HomeMy Public PortalAbout9716 LEMON AVE_Electrical__ 76A663 DBS SA,11-M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR AP LICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT N .
ELECTRICIAN / REC VED BY READY FOR DATE ISSUED
ADDRESS J / j4d5efdo!% ,,.�- FIRST INSPECTION _
CITY TEL NO. Jvo /.
COUNTY LICENSE NO. q O EXPIRES BUILDING
PERMIT FEES ADDRESS
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS 3 NEAREST
RECEPTACLES Z CROBB ST.
WALL SWITCHES 3 OWNER k /V A C
TOTAL OUTLETS J Q 5C . V MAIL
ELEC. RANGES 2S ADDRESS
ELEC. HEATERS /� 25 •Z� CITY TEL. NO.
FIXTURES ` 3 5 r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IH CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
%2 6 LEBB $ .25 SIGNATURE OF
1112 2 .50 PERMITTEE
2 s 1.00 INSPECTION RECORD
5 is 1.50
is so 2.50
so 200 5.00 _
200 500 10.00 J
600 1 000 15.00 Z
OVER 1000 20.00 ('
M.G. BET/FREQ. CHANGER-HP
WELDERS:AC-KVA
O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF DRIB.) -
MOVED MOTORS (75% GV DRIG.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT
FIXTURES $1.00 oWIRING / ✓ Q /� '
SUPPLEMENTARY .50 FIXTURES or
II POWER /
TOTAL FEE 0 ` 6 UTILITY CO. NOTIFIED
FINAL
76A663 Das 6A 11-511 APPLICATION FOR PERMIT
3�EPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DIST RI NO. GROUP ZONE PERMIT NO.
4 - AELECTRICIAN , ,4 T C_3 �4S� IF
/ / ` R EIVED BY READY FOR DATE ISSUED
ADDRESS V FIRST INSPECTION
i
CITY TEL NO. -
COUNTY LICENSE NO. EXPIRES qDD N G
ESS
PERMIT FEES t
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES
WALL SWITCHES OWNER
TOTAL OUTLETS 5c $ U MAIL
ELEC. RANGES 25 ADDRESS
ELEC HEATERS 25 CITY TEL. NO.
FIXTURE 5 I 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 1 CERTIFY THAT I 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 PROPERTY DESCRIBED ABOVE.
I/2 & LESS S .25 SIGNATURE OF 11
4
1/2 2 .50 PERMITTEF /
2 s ''O° INSPECTION RECORD
s is t.SO
is s0 2.50
s0 200 5.00
200 600 10.00 -1
Q
500 1000 15.00 Z
OVER 1000 20.00 (g
M.G. BET/FREQ. CHANGER-HP Q'
WELDERS:AC-KVA °
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG.) -
MOVED MOTORS (75% OF ORIO.)
MISC.
51GNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.00 1 u CONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE S ( Q UTILITY CO. NOTIFIED .r•
FINAL �y 3
WORKERS'COMPENSATION DECLARATION /6-663 10/81 APPLICATION FOR ELECTRICAL PERMIT
V,rthat I have a certificate of consent to self insure, CE-sosGof Workers' ompensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDINGAND.SAFETY
cc ec38 C) �.�Policy CompanyY � FOR APPLICANT TO FILL IN - JOB.
❑ • EACH NO FEE ADDRESS 47 r•7 L1
copy isere
Certified hereby furnished New Residential Bldgs & Pools
$ —
/Certified copy is filed with the,county budding inspection
1 & 2-Family, Sq Ft $ LOCALITY
depart ent Multi-family Sq Ft NEAREST, A%
�f CROSS ST
–�� r% f� Residential Swimmmg'P OWNER OR O �l
Date r➢ Applicant FIRM NAME / �� �1.�
CERTIFICATE,OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw / MAIL !y
COMPENSATION INSURANCE , ADDRESS
First 20
(This section need not be completed if•the work Involved by the Total No Additional CITY Tel No
peimit is for one hundred dollars ($100)or less.) ,
t, PLAN CHECK,
I certify that in the performance of the work for which this permit .APPLICANT `
is Issued,,I'shall not employ any person Ili-any manner so as to ADDRESS
become subject to the Workers'Compensatiion Laws Lighting Fixtures First 20 0 11
Additional
Total No CITY Tel No
Date Applicant, Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT,-1f,',after making this Certificate! of
Exemption,you should become subjecttothe-Workers'Compensation Range—. Heater_ D W APPLICANT
provisions^of the Labor Code, you,must forthwith comply with such, Oven _ Dryer WM ADDRESS d t�--
provisions orrthis'permit shall be deemed revoked {Top — FAU W H CITY el N
LICENSED CONTRACTORS DECLARATION Hood — Fan _;Other_
I hereby affirm that I am licensed under provisions'of'Chapter 9 LICENSE
(commencing with Section^7000) of Divisidn'3'6f the Business and ' Disp — Room Air Cond `� REG•NUMBB ER / J Class
Professions Code,and my license',is In full f ce and effect . Power Apparatus& Large Appliances DISTRICT NO\S PRWSBSize& Type HP, KW,KVA,or KVAR J0,
License Number ' - ✓� LIc Class �r D U to 1 Incl FINAL
31 -ZC7 ' gip— p DATE /O /
b{{ 11 Over 1 to 10 Incl VALIDATION Q
Contractor— Dat Over 10 to 50 Incl FINAL V
❑ I am exempt und1.er Sec Over 50 to 100 Inc BY � a
B&P C for this reason • ' Over 100 N
Services„Swbd,MCC & Panelboards Z
Date - 0- 200 Amp Under 600 V
Signature 201,- 1000 Amp Under 600 V ,
�• Over 1000 Amp°or Over 600'V
❑ Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole& Appurtenances 2 ,
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit g
I hereby affirm that 1 am exempt from the Contractor's License Law ACCT.Ar
for the following reason(Section 7031 5, Business and Professions
Additional Sign Branch Circuitsf'9±��y
Code) J.7U7 56.50
❑ Misc-Conduits& Conductors 1
I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) _
is not intended,or offered for sale (Section 7044;Business , TOTAL
ItiF�6 �
- � and Professions Code) ,,.
•
CONSTRUCTION LENDING AGENCY, CKI ,56.50
I hereby affirm that there Is a construction lending agency for the `WGE , , Ott!
performance of the work for which this permit is Issued(Sec 3097, PERMIT FEE (Sub-Total) o Wu
Civ C)
PLAN CHECKING FEE, / " S/171V Lender's Name PERMIT ISSUING FEE I v r��•i,� oa�g
Lender's Address / 7,
I ceyfinspection
e read this application and state that the above TOTAL FEE
inforect I agree to,comply with all County ordinances ,
and gulating Electrical win , and hereby authorize
reprthis County to u n the above-mentioned
proppurpo s
t! SEE REVERSE FOR EXPLANATORY LANGUAGE
SI r o , ermi tee Date