HomeMy Public PortalAbout5635 HALLOWELL AVE_Electrical__ D.B.S.SA 25M SETS 10-47 ®p PLICA�BION FOR
PEla l�6Tr
DEPARTMENT. OF B �G AM S. FM
f�.�SEffiJl $Y1@ SC Cf' ICI f18���.8
COLD OF LOS, ANGEMS
FOX. CHIMPGI E R
NAA9E DISTRICT NO. GROUP ZONE PERMIT NO.
ADD SSS
1R D B READY FOR DATE ISSUED
U CIT - TEL.NO. FIRST INSPECTION
1
COUNTY 3 �S �
W CFRT.NO. EXPIRES ®
Rx�� APPLICANT FI .L IN HEAVILY OUTLINED FORTI N ONLY
ar
E'SC Oi® OF WORK ADDRESS
NUMBER OF OUTLETS AN CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS 9W. PLUGS FI* C 05S 2T.
OIRCUIT., A B C D E F G H a NAME.
Z MAIL
sY ADD S
O
CITY TEL.NO.
1 AIN THE LEGAL OSSESSOR O�'THE ABOV OCi
ANGELEG COUNTY C OF QUALlFICAT
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®
ELEcA.4AN.
I AAA THE LEGAL OWNER OF THE PROPA DESCRIBED
ABOVE
OWNER.
CORRECTIONS
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NO. OOUTLETS S APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
} NO. OF MOTORS H.P. CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ —FIXTURES
MISCEL ANEOUS POWER
' PERMITFEE $ S FINAL CO.NOTIFIED
TOTA
76A6C%3-CE806 10/72 APPUCAMN OR EdEUMC AL PERM �L1I
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB �^
BUILDING AND SAFETY DIVISION ADDRESS
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACH FEE OWNER OR
RECEPT. $ $ FIRM LNAME �-
FIRST 20 25 Q ADDRESS ��) V � /'�
LIGHT TOTAL CIT � TEL. N0.` l�
SWITCH OVER 20 .10 -
PLAN CHECK
LIGHTINGTOTAL FIRST 20 25 APPLICANT
FIXTURES iEl �10
OVER 20 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT ...1
STA. COOK DISP./F.A.U. ADDRESS D
SPACE HTR, AIR COND. CITY TEL. N0. g
LICCLOTHES WASH.�_DISHWASH.� REG.NS B CLASS
REG. NUMBER
FAN OTHER 1.000
D 1 HEREBI' ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 00 LICENSED AS REQUIRED BY LOS ANGELES OUNTY AND STATE OF
CALIFORNIA OR TH 1- I AM THE LEGAL NER OF THE ABOVE
((� DESCRIPED RESJ0 NTIAL PROPERTY. CD
v`: 1 - 10 3.00 0 ; V
PERMITEE
10 - 50 5.00 SIGNATUR CD
F-
50 - 100 10.00 rJ
DISTRICT N0. 4PED BY W
d
100 - 500 15.00
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPE R'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICE NOTOVER 600 VOLTS OR 200 AMP / 3.00 00
UNDERSLAB WORK
SERVICEOVER 600VOLTSOR 200AMP 10.00 ROUGH CONDUIT
TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL 741ILL -ems
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00 31QO
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VA IDA`TI(xN cK." M.O. CASH
Vit' � 70?�� '2 2 0 27P0A
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
DB S-A 7-40 25M F APPLICATION FOR.PERMIT
DEPARTMENT OF BUILDING AND SAFETY ullu
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NATURE 9' INSTALLATION DISTRICT NO. GROUPZONE PERMIT No.
WIRING FIXTURES SERVICE 7= I
RECEIVED BY READY FOR DATEISSUED
RANGE HEATER POWER . _( FIRST INSPECTION 4
SIGNS MISCELLANEOUS
..PPLICANT FILL ISN HEAVILY OUTLINED PORT/I/ON/ONLY
JOB
Q NAME A / � F"Sf ADDRESS
U A t
� ADDRESS a/ � �/—�� �/t^-� _ LOCALITY �L4L.�CQ�C�1
NEAREST
W CITY Q�6 _ TEL a. A.3 CROSS ST.
pj COUNTY /�j-3/–Vl .
CERT. NO. EXPIRES +G 7 !r NAME
DESCRIPTION OF WORD Z MAIL
NUMBER OF OUTLETS ON CIRCUITS 3 ADDRESS
LOCATION BY ROOMS O �i �,E'
CITY t%'TEL No.
LIGHT OUTLETS II SW.I PLUGS IFIXT. 1 AM THE LEGAL POSSESSOR OF THE ABOVE S
CIRCUIT A I B C D E k I F { G H I ANGELES COUNTY CERTIFICATE OF.AQUA i. 9C T.ION
LIVING ROOM bl
Tia
Y If oLECTRU-IAN.
DINING ROOM IAM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
_ ABOVE. esp
BRFST. RM. owNeR. d
BATH CORRECTIONS
ENT. HALL
HALL NO.
FRONT PORCH I
OUTSIDE � r
KITCHEN
SERV. PCH.
BDRM. NO.
1
CLOSET __ OI A� 2
U
BDRM. NO. I_I � � _ p////�Jj! A / a
CLOSET __ I I "'W' 1'—A -_./la jd�di •.
qq ,,
TOTAL
NO. OF OUTLETS $
AWLAPPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H. P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES Rfli AV ctinqT
b U U
MISCELLANEOUS $ POWER
�§u
V
PERMIT FEE $ / � UTILITY CO. NOTIFIED
TOTAL FEE 1-sa 41k, FINAL
i WORKERS'COMPENSATION DECLARATION CEA8o6G 10/81 APPUCAMOM FOR EL�LrCTMCAL� PERNT , n
I herebyy affirm-that I have a certificate of consent to self insure,
or a'cPrtificate of Workers' Compensation Insurance, or a certified -COUNTY OF LOS ANGELES BUILDING AND SAFETY. 'uf
copy thereof(Set.-3800 Lab. C.)
Policy No CpmPariy' ' FOR APPLICANT TO FILL IN s, JOB
E-1` Certified copy is hereby furnished. New Residential Bldgs:&'Pools EACH NO: - FEE ADDRESS � Q/rQt17��
Certified copy is filed with the county building inspection 1 & 2-Family Sq.Ft $ — $ LOCALITY '
11
'department;, Multi-family Sq:Ft. NEAREST
CROSS ST.T. L-o'�e �a
Residential Swimming Pools
Date Applicant OWNER FIRM NAME
CERTIFICATE`OF EXEMPTION FROM WORKERS' � MAIL IF
COMPENSATION INSURANCE, Outlets:Rec Light Sw. �q ADDRESS �p �,
First 20 0l
(This section•need-not be completed if the work involved by the CITY.- �r Tel.No.
Total No Additional 7
permit is-for one-hundred dollars($100 or less.) �'.CQ r
�
I'certify that'in the'peHormance of the,work.for which this permit PLAN CHECK
is issued,.l shall,not-employ an t y person in.any manner:so as`to APPLICANT
.become subject to-the,Workers',Compensation,Laws. r Lighting Fixtures First 20 ADDRESS
Total No:. Additional CITY Tel.No.
Date Applicant
,NOTICE.,TO APPLICANT If; after making this Certificate of -Fixed Appliances Not Over 1 HP PERMIT
-Exemption,you should become subject to the Workers'Compensation Range� Heater_ D.W. _ APPLICANT 4610 .
' provisions ofthe;Labor Code,,you must forthwith comply with such Oven 2L Dryer �,W.M._ ADDRESS
provisions or this permit shall'be de'emed'revoked. Top FAU W.H.
LICENSED CONTRACTORS DECLARATION. Hood Z Fan Other_ // CITY Tel.No.
I hereby.affirm that'I am licensed under,provisions of Chapter 9 CO' /� .� LICENSE OR
Disp.-aL Room Air Cond. Class. '
(commencing.with Section 7000) of Division 3 of.the Business and REG.NUMBER
Professions Code,and my Iicense,is in full fOrCe and effect:• DISTRICT NO. PR ED BY
Power Apparatus&'-Large Appliances. v
Size&Type HP,KW;KVA,or KVAR
License Number .' Lic:Class Up to ] Incl. FINAL '
O
Over t to 10•Incl. DATE .
Contractor Date Over 10 20 50 Incl Z 3-1 Z, VALIDATION 0,
❑ FINAL : . .' U
I am-exempt under Sec., Over 50 to 100 Inc.. BY W
B.&P.C.for this reason Over 100 1
Services,Swbd.,MCC& Paneltioards' Z
Date: 0- 200 Amp.Under.600 V D
Signature 201 - 1000 Amp.Under 600 V "
Over 1000 Amp.or Over 600 V
Exemption.for Reg.Maint.Elect. +-
SINGLE FAMILY Temp.Power Pole&-Appurtenances
HOMEOWNER-BUILDER DECLARATION' "1
Sigri'with One Branch Circuit -!,'L•: �
' I hereby affirm that I am exempt from the Contractor's Lkcense Law 1
for the following reason (Section 7031:5, Business and Professions Additional Sign,Branch Circuits «;
�:.
Codej: -_- £ -_-
Misc.Conduits& Conductors TENS-
❑ I,as owner of the property,will do the work and the structure
is not.intended or offered for.sale (Section 7044, Business Other(See Complete Fee Schedule)_ D t',:AL 95T .
and Professions Code). HCr
J
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the C.H.s G
-performance of the work for which this permit is issued(Sec.3097, PERMIT'FEE (Sub-Total)
Civ.C.).
PLAN CHECKING FEES
00f'011-0131
Lender's Name
PERMIT ISSUING FEE" Q t Ar 9
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE �,3
information is correct. I agree to comply with all County ordinances
and.State laws regulating Electrical wiring, and-hereby authorize v _
representatives of this County,to enter upon the above-mentioned
property for inspecti urposes.
';SEE REVERSE FOR EXPLANATORY LANGUAGE - - .� • --. -
/Signature.. er ee -Date