HomeMy Public PortalAbout9824 LEMON AVE_Electrical__ 76A663 OSS SA 11-49 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC
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COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN 1r4f —� yO
e.. RECEIVED BY READY FOR DATE ISSUED
ADDRESS p FIRST INSPECTION
CITY TEL. NO!'1))t• U
COUNTY LICENSE NO. EXPIRES/.>' — I6— k'ZBUILDING
PERMIT FEES ADDRESS
FEE
NUMBER OUTLETS EACH LOCALITY
LIGHT 5C III NEAREST
6
CROSS ST.
� RECEPTACLES 5
`J FIXTUREB 5 OWNER #-4
3 / WALL SWITCHES 5 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
'�✓ I misc. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ ,THIS
NUMBER OF CIRCUITS INSTALLED:
TOTAL APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS - AND STATE LAWS REGULATING ELECTRICAL WIRING.
NUMBER HORSEPOWER FEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NEW Mvo. HP OVER INC. EACH ANGELES COUNTY LICENSE, OR AM THE LEGAL OWNER
1/z a Ess $ 25 OF THE RESIDENTIALAPD�PP7ESC .
I/z 2- .50 SIGNATURE OF
2 5 1.00 PERMITTEE
5 is 1.50 INSPECTION RECORD
15 50 2.50
50 200 5.00
200 500 10.00
500 1 000 I5.00 J
Q
OVER 1000 20.00 Z
1
M.G. SET/FREQ. CHANGER-HP EJ
WELDERS: AC-KVA R'
GENERATORS - KW O
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG.)
"MOVED MOTORS (75% OF ORIa.)
MISC.
SIGNS
TYPE: NO.TRANS.
TYPE• NO. LAMPS APPROVALS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1,00 CONDUIT -
FIXTURES $1.00 WIRING I
SUPPLEMENTARY .50 FIXTURES ur—i"A
a POWER
TOTAL FEE $ UTILITY CO. NOTIFIED
FINAL
76A663 DBS 5A 11-SO APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES LEmAl�T OR I C
WILLIAM J FO HIEF ENGINEER
FOR PLIC T FILL IN DISTRICT NO. GROUP ZONE PERMIT NO
s Z�Sf
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSU D
ADDRESS y / FIRST INSPECTION I
CITY0. TEL NO-71e74916'1 ��
COUNTY LICENSE NO EXPIRES (VV BUILDING
ADDRESS LAA
PERMIT FEES
FEE
NUMBER EACH LOCALI
LIGHT OUTLETS NEAREST
CROSS ST
RECEPTACLES
WALL SWITCHES OWNER
TOTAL OUTLETS Sc $ MAIL
ELEC RANGES 25 ADDRESS
ELEC. HEATERS 25
CITY TEL. NO.
FIXTURES 5 1 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 ' CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER I ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE
OF THE RESIDENTI PROPERT DESCRIBED AB V
NEW MVD. HP OVER INC. EACH 2
1/2 9 LESS $ 25 SIGNATURE OF T
1/2 2 .50 PERM ITTE
2 5 1.oo INSPECTION RECORD
5 15 1.50
15 50 2.50
50 200 5.00
200 Soo 10.00 J
Q
500 7000 15 00 Z
OVER 1000 20 00 V'
M G. SET/FREQ. CHANGER-HP
0
WELDERS AC-KVA '
GENERATORS-KW '
TRANSFORMERS-KVA ,
TEMP MOTORS (75%OF ORIG )
MOVEDMOTORS (75%OF ORIG.)
MISC
SIGNS
NO. NO. TRANS. I APPROVALS
NO NO LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT
CONDUIT n
WIRING $1.00 WIRING 1�.,/JA1..a,/.�✓ I�.�/5 1I
FIXTURES $1 00 r
FIXTURES
SUPPLEMENTARY So
POWER
TOTAL FEE $� UTILITY CO NOTIFIED
'^ ® FINAL ...r 1.
� v
WORKERS'COMPENSATION DECLARATION CE 8066 r°'B' APPLICATION FOR ELECTRICAL PERMIT
I hereby,'pf{irm that I have a certificate of consent to self '
insure', or a certificate of-Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
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
❑ 1 & 2-Family, S Ft L — $ LOCALITY
Certified copy is filed with the county building mspec- Y 9
tion department Multi-family Scl Ft — NEAREST
CROSS ST
Residential Swimming Pools - OWNER OR
Date Applicant FIRM NAME �r
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw MAIL t�
COMPENSATION INSURANCE yot
ADDRESS 740
This section need not be completed if the-work Involved b First 20
( p y Total No Additional CITY Tel No7"
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 Wo rs'Compensation Laws Lighting Fixtures First 20 ADDRESS
_AwdTotal No Additional CITY Tel No
Date Appli t Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, aftJ making this Certificate APPLICANT Y�
Exemption, you should become subject to the Workers' Range_ Heater—D W
Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W M — ADDRESS,�>ff
with comply with such provisions or this permit shall be Top — FAU —W H — CITY Tel N
deemed revoked . HooFP
d _ Fan _Other_
LICENSED CONTRACTORS DECLARATION • LICE SE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER Class
(commencing with Section 7000) of Division 3 of the-Business DISTRICT NO PROC S D BY
and Professions Code,and my license is in full force and effect Power Apparatus & Large Appliances ' f !i G CL
Size 8 Type HP, KW, KVA, or KVAR �/ (�a Q
License Number Lic Class Up To 1 Incl FINAL V
_ Over 1 to 10 Incl DATE /8�� V LIDATION
Contractor Date Over 10 to 50 Incl O
FINAL
❑ I am exempt under Sec Over 50 to 100 Inc BY tw Over 100 Av�
B &P C for this reason
X27&4A
DateServices, Swbd , MCC& Panelboards q , # o 0 0 0 0 2
—
1 0 -200 Amp Under 600 V (!Q
Signature 201 - 1000 Amp Under 600 V I - - 25.50
ElExemption
1000 Amp or Over 600 V
Exemption for Reg Maint,Elect o o 0 2 5 5 0 E
SINGLE FAMILY Temp Power Pole & Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0 a 2 3 =8 5
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031 5, Business and
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 Other (See Complete Fee Schedule)_ ►
7044, 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 C /�
I certify that I have read this application and state that the A TOTAL FEE J V
above information is correct I agree to comply with all County
ordinances and State jaws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-menti property for inspectyr;oses3 � SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig
a,"
r6 of Permittee Date
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