HomeMy Public PortalAbout10656 KEY WEST ST_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR LI ANT / ILL IN (STRICT NO. GROG—USP ZONE PERMIT N
ELECTRIC ( A-1
76 C�
RECEIVED BY READY FOR DATE IBBUED
ADDRESS FIRST INSPECTION
_/7
CITY L. NO.
ah - 5-
COUNTY LICENSE NO. EXPIRES BUILDING
PERMIT FEES
ADDRESS
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROBB ST.
WALL SWITCHES OWNER
TOTAL OUTLETS 5a 8 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
CITY TEL. NO.
FIXTURES B
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC.
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE ANGELES COUNTY LIC NSE, O 1 AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE REHIDENTIA PER DEH RIB BOVE.
5
I/2 6 LEBB s .25 SIGNATURE OF
I/2 2 .50 PERMITTE
2 5 1.013 INSPECTION RECORD
5 is 1.513
15 50 2.50
50 200 5.00
200 500 10.00 J
500 1000 15.00 Q
Z
OVER 1000 20.00
M.G. SET/FREQ. CHANGER-HP
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIB-)
MOVED MOTORS (75% 13F ORIG.)
MISC.
SIGNS A*
NO. NO.TRANS. APPROVALS
NO. NO. LAMPS
DATE INSPECTO!}b NAME
FOR EACH PERMITS
WIRING _ $1.00 CONDUIT
FIXTURES $1.00 WIRING �� - .�.+--��•
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE D UTILITY CO.NOTIFIED
FINAL /
76A663 DBS#5A 2-S3
ION
wothat I Cofy1PENSATate of consent to 76A663 °PW`'2-9'' APPLICATION FOR ELECTRICAL PERMIT
76A663
I hereby affirm that I have a certificate of consent to self Insure,
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
❑ Certified copy is hereby furnished New Residential Bldgs.&Pools NO EACH FEE LOCALITY
El Certified co is filed with the count building inspection 1 &2-Family,Sq Ft
PY Y 9 P — NEAREST �
department. Multi-family Sq.Ft CROSS ST I��/ONri-
Date Applicant Residential Swimming Pools ASSESSOR
/ PAGE ' PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS'
Outlets:Rec. Light Sw Fl }��/l�RM NAME/� •Q p�SCIS✓�G L�
COMPENSATION INSURANCE o?,6C�
- First 20 MAIL
This section need not be completed if the work Involved b the
permit is foi one hundred dollars($100)or less.) Y Total No. Additional ADDRESS
I certify that in the performance of the work for which this permit CITY r��r�,e G � Tel No lj/y3^�Oy7/.
Is issued, I shall not employ any person In 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 RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel 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 O Power Apparatus&Large Appliances APPLICANT ;fr Ol1V*'i0e1' AVC'
LICENSED CONTRACTORS DECLARATION Size&Type�P,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 AAOver 3 to 10 Incl. ! �• 0 ,,�+�c�aL��
(commencing with-Section 7000) of Division 3 of the Business and e , / CITY P,�s��jt/� Tel No 7_ �f
Professions Code, and my license Is in full force and effect. Over 10 to 50 Incl. }
LICENSE OR ����b Z Class L'2p
`� Over 50 t0 100 Inc] REG NUMBER d
E , Z 620 Over 100 DISTRICT NO PR�,/SE'D'BY O
License Number Lic.,Class i n y G.Gl��z U
` Services,Swbd.,MCC&Panelboards r I/Q
o`�•PO/A,p,GiCTQQ ,,4e A-1-2-V 7L 0-399 Amp.Under 600 V FINAL 0
Contractor Date DATE
❑ 400-1000 Amp. Under 600 V
I am exempt under Sec VALIDATION V
Over 1000 Amp or Over 600 V FINAL d
B&P C for this reason BRANCH CIRCUIT FEES BY ,� CO
a
15A,or 20A, 120V,Lighting or Recept. I f Z_
/li D1 To 10 Branch Circuits ACCTea
Signature f 11 To 40 Branch Circuits 3303 0.70
F-141 Or More Branch Circuits .t
Exemption for Reg.Maint Elect 15A,20A,208V To 277V Lighting Br Circuits 1 I TE{1S
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION TOTAL 50-70
t
c
Branch C
B
with One ranCircuit
VV
I hereby affirm that I am exempt from the Contractor's License Law Sign `�Cr� 50.70
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits r
Code) CHANGE .00
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code) , GOOD-000I PM
CONSTRUCTION LENDING AGENCY 6046 1 PM 5:30
1 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.)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE d
Lender's Address if
I certify that I have read this application and under penalty of purjury state TOTAL FEE Q�
that the 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 above-mentioned property
for i pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
' 21,
SIGNATURE OF PERMITTEE4/y-oleDATE