HomeMy Public PortalAbout9133 HERMOSA DR_Electrical__ 76A663 DBS SA 7-61 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ��77Ap�7 �.s•:
COUNTY OF LOS ANGELES ELECTRI
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WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTT NO. GROUP Z,0pE PERMIT NO.
_ .= I G G LS
ELECTRICIAN J fi �T1AV P
ADDRESS f!Va--'l ` I RECEIVED READY FOR DATE ISSUED'
FIRST IN PECTION
CITY /Q�.�� TEL NO! ,L �-
COUNTY LICENSE NO. EXP=REB /�i �.3�d'I LBW LDING /.I/ $3
PERMIT FEES ADO RES9 /% J ♦♦ C/ / G(/d/�J
NUMBER EACH FEE/ _LOCALITY 1-11 �Zr ` +
LIGHT OUTLETS (' ( NEAREST Q A/
RECEPTACLES )' /, �
WALL SWITCHES OWNER / ./5�—p ( 2FJ-'w�4
TOTAL OUTLETS Sc 9 MAIL �A �
ELEC. RANGES y5 ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
FIXTURES 5 O 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. PPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS 3 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. ,
MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB
NUNeeR HORSEPOWER ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
FEE OF THE RESIDENTIAL PROPERTY DESCRIS D ABOVE.
NCW MVD. NP OVER INC. EAGN ���/nyyy�_/'+
I/9 s Elea $ .25 SIGNATURE OFr%�!� �`��+ :=I� v
I/p 2 .50 PERMITTEE
2 s 1.00 INSPECTION RECORD
B 1s 1.50
15 so 2.50
BO 200 5.00
200 Boo 10.00 J
500 1000 15.00 Q
Z
OVER 1000 20.00 UI
M.G. SET/FRED. CHANGER-HP d.
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA _
TEMP. MOTORS (75q DE ORIG-)
MOVED MOTORS (75% OF CRIB.)
M ISC.
SIGNS
NO. NO.TRANS APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 (JJ CONDUIT /1
FIXTURES $1.0o WIRING
SUPPLEMENTARY .50 FIXTURES /i7.Jf lM
POWER
TOTAL FEE S Y �� UTILITY CO. NOTIFIED q,
FINAL
wOR11 he
OMPENSAIIo" DECLARATION t" 76A663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
6-0019
I hereby effll2 t11 hat I have a certificate of consent to self insure,
ora certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3600 Lab. C.)
Policy N0. Company FOR APPLICANT TO FILL IN JOB
ADORE56 E!\ OJ
❑ Codified copy is hereby furnished. New Residential Bldgs.8 Pools EFEE
LOCALITY c
❑ Certified copy is filed with the county building.inspection 1 8 2-Family,Sq,Ft. NEARESTdepartment. Multi-family Sq. Ft. CROSS ST.Date '-Applicant Residential Swimming Pools - lA�ggpEBo00KCERTIFICATE OF ExEMPTION FROM WORKERS' Outlets' c. Light Suv. FIRM NAMECOMPENSATION INSURANCE' First 20(Thissectionneed not be completed if the work Involved by the i� _ MAIL -72
Total No. AdditionalAOORE6SpermiC Is for one hundred dollars(5100)or less.) 'wI-certify that in the performance of the'vvork for which this permit ITY '71- Cis issued, I shall not employ any person m 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 7
RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY T.I.No.
Exemption,you should become.subject,to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked. Power Apparatus 8 Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size 8 Type HP.KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions ofChapter9 Over3to 10 Ind.(commencing with Section 7000) of Division 3 of the Business and CITY TeI,No:
Professions Code, and my license is in full force and effect. Over 10 to 50 Ind. }
Over SO to t00 Incl. REGNNU BER SE OR Class. OL
Over 100 DISTRICT N0. PROCESSE O
License Number Lic.Class `— 08
L..1
_ vice/�I Swp%/bdd{y,�pgC-B Pappappelboards d• -
Contractor Date �/ 0-4138 Amp.Un17er 600 V / DA7E '
❑ I am exempt under Sec. 400-1000 Amp.Under 600 V - H "� w
!!! VALIDATION
_ Over 1000 Amp.or Over 660 V FINAL o�
- 8.8P.C.for this reason ev W
BRANCH CIRCUIT FEES
Date: 15A,or 20A, 120V,Lighting or Receipt. 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 27N Lighting Br.Circuits
SINGLE FAMILY Temp.Power Pole 8 Appurtenances - s
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): _r-r.r
/1 -s
Misc.Conduits 8 Conductors E .I�
L� Ias owner of the property, will da the work and the structure e
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) .Mi)l�il _ a - 40
and Professions Code). lli
7 qj i
CONSTRUCTION LENDING.AGENCY ;-rr
I hereby affirm that there is a construction lending agency for the f,.i-1tf- Q I'E
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) D D
Civ. C.)
PLAN CHECKING FEE (I�iI j[I—I iii I
,7r
Lender's Name _+:pry I Ery_ ,4:=f,
PERMIT ISSUING FEE - {. Ili
Lender's Address -' -
I certify that I have read this application and under penalty of purjury state TOTAL FEE 0
that the above information is correct. I agree to comply with all County -
ordinancesand State laws regulating Electrical wiring,and hereby authorize
representatives of this County to enter upon the above-mentioned property -
for inspection rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
aus�9
IGNATURE OF PERMITTEE 9GATE