HomeMy Public PortalAbout9253 KEY WEST ST_Electrical__ 76AS63 DBS SA 11-150 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT�IJO. GROUP ZONE PERMIT NO.
ELECTRICIAN R F Walton `i/ ° q �
ADDRESS 5134 N. Acacia. St. R�VE�Y FIRST INSPECTION /DY FOR DATE ISSUED
CITY San Gab* TEL NO.AT 68583
COUNTY LICENSE NO. 1104 EXPIRES BUILDING 9253 Key ?Vest Ste
PERMIT FEES
NUMBER EACH FEE LOCALITY Temple Clty
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST.
WALL SWITCHES OWNER Be F,e Turner
TOTAL OUTLETS SD $ MAIL
ELEC RANGES 25 ADDRESS
ELEC HEATERS 25 CITY TEL. NO.
FIXTURES 5E7W 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. HP OVER INC EACH OF THE RESIDENTIAL PROPE Y DESCRIBED ABOVE.
lid /2 6 LESS $ .25 SIGNATURE OF
I/ 2 ,g0 PERMITTE
2 5 1.00 INSPE TION RECORD
5
is 1.50
Is 50 2.50
so 200 500
200 500 10.00 J
500 1 DOE] 15.00 Z
_Z
OVER IOOO 20.00 0
M G HET/FREQ. CHANGER-HP m
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 CONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50FIXTURES
POWER
TOTAL FEE UTILITY CO. NOTIFIED
FINAL
)NORKERS'COMPENSATION DECLARATION 20 0019 DPW 3/87
l'nery'affirm that I have a certificate of consent to self cEeobG APPLICATION FOR ELECTRICAL PERMIT O
;Insure, o� a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof (Sec 3800, Lab C )
Policy No Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS 5 AEV T ST,
Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ _ $ LOCALITY _
tion department Multi-family Sq Ft TT
Residential Swimming Pools Ow3RCROSS
Date Applicant FIRM NAME F/�cJ�1�' //1`/N/
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec�Light 3 Sw .l MAIL g5�7l
COMPENSATION INSURANCE V ADDRESS
First 20
(This section need not be completed if the work involved by Total No Additional 3 Z CITY Tel No
the permit is for one hundred dollars ($100) or less.) ) PLAN CHECK
I certify that in the performance of the work for which this \ APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws
Lighting Fixtures First 20 ADDRESS q W1 A"U LEY
Additional �QQ6
Total No CITY T. 0 Tel N
i/ Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, after makm his Certificate of 4ELEt)V_J C,
Exemption, you should become suble to the Workers' Range— Heater—D W — APPLICATION US
Compensation provisions of the Labor Co e, you must forth Oven Dryer —W M — ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W H —
deemed revoked Hood — Fan —Other— CITY �� el 0
LICENSED CONTRACTORS DECLARATION Dlsp — Room Air Cond Class LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances I DISTRICT NO PRO C EDB d
and Professions Code,and my license is in full force and effect
Size &Type HP, KW, KVA, or KVAR J` O
License Number Lic Class Up to 1 Incl FINAL U
Over 1 to 10 Incl DATE —�
Contractor Date ALIDATION O
Over 10 to 50 Incl FINA U
I am exempt under Sec Over 50 to 100 Inc gY
B 8P C for this reason
JOQ S Paz ,�I-1)/ CL
Services, Swbd , MCC& Ponelboards
Date 0- 200 Amp Under 600 V D @'O 5 aJ A Z
Signature 201 - 1000 Amp Under 600V
❑ Exemption for Reg Momt Elect Over 1000 Amp or Over 600 V #,o 0 o 0 o 2
�
SINGLE FAMILY Temp Power Pole &Appurtenances 4o 0 4 5 0 0
HOME OWNER-BUILDER DECLARATION =
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit o,o e 4 5,Q Q
Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits 0 9 0,1
y,8
8
Professions Code)
I, as owner of the property, will do the work and the Misc Conduits&Conductors
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— ,
Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec 3097, Civ C )
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address –
I certify that I have read this application and state that the TOTAL FEE 5r0
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 purposesSEESEE REVERSE FOR EXPLANATORY LANGUAGE
oC�7
0S
SiAgnajt Per ittee Date '