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Home My Public Portal About4929 HALLOWELL AVE_Electrical__ DB S-A 12-43 2SM �' APPLICATION FOR PERMIT _ 10ARTMENT OF BUILDING AM SAFETY I APPLICATION 1� Y�l l PERMIT r COUNTY OF LOS ANGELES ELECTRIC WM. J.AFOX HAEF ENGINEER- - q NAME , !! DISTRICTNO... -GROUP ZONE PERMIT NO. ��U.. ADDRESS_ ` , 6 U�1 CITY TEL.NO. RECEIVED BY, FIR READY NSPPEC1T/IO'N/ DATE ISSUED W COUNTY CERT.NO. y� EXPIRES APPLICANT PILL H lM'Y OUTLINED PORTION ONLY JOB DESCRIPTION OF,F,WORK ADDRESS /L A NUMBER OF OUTLETSONCIRCUITS LOCALITY �1* LOCATION BY ROOMS NEAREST pp LIGHT OUTLETS SW. PLUGS MIT CROSS S !L CIRCUIT A I B C I D E F G H lz NAME Z MAIL 3 ADDRESS O CITY TEqN 1 'AM THE LEGAL POSSESSOR OFS ANG9LE5 COUNTY CERTIFICAT OF Q iAM THS LEGAL OWNER OF THE PREDABOVB CORRECTIONS J Q Z !Y O TOTAL NO. OF OUTLETS 20 APPROVALS NO. OF FIXTURES DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING Vl(tntL>/ NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE $ ZS UTILITY CO.NOTIFIED TO LFEE � '� S �5 FINA �lf� / �"I✓ �/ Y�v' r WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT - I herbby affirm that I have a certificate of consent to self Insure, 76A663 or a certificate of WorRer's Compensation Insurance, or a certified COUNTY OF L S ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec 3800 Lab. C.) :• . Policy N0. Company FOR APPLICANT TO FILL IN - JOB ODRESS ALLy ii Certified-copy,is hereby furnished New Residential Bldgs &Pools NO. EACH FEE LOCALITY - 1 &2;Family,Sq Ft - _ $ $ ,Certified copy Is filed with the county building Inspection NEAREST , � department Multi-family Sq Ft pp CROSS ST o"WryQ-r /S Date Applicant Residential Swimming Pools MAP BOOK ' ef�a PAGE �1lO nn T PARCEL/ OR CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rea_Light Sw •FFIIRM NAME A 1 '1 COMPENSATION INSURANCE First 20 MAIL (This section need'not be completed if the work Involved by the Total No Additional ADDRESS permit'Is'.for one hundred dollars($100)'or less.), I certify that in the performance of the work for which this permit CITY Tel No is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws., Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE•TO,APPLICANT:,if, after making this Certificate of CITY -Tel No Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. �ovisions of the'Labor Code, you must forthwith coin with such PERMIT p comply Power Apparatus&Large Appliances APPLICANT provisions or this permrt'sPiall be deemed're'voked. , %i, ILICENSED CONTRACTORS DECLARATION Size&Type HP.KW,KVA,or KVAR ADDRESS I hereby affirm that I am'licensed under,provisions of Chapter 9 Over 3 to 1,0 Incl. (commencing with Section 7000) of Division 3-of the Business and ' CITY Tel No Professions Code, and my license is in full force and effect Over 10 to 50 Incl •'LICENSE OR Over 50 to 100 Incl REG NUMBER Class Over 100 DISTRICT NO PR OC SED BY 0 License Number Lic Class hp Services,Swbd,MCC&Panelboards [l0 0-399 Amp.Under 600 V FINAL Contractor Date DATE 9 t� C) El --- - - 400-1000 Amp.Under 600 V U c.J\ / I am exempt under Sec. VALIDATION W Over 1000 Amp.or Over 600 V FINAL a- B&P C for this reason BRANCH CIRCUIT FEES BY Z Date. 15A,or 20A, 120V,Lighting or Recept 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits '41 Or More Branch Circuits 0' Exemption for Reg'-Mamt Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION _ h(rr a I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit t7ti•4TQa for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits ;313`, fin1 Code) t T Cts AI,as owner of the property, will do the work and the structure Misc.Conduits&Conductors 1 1 Ct S - g is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) TOTAL a A and Professions Code). CK 70.11 CONSTRUCTION,LENDING AGENCY HE I hereby affirm that there is a construction lending agency for the CHANGE .1 performance of the work for which this permit Is Issued (Sec 3097, PERMIT FEE (Sub-Total) - -. Civ. C.) PLAN CHECKING FEEr{•� I Lender's Name - - _. .. _ 1' 6/17/.- 0000—r ' PERMIT ISSUING FEE 5 0310 1 AN Lender's Address I certify that I have read this application and under penalty of puriury state TOTAL FEE that the above Information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize representatives of this County to ter upon the above-mentioned property for inspec o,purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SIGPaTuFfE 1`P MITTE 'DATE .. WORKERS COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 •APPLICATION FORELECTRICAL PERMIT - I hert9by affirm that I have a certificate of consent to self Insure, or a certificate of WorRer's Compensation Insurance;.or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING•AND SAFETY DIV. copy thereof(Sec.3800 Lab. C) - P❑oliCy NO. Company. FOR APPLICANT TO FILL IN JOB ADDRESS �/�J W vt..-✓ Certrfiad copy is hereby furnished r " New Resldentlal Bldgs &Pools•-. NO. EACH FEE'. $ $ LOCALITY 7 Certified co is filed withthe county'. ins ection,,' - 1 &2-Family,Sq Ft PY Y 9 P NEAREST' _ -department Multi-family Sq Ft CROSS ST Date'' Applicant Residential Swimming Pools, A SSOR V .. � ,� ' �D J PAGE •�� PARCEL OO CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. — OWNER OR ME COMPENSATION•INSURANCE pp //-- FIRM NAME m ..•.r,., First 20 MAIL I (This�sectl.' eed not be completed If the'work involved by the ADDRESS k Total No. Additional permit is for one hundred dollairs(5100)or less.) 1 certify tF atFi i the perfor"mance'of the work for which-this permit CITY Tel'No J� IS issued, I shall not employ any'person'in any manner'so as to PLAN CHEC become)suble_ct to,the,Workers' Compensation Laws .� Lighting Fixture First 20 - APPLICANT - Total No L, Additional Date.' h APPlicant, _ �,•,• . _ O ADDRESS NOTICE,-TO;AP.PLICANT. If, after.-making this Certificate of %E DENT[ APPLIANCES NOTOVER3HP. . CITY- Ter'No Exemption,'you should-become subject to the Workers'._ Compensation OTHER APPLIANCES NOT OVER 3 HP. iovisicns of!the-Labor Code;you must, com I with such PERMIT ' P Y ply � - - - APPLICANT provisions or this-permit shall',be,deemed revoked '° Power Apparatus&Large Appliances r' LICENSED C01 TRACTORS-DECLARATION Size&Type HP,KW,/�V I or KVAR' ADDRESS , I hereby affirm'that I am'licensed-under provisions of Chapter 9 /_ Owto 3 to 10 Incl (commencing with Section 7000) of Division.3-of-the Business and CITY Tel No Professions,Code, and my license is in full force and effect • Over,10 t0 50 Incl. LICENSE OR • Over50 t0 100 Incl. - REG NUMBER Class a ' - 'Over 100' DISTRICT NO PROCESSED BY .O .License Number Lic.Class v: Services,Swbd.,MC FINAL _ O Contractor hDate �� mp Under 0-Vj f "' 400-1000 Amp.Under 600 V V I am exempt under Sec VALIDATION Over 1000 Amp or Over.600 V -FINAL 1117 LU -- •'B.&P.C,-for-this-reason- - BRANCH CIRCUIT FEES BY s co co 15A,or 20A, 120V.,Lighting or Recept_ Date -ZT.. Z _ _ l� 1 To 10 Branch Circuits Signature i1 To 40 Branch Orcuds 41 Or More Branch Circuits ❑ Exemption for Reg Maint Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILYTemp: Power Pole&Appurtenances _ HOME OWNER-BUILDER DECLARATION g'e ['hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch�Circwt' i U., e , for the following reason (Section 7031 5,:Business and Professions Additional Sign Branch Circuits : ]� 4 �c Code)' IJ30 r .�, ev- AI, as.owner of.the property, will do the work and the structure Misc.Conduits&Conductors � _ 1 ITEM_ 'is not intended or offered for sale (Section 7044, Business Other(See Complete Fee'Schedule) T1=1Tiy� �€ 435 and Professions Code) �..-. CONSTRUCTION LENDING AGENCY �'Lt�q-��i'it, i �oi= I hereby affirm that there is a construction'lending agency for the CHANGE- .011 performance of the work for which this permit is issued (Sec 3097, PERMIT FEE. (Sub-Total) - CIV C) PLAN.CHECKING FEE , - 0000-000 " Lender%Name 1 t/1r/7 PERMIT ,ISSUING FEE 03091 AN joCIL Lender's Address I certify that I have read this application and under penalty of pu}Iury state TOTAL FEE. Q q, that the above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize ` representatives of this Count to enter upon the above-mentioned property for inspe n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE IJ 7 V SIG URE OF PERMITTE A '