HomeMy Public PortalAbout9154, 9154 1/2, 9158 LAS TUNAS DR_Electrical__ 76A663 DBS 5A 25M SETS 11-46 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT NO. GROUP ZONE PERMIT NO.
FOR APPLICANT TO FILL IN �� 0;2"B %}
ELECTRICIAN REC BY READY FOR DAT ISSU D
FIRST INSPECTION r l
ADDRESS )— " - - J
CITY TEL. NO. d 8 r
BUILDING 2 L
LICENSE NO. U EXPIRES ADDRESS
DES RIPTION OF WORK
FEES LOCALITY
NUMBER I OUTLETS EACH
CROSS
LIGHTS Sc $ STREET 5;1-
RECEPTACLES 5 %
FIXTURES s OWNER
WALL SWITCHES - 5 I MAIL
ADDRESS
ELEC. RANGES 25
ELEC. HEATERS 25 CITY TEL. NO.
MISC. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LI
LIGHTS RECEPTACLES
MOTORS ELECTRICIAN.
NUMBER HORSEPOWER FEE
NEW MVD. HP OVER I INC. EACH I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP-
1/2 s LESS I $ :2S ERTY DESCRIBED ABOVE.
%2 2 .50
2 5 1.00 OWNER.
5 15 1.50 INSPECTION RECORD
15 so 2.50
50 200 5.001
200 500 10.00
500 1000 15.00 J
Q
OVER 1000 20.00 _Z
M.G. SET/FREQ. CHANGER-HP I 2
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG•)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
TYPE: a A/ ` NO.TRANS. /
TYPE: NO. LAMPS v APPROVALS.
PERMIT FEE DATE INSPECTOR'S NAME
FOR ISSUING PERMIT: av CONDUIT
WITHOUT FIXTURES $1.00 I WIRING '
WITH FIXTURES 1.25 FIXTURES
SUPPLEMENTARY .50 I
POWER
TOTAL FEE $ UTILITY CO. NOTIFIED
FINAL
1
WORKERS'COMPENSATION DECLARATION CE-306G (2-80) APPLICATION FOR. ELECTRICAL PERMIT
I herebyaffirm 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.C.) n
FOR APPLICANT T.O.FILLIN JOB /�)
Policy No. Company EACH NO, FEE ADDRESS .�7` �7 r
New Residential Bldgs.&Pools
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ '— $ LOCALITY "]��/L4/04 4 e j •r^
Multi-family Sq. Ft. — NEAREST
ECertified copy is filed with the county building inspection CROSS ST �Y(
de artment. Resideritial Swimming Pools OWNER OR .n
p FIRM NAME �SJ�Las
Date Applicant Outlets: Rec.—Light_Sw. MAIL
First 20 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.. Additional CITY Tel No.
COMPENSATION INSURANCE CL
0
PLAN CHECK
APPLICANT ()
(This section need not be completed if the work involved
Lighting Fixtures First 20
by the permit is for one hundred dollars ($100) or less.) Additional ADDRESS �
Additional
Total No. 0
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY_ Tel No. U
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. _ APPLICANT "/0 ' ;' �'/i e% 1L
p /' y/ Oven _ Dryer_W.M._ ADDRESS�;. S'�l S• 9 j -�� Z
ate '7r`e Applicant3sy Top _ FAU _W.H.._ s,t
Hood _ Fan _Other_ CITY ��P9�/ Tel No..Y _�TjyS
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR O
Exemption, you should become subject to 'the Workers' REG.NUMBER r !3 Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES D BY,
with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR �
deemed revoked.'
Up to 1 Incl.
FINA
Over 1 to 10 Incl. DATEL
VALIDATION
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. ,
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. BY AL
9 (commencing with Section 7000)of Division 3 of the Busi- Over 100
ness and Professions.Code, and my license is in full force and
effect. Services
License Number y/�f Lic.Class eel O 0-200 Amp. Under 600 V //a
201-1000 Amp. Under 600 V
ContractorZP-4CF ,E Date 41^ Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's Additional Sign Branch Circuits - �3 9 2 6 A
License Law for the following reason (Section 7031.5, Busi- ' '
ness and Professions Code): 4 0 0 0 o * 2
Misc.Conduits&Conductors ' ' '
I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— 2 o e 2 5,5 Q
structure is not intended's or offered for sale (Section' '
7044, Business and Professions Code). 0'0•o 2 5.50=
CONSTRUCTION LENDING AGENCY 4 '
I hereby affirm that`theie is a construction lending agency09.0 4 8 4
for the performance of the' work for which this permit is PERMIT FEE (Sub-Total)
issued (Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE - (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE '
I certify that I have read this application and state that the TOTAL FEE
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
Signature of Permittee Date