HomeMy Public PortalAbout9252 KEY WEST ST_Electrical__ S
` 76A663 DBS SA 11-513 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
_
Z'2--7 97- 30
ELECTRICIAN Re Fs WAlton RECEIV D BY READY FOR DATE ISSUED
ADDRESS 5134 N. Acacia Ste FIRST INSPECTION
CITY San Gabe TEL. No. AT 685 33 ll '2 3
COUNTY LICENSE NO. 1104 EXPIRES ABUILDING
DDRESS 9252 Key west Ste
PERMIT FEES Temple Cit
NUMBER EACH FEE LOCALITY P y
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES 'p
WALL SWITCHES OWNER Bo E. Turner
TOTAL OUTLETS SD MAIL
ELEC RANGES 2S ADDRESS
ELEC HEATERS 25 CITY TEL. NO.
FIXTURES 5
1 HEREBY ACKNOWLEDGE THAT 1 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 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEw MVD H OVER INC EACH OF THE RESIDENTIAL PROPE DESCRIBED ABOVE.
T— I/2 S LESS $ .25 SIGNATURE OF
1/2 2 .50 PERMITTE
2 5 1.00 INSPECTION RECORD
s 15 1.SD
15 50 2.50
50 200 Soo
200 500 10 00 J
500 1000 15 00 Z
Z
OVER 10013 20.00 13
M Q SET/FREQ. CHANGER-HP R�
WELDERS'AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIG.)
MISC
SIGNS
NO. NO TRANS.
APPROVALS
NO NO LAMPS
FOR EACH PERMIT? DATE INSPECTOR'S NAME
WIRING $1.00 Ji
CONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
!� POWER 1
TOTAL FEE !A D"' UTILITY CO.NOTIFIED _ l
FINAL �� /a
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
"
I hereby affirm that I have a certificate of consent to self insure, 76A663
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
❑' Certified copy is hereby'furnished New Residential Bldgs &Pools NO EACH FEE ADDRESS
g
1 &2-Family,SFt — $ $ LOCALI
EJ Certified copy Is filed with the county building inspection NEAREST'
department Multi-family Sq Ft
Gam`
CROSS ST
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
a a
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec _Light Sw' FlRM NAME > L L'L�
COMPENSATION INSURANCE ,_ L' �I/FP' �• CP�QIU
First 20 MAIL
(This section need not be completed If the work Involved by the Total No Additional ' ADDREss-�/}hre 1 i j ✓tom
permit is for one hundred dollars($100)or less)
I certify that in the performance of the work for which this permit CITY77 `j• Tel No rvr
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 OVE 3
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 Power Apparatus&Large Appliances APPLICANT
r 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
(commencing with Section 7000) of Division 3 of the Business and CITY Tel No
Professions Code, and my license is in full force and effect Over 10 to 50 Incl }
Over 50 to 100 Incl - - - LICENSE OR _ _ Class _
REG NUMBER - d
Over 100 DISTRICT NO PROCESSED BY O
License Number Lic Class U
ServiMces,S bd,MC & anelb aarrrds O�
Contractor Date /vv � n P-e,4 DATE O
❑ I am exempt under Sec 400-1000 Amp Under(((6///00 V Z- VALIDATION W
Over 1000 Amp or Over 600 V FINAL d
B&P C-for this reason BRANCH CIRCUIT FEES BY ff)
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
Exempticn -
for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit `` °
I hereby affirm that I am exempt from the Contractor's License Law _
for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits _ S'_I
d
&C
d
Conuits Conductors TEN-]
- E' —
I, as owner of the property,will do the work and the structure Misc - - •�- .�,.0
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) T)OTf-1L 85= 18
and Professions Code) 1, C ril
HEK ''--
CONSTRUCTION LENDING AGENCY ( tnt42��t1.I-t-
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) Q
Civ C)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE 5;24.1, (J
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE jf
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 inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
AT E F RMITT DATE