HomeMy Public PortalAbout6227 IVAR AVE_Electrical__ . 975 6 3
DBS-5A 12-54- APPLICATION. �FOR 'E L E C T g n®C ..B • Em_ . . R W T
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los AngelesBUILDING ( y� �
WM. J. FOX, COUNTY ENGINEER _ADDRESS .L (- ��� fr/� tf
C:ASSATT D. GRIFFIN, SUPT of BUILDING Y '
FOR APPLICANT TO FILL IN LOCALITYref � ,
PERMIT FEES NEAREST C_ , "
^ ^/`
CROSSST: '`; � T ��� //`'C l. '
FEE--
NUMBER EACH OWNER ig, r ret
LIGHT.OUTLETS _ '�2p�
RECEPTACLES _�rMAIL
WALL SWITCHES ADDRESS
(J 1��� /r* 2•� y
TOTAL OUTLETS - 56. $ '�j CITY Jj E yyf; / • ••. T/EL. NO. 'r�°`/ �
ELEC. RANGES 25 ELECTRICIAN /j/a�
ELEC. HEATERS 25
ADDRESS-
KW
DDRESS_KW EA CITY' TEL. NO.
FIXTURES �' 5 .�. LICENSE NO.
NUMBER OF LIGHT CIRCUITS' DISTRICT NO. I GROUP ZONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
' NEW .,MVD. HP OVER INC. EACH J C"AlK �/,f� D 'r
V2&LESS S. .25 J - �.+ �'W(is IIC, e
_ %2 2 .50s A' .. ��z-..ex^y✓
2 - 5 1.00
5 15 1.50
15 50 2.50 -
50 200 5.00
NO. SIGNS NO. TRANS. -
NO. SIGNS NO. LAMPS _
FOR EACH PERMIT: - 7"_ '
_WIRING _ $1.00 -
FIXTURES $1-.00-
SUPPLEMENTARY .50
I APPROVALS
TOTAL FEE
Is3 // DATE. INSPECTOR'S SIGNATURE
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY q
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING �,.. �.S�.S . /Yl ✓
ELECTRICAL WIRING. r
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS'ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER -
DESCRIBED REST DENT I AAL PROPERTY.=7o��y/,�� UTILITY CO. NOTIFIED ���Lfr�3 Gam•
SIG
PERMITTEE- y `'�"�r�''��� 'zlFINAL
WILLIAM J. FOX, COUNTY ENGINEER VALII1,916 g..AIR "1'!7W'28
�/ ! DEPUTY
IF
I n p /� p 2 2 p 5� /� p (�2 n /�/� 5�
W� .
COMPENSATION'DECLARATION CE806G (2-80) ' U� P Lb�CLy1�� N FOR EL EC U �O ALS IrLSII�CIIG11� III hereby' ffirm 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.G.)
FOR APPLICANT TO FILL IN JOB T1/
Policy No. Company ADDRESS U✓ �a 7 •y Vor
New Residential Bldgs. Pools EACH' NO. FEE ,
0 Certified copy is hereby furnished. -1 &2-Family,Sq. Ft. $ — $ LOCALITY Temple 014v .
Multi-family Sq. Ft. — NEAREST
WCertified copy is filed with the county building inspection CROSS ST
depar mens. Residential Swimming Pools OWNER OR J 1
ynnFIRM NAME ! 1
Date la Applicant Outlets: Recl9ughtSvv. f MAIL a
First 20' `. ADDRESS � a ( 'VlAr
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tern o. V'L5=9 }
COMPENSATION INSURANCE
PLAN CHECK n- �
(This section need not be completed if the work involved APPLICANT O
U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS,
Additional
1 certify that in' the performance of the work for which th1.is Total No. CITY Tel No. 0
Fixed Appliances Not Over 1 HP
permit is issued, I shall not employ any person in any manner PERMIT /
so as to become•subject to the Workers' Compensation Laws. Range_ Heater_D.W. 1 APPLICANT f�1 1� ' �, tL
Oven Dryer 1 W.M. ADDRESS fs 1�h /��71P �
Date Applicant
Top — Fan —Other— CI TYSQrl GohrleI Tel No. aR /_'V(• z
Hood Fan _Other_
NOTICE TO APPLICANT: If, after makingthis Certificate of .� ` ! LICENSE OR /�
Disp. Room Air. REG. NUMBER 7Class (�'
Exemption, you.should become-subject to the Workers'
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY'
with comply with, such provisions' or this permit shall be Size&Type HP,KW,
KVA,or KVAR e
deemed revoked. v
Up to 1 Incl.
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl• 2 — VALUATION
FINA
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. BY
BY
9 '(commencing with Section 7000) of Division 3 of the Busi Over-100
ness and Professions.Code, and my license is in fullforce and
effect. / Services
"1�!'� '('16
0-200 Amp. Under 600 V �`�'O OS
License Number /Lic.Class 201-1000 Amp.Under 600'V
Contractor e 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
Additional Sign Branch Circuits 2 2 .O A
License Law for the following reason (Section' 7031.5, Busi-
ness and Professions Code,): #.0 0-0 0 0 2
Misc.Conduits&Conductors
1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section I •o 0 47.2 5
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is'a construction lending agency 9.° 4 7 2 5 50
for the performance of the work.for.which this permit is PERMIT FEE (Sub-Total) '
issued (Sec. 3097,Civ.C.). 00 $ 8 5
Lender's Name
PLAN CHECKING FEE (One-Fourth Permit Fee)'
Lender's Address PERMIT ISSUING FEE /0
I certify that I have read this application and state that the TOTAL FEE 7
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
'hereby authorize representatives of this County to enter upon
the ab ve-mentioned property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
sr—
Si nature of Permittee Date
j.
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