HomeMy Public PortalAbout9066 HERMOSA DR_Electrical__ 76A663 5A 25M SETS 7-48 APPLICATION FOR PL
BABY
DIiPARTCOU OFF LOS AG AND SAFETY
COU �J�L���Y�
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COUNTY OF LOS ANGELES
-o WM. J. FOX CHIEF ENGINEER
qza Fc a " s Y7 CI �4 �. DISTRICT NO. GROUP ZONE PERMIT NO.
"a NAME. Al _
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ADDRESS [I[ Q N .CA / U / f /
W CITY/"f /l IT -)-, I7COUNTY �j�� TEL.NOr�!.Z L•+G AI I RECEIVED FIRST INSPECTION %r,T %UED
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LICENSE NO. /] / U EXPIRES/ �JO 44 - (!/ �"/�////+
APPLICANT FILL IN HEAVILY OUTLINED POJOB
RTION ONLY
DESCRIP'T'ION OF WORK ADDRESS tT�/ ) O S QDPJ
NUMBER OF OUTLETS ON CIRCUITS LOCALITY •P T117 /'� I2 1
LOCATION BY ROOMS NEAREST r y�
LIGHT OUTLETS SW. PLUGS FliT CROSS ST. L / 1 /
CIRCUIT A 8 I C D E F G I H C NAME
z I MAIL
yy// 3 MAILADDRESS a �j'
1
;-A 4R / "f D CITY 4 �'1 !7 e ('1 /STEL.NO.
ABOVE LOS
{ei / ^ / ANGELES COUNTY CE1 AM THE LEGAL RTIFICATE�j OF QUASSESSOR' OFHy�IFICAT ON..
I AMFenny,OWNER OF THE PROPERTY DESCRIBED. erd l " S `/f
. . OWNER.
CORRECTIONS
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NO. OF OUTLETS $ APPROVALS
NO. OF FIXTURES /4/ $ DATE INSPECTOR'S NAME
-NO.-OF MOTORS H.P. S CONDUIT
NO. OF SIGNS TRANS. - !I; L 6A-7 w V�
NO:OF RANGES OR HEATERS $ FIXTURES '
MISCELLANEOUS $ POWER //
)PERMIT FEE $ UTILITY CO.NOTIFIED A / /v // /
-NOTA FEE FINAL - ��. Y/ � '� '..t -.
WORKER S'COMPENS ATIONDECLARATION CE 806G (280)63 APPLICATION FQR 'ELECTRICAL PERMIT {�
CEAlJ
I hereby -itt irm 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
a certified copy thereof(Sec. 3800,Lab.C.)
FO RAPPLICANT TO FILL IN JOB ! D
Policy No. Company New Residential Bldgs.&Pools. EACH NO. FEE ADDRESS
�r,Certified copy is hereby furnished ,1-&2-Family,Sq. Ft.% $ $ LOCALITY C.r
-❑ - _ Multi-family Sq. Ft. NEAREST
Certified copy is filed the county building inspection - CROSS ST
department. Residential Swimming Pools OWNER OR•
_ /! FIRM NAME
Date / Applicant Outlets' Rec.-Light Sw. l MAIL V
First 20
TIFICATE OF EXEMPTION FROM WORKERS' Total.No. Additional CITY---/",
ITv Cid Tel N '� }
COMPENSATION INSURANCE.
I • PLANCHECK 1
(This section.need not be completed if the work involved APPLICANT U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20- Additional ADDRESS cr
Total No. O
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP - CITY - TeI No. ♦—
permit is issued, I shall not employ any,person in any manner PERMIT - W
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. FERMI AN _ S
/%'^-� Oven _ Dryer_W.M. , ADDRESS �` N
�J(j Z
Dat 2 APPlicanf7 ToP — FAU, T.�.,H. D _6' 7
Hood Fan _Other_ CITY
Tel IV o.
NOTI E T APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._ LICENSE OR A
Exemption,••you should become subject to the Workers' REG, NUMBE B:L lass c '�l
Compensation,provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. f PROLES O BY
with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR . /CJI
deemed' revoked. Ss t/UUU 1
e .Up sol Incl. -. FINAL
LICENSED CONTRACTORS DECLARATION
Over 1 to 10 Ind. DATE Z;,� V Asfl DAT10N
Over 10 to 50 Incl.
I hereby affirm that 1 am licensed under provisions of Chapter Over 50 to 100 Inc. _ BV A
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100
ness.and Professions.Code, and my license is in full force andf-�/v`"'
effect: Services
License Numb is 1� V,{`/Z_ Lic.Class e / 0-200 Amp. Under 600 V
201-1000 Amp. Under 600 V
Contragfq Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DE LARA ION Temp. Power Pole&Appurtenances R:96555A
.
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contract - I • • Q Q 8 i "
License Law for the following reason (Section 70 Busi- Additional Sign Branch Circuits 'e'� • tJ o
ness and Professions Code): - O'Z`Z 3 a•$'] -
Misc.Conduits& Conductors ,
I, as owner of the property, wi o the work and the Other (See Complete Fee Schedulel— -
structure is not intended or ffered for sale (Section e
7044, Business and Professi s Code). -
• CONSTRUCTIO ENDING AGENCY ,
I hereby affirm that the is a construction lending agency s
for the performance the work for which this'permit is
issued (Sec. 3097,Ci .CJ. - PERMIT FEE y_ ISub-Total)
Lender's Name - PLAN CHECKING FEE (One-Fourth Permit Feel _
Lender's Ad ss PERMIT ISSUING FEE. o
I certif that I have read this application and state that the TOTAL FEE -
abov nformation is correct. I agree to comply with all County
or 'aces and State laws regulating .Electrical wiring, and t
hereby authorize rep sentatives of this County to enter upon
the ab ve- endo a grope for inspection purposes. `
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Dal -