HomeMy Public PortalAbout5932 HART AVE_Electrical__ 76AS63 De'S SA 11-49 APPLICATION FOR PERMIT
-iDEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES'.
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE 1PEERRMIIT�NO.
ELECTRICIAN / - —" D
f
RECEIVED BY READY OR DATE ISSUED ..
ADDRESS6J� o .Pf /' FIRST INSPECTION (J
CITY TEL.N0. � � - L V
COUNTY LICENSE NO. EXPIRES BUILDING
BUILDING f•
ADDRESS Y�-
PERMIT FEES �
FEE
NUMBER OUTLETS EACH � LOCALITY /C 3
LIGHT Sc $ - NEAREST
CROSS ST.
/ f—= RECEPTACLES 5
jj FIXTURES 5 OWNER
WALL SWITCHES 5 MAIL
' ELECT RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
M ISC./v���,ip/6 f•�, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF CIRCUITS INST LLED:
TOTAL APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY .ORDINANCES
MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING.
NUMBER HORSEPOWERFEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
"
NEW MVD. HP OVER INC. EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL OPERTY DESCRIBED ABOVE.
112 6 LESS $ .25 _
%2 2 .50 SIGNATURE OF `
2 5 1`.00 PERMITTEE 41 ✓ rr' .r.r,
S is 1.50INSPECTION RECORD
`. is so 2.50
So 200 5.00
200 SOD 10.00
Soo 1000 15.00 J
OVER 1000 20.00 Z
M.G. SET/FREQ. CHANGER-HP (y
WELDERS: AC-KVA
GENERATORS - KW - O
TRANSFORMERS - KVA
TEMP. MOTORS i75% OF DRIG.)
MOVED MOTORS (75% OF ORIO.)
MISC.
SIGNS
TYPE: NO.TRANS.],
TYPE: NO: LAMPS - APPROVALS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT IWI� An,
FIXTURES $1.00 WIRING -ILI-Z—/5 6'4111_ v
SUPPLEMENTARY - .50 FIXTURES
POWER
TOTAL FEE $ UTILITY CO.NOTIFIEDvtv—v
FINAL
ob
t
ION
WORKER'S I have
a certificate
of consent ON 20-0019 DPW(12-91) GWPPL���SSAT�®0V' FOR En ECTMICAn PERNT
76A663 wl LL LL u�u u
I hereby affirm that I have a certificate of consent to-self ir�sUS'e,
or a certificate of worker's Compensation Insurance. or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑ ADDRESS
y
ADD
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
❑ 1 &2-Family,Sq.Ft. $ $ LOCALITY
—
Certified copy is filed with the county building inspection _ NEAREST
department. Multi-family Sq.Ft. CROSS ST. 1
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
OR
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. FFIIRM NAME
it
COMPENSATION INSURANCE
First 20 MAIL
(This section need not be completed if the work involved by the {J Z
permit is for one hundred dollars(5100)or less.) Total No. Additional ADDRESS
certify that in the performance of the work or which this permit CITY i Tel.No.
is issued, I shall not employ any person a y anner so as to PLAN CHECK
become subject to the Workers' C ens io s. Lighting Fixtures First 20 APPLICANT
05
Total No. Additional ADDRESS
/D
Date Applicant ESIDENTIAL APPLIANCE NOT OVER 3 HP.
NOTI TO AP LI ANT: If, aft m ing t is Certific e of CITY r Ce Tel.N .
Exemption,y v should become subject t he,Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. /
provisions Of the Labor Code, you must forthwith Comply with SUCK PERMITAPPLICANT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances
LICENSED 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 10 Incl. �ry
(commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. .fG� r
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. �y
LICENSE OR /7 ClassCs �/ �-
Over 50 to 100 Incl. REG.NUMBER (/ r 0-
Over
Over 100 DISTRICT NO. P ESSED BY Q
License Number � Lic.Class�! V
Services, w C&Panelboard5
Contractor Date 0-399 A Under 600 V DATE 0
❑ I am exempt under Sec. 400-1000 Amp.Under 600 V !d. ~
Over 1000 Amp.or Over 600 V FINAL VALIDATION
(% a
B.&P.C.for this reason BRANCH CIRCUIT FEES BY
Date: 15A,or 20A, 120V,Lighting or Recept. Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits ;!
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT a or-
HOME OWNER-BUILDER DECLARATION
I herebyaffirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 330� 77ar1
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 9�0n
Code): 1 ITEMS
El1, as owner of the property,will do the work and the structure Misc.Conduits&Conductors fITA1 77 - 40
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) t�t
and Professions Code). > CHECK -77.40
CONSTRUCTION LENDING AGENCY CHANGE .00
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total)
Civ. C.) 00001-0001 7/ °;`56
PLAN CHECKING FEE 777 1 { 1199
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE
othatodateka
n is correct. 1 agree to comply with all County
regulating Electrical wiring,and hereby authorize
nt to enter upon the above-mentioned property
SEE REVERSE FOR EXPLANATORY LANGUAGE
D. '