPLEMENTARY .50 I FIXTURES
POWER
�+
TOTAL FEE $ � +� tfi UTILITY CO. NOTIFIED
® FINAL
Il--
WORKERS'COMPENSATION DEcLAkaTION CE-806 Iasi APPLICATION FOR ELECTRICAL PERMIT
I hereby QfHrm that I have a certificate of consent to self ��Oba
Insure, or a tbrtificdte of Workers'Compensation Insurance, COUNTY OF LOS ANGELES �G BUILDING AND,SAFETY
or a on fled copy thereof (Sec. 3800, Lab. C.) ADWESS
r
Policy No. Company KA AntICANT TO t#1 IN O /
❑ Certified copy Is hereby fumished. New Residential Bldgs. 8 Pools f EACH NO. ; FES LOCALITY ,C
❑ Cbrttfled copy Is filed with the county building Inspec- 1 8 2-Famlly,-Sq. Ft.
tion department- Multl-family Sq, H. tziR
ST.
Rl Sh
Date Applicant ealdentlawlmmin¢PooOWNER OR
RM NAME
CERTIFICATE OF EXirMPTION FROM WORKOutlbh: Rbc�Llght�Sw.�
WORKERS' Outlets:
r L OCr/
COMPENSATION INSURANCE
y/
First 20
(This section need not be completed N the work Irrrofred Ery Total No I lfZCITY fr Tel. No. L('141--277
p
tb* ermit ts for one hundred dollars(;100)or loss.) Additional
CNECK
E certify that An the.performonce of the work for which this App
permlt is Issued, I shall not errlploy any Person In any manner
so as to become sublect to the Workers Compensation[taws. Lighting Fixtures Flat 20 ADDRESS
Total No., Additional CITY Tel.No.
Date ATpllcant Fixed Appliances Not Over 1 HP
NOTICE: TO APPLICANT: If, after making this Certlflcate oi' PEW
Exemption, you should bbcornb' subject to the Workers' _Range- Heater—D.W. — Cwt
CompeRsatlon provlsloris of the Labor.Code, you must forth- Oven — Dryer —W.M — ADDRESS
with comply with such provlslbnr or this permit shall be Top _FAU W.H. —
deemed revoked, Hood _ Fan In Ctther_ CITY Tel. No.
LICENSED CONTRACTORS DECLARATION ( � LICINSE QR
I hereby affirm that I am licensed under provisions of Chapter 9' oleo. T Room Air Cond. REG NUMBER Class
(commerxing with Section 7000).of Division 3 of the,Bustness _ DISTRICT NO. B
and Profeplons.Code;and my license is In frill force apd effect. Power.Apparatus 8 Large Appliances
Slze 8 Type HP, KW, KVA,or KVAR'
License Number i Ic. Class Up to 1 Incl. FINAL
T Over 1 to 10 Incl. DATE /-�L VALIDATFON
Contractor Date Over 10 to 50 Incl, NAL
G
❑ I am exempt under.Sec. Over 50 to 100 Inc. YV saa
B.BP.C. for this reason Over 100-
Dole: Services, Swed., MCC R Panelboards ►
0 -200 Amp. Under 600 V
Signature 20T- 1000 Amp. Under"V
❑ Over 1000 Amp. or Over 600 V
Exemption for Req. Malnt_ Efett.
SINGLE FAMILY Temp. Power Pole 8 APpurtgnances
ROME OWNER-BUILDER DECE ARA'IION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Orcults
Law for the following reason (Section 7031.5, Business and
FQsions Code), 2 8 4 9. b A
as owner of the property, will do the work and Mli
the c. Conduits 8 Conductors
s , $} 0 0 0 0 0 2
structure Is not Intended or offered for sale (Settlors Other (See C"orpplete Fee Schedule).—,
704", Business and Professlons Code). 2{0 0 4 f3 0 0
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a torutructlon lending agency for o n o (f (� Q
the performance of the work for which this permit Is Issued PERMIT FEE (SubS-Total) _ 1 2 2 1 —82
(Sec. 3097, Civ. C.)_
PLAN CHECI<ING FEE
Lenders Name
PERMIT ISSUING.FEE
Lenders Address d
I certify that I have read this application and state that the TQT�4L FEE
above Informgtlon Is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
�fteby authorize representatives of this County to enter upon
boyo- do property for Inspectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
natur of PertnIft" Date