HomeMy Public PortalAbout5205 HALLOWELL AVE_Electrical__ 76A663 DBS SA 11-60 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES '""RIC 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TOFILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
Sr t9��o-9
ELECTRICIAN _
I RECEIVED BY READY FOR DATE ISSUED
ADDRESS
G .� (+ � - FIRST INSPECTION
clrY San Gab. ^� TEL. NO. {AT 68583 l vAl�'�
COUNTY LICENSE NO. 1104 EXPIRES ABUILDING
DDRESS 5205 No Hallowell Sty.
PERMIT FEES
. FEE Temple City' -
NUMBER EACH LOCALITY _ ---
LIGHT OUTLETS 11 NEAREST
RECEPTACLES 14 CROSS ST.
WALL SWITCHES 12 OWNER Celeste
TOTAL OUTLETS 37 5C $ 1 85 MAIL -
ELEC. RANGES - 25 ADDRESS `
ELEC HEATERS 25 CITY - TEL. NO.
FIXTURES 1 s 55
1 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 1 AM THE LEGAL OWNER
NEW MVD. HP OVER I INC.
EACH OF THE RESIDENTIAL PROPERTY ESCRIBED ABOVE.
1/2 s LESS $ .25SIGNATURE OF -
1/2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 15 1.50
is 50 2.50
So 200 5,00
200 560 10.00 J
Soo 1000 15.00 Q
Z
'OVER 1000 20.00 (�
M. G. SET/FREQ. CHANGER-HP - Q:
WELDERS: AC-KVA I 0
GENERATORS-KW
TRANSFORMERS-KVA ,
TEMP. MOTORS (75%OF ORIG.)
MOVED MOTORS (75%OF ORIG.)
MISC.
SIGNS
NO. NO. TRANS. I APPROVALS
NO. NO. LAMPS
'DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1:00 I �I -
FIXTURES $1.00 I - CONDUIT WIRING • �d �� /L'.l�N�1
SUPPLEMENTARY .50 r FIXTURES / J-—1 l -.("1
POWER
TOTAL FEE. ' I $ 4 40 UTILITY CO. NOTIFI ED I 1
® ,/ FINAL �� /'�/ If'• -�L�i..ay
WORKERS'COMPENSATION DECLARATION CE-806G (2-80) APPLICATION FOR ELEC RICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or 77C
a certified copy thereof(Sec. 3800,Lab.C.)
FOR APPLICANT TO FILL IN JOB
Policy No. • Company EACH NO FEE ADDRESS
❑ New Residential Bldgs. &Pools
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft $ — $ LOCALITY C
co Multi-family Sq. Ft. — NEAREST
Certified
copy is,filed with the county building inspection Residential Swimming Pools CROSS ST L N,
department. OWNER OR
RM NAME Rjj , CSQ,4 L
Date Applicant Outlets. Rec.—Light_ Sw. AAIL
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY7Tel No
COMPENSATION INSURANCE PLAN CH K }
APPLICANT --- -- - 0 '
(This section need not be completed if the work involved
by the -permit-is for one hundred dollars ($100),or less.) Lighting Fixtures First 20 ADDRESS U
Total No.
Additional
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. 0
permit is issued, I shall not employ any person in any manner PERMIT 0
so-as to become subject to the'Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT W
CL
Oven _ Dryer_W.M._ ADDRESS
Date• Applicant Top _ FAU _W.H. Z
Hood _ Fan _Other_ CITYTel No
NOTICE TO APPLICANT. If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR
� " Exemption, you should become subject to the Workers'.
REG'. NUMBER Class
Compensation provisions of the Labor Code,, you must forth- Power Apparatus& Large Appliances- DISTRICT NO. PROCESFgU BY
with comply with such provisions or this permit shall be
deemed revoked. ,Size&Type HP,KW, KVA,or KVAR �J^�
• Up to 1 Incl. '
FINAL
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS'DECLARATION - VALIDATION
I' Over 10 to 50 Incl. ,
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9'(commencing with Section 7000) of Division 3 of the Busi- Over 100 BY,
ness and Professions Code, and my license is in full force and
effect. r 1 Services /
License-Number- Lic. Class 0-200 Amp. Under 600 V
201-1000 Amp. Under 600 V
Contractor �' Date Over 1000 Amp'.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances '
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit x5'4.0,3'A
,4 0 3 A
License Law for,the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code). # o-o•o 0 0 2
- Misc.Conduits&Conductors. '
I as owner of the property, will do-the work and the I Other (See Complete Fee Schedule)—
structure - 2.3,50
is not intended or offered for sale (Section
7044, Business and Professions Code).
• CONSTRUCTION LENDING AGENCY '0804-8
,0 0 -,2,3,5 Fu
I hereby affirm that there 'is a construction lending agency 8 0 4_8
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued (Sec. 3097,Civ.C.). '
Lender's Name I
PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE '
Y
I certify that I have read this application and state that the TOTAL FEE 243 r
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and z
hereby authorize representatives of this County to enter upon
the ove-mentioned property•for,inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
` Signature of Pe ittee Date °