The URL can be used to link to this page

Home My Public Portal About10022 LIVE OAK AVE_Electrical__ 76A663 DBS SA 3-5o APPLICATION FOR PERMIT DEPARTMENTLOAT ANGELES SAFE COUNTY OF S L WILLIAM J. FOX, CHIEF ENGINEER `� FO APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. 1 ELECTRICI,A,AI �i ,��J RECEIVED By READY FOR DATE ISSUED ADDRESS FIRST INSPECT r' V ION v r O CITY / TEL NO. �y _,,/t�/�+' ,,• ' '� COUNTY LICENSE NO. �/7/ EXPIRES 'S_ ADDRESS /Qd� PERMIT FEES FEE l` NUMB R EACH LOCALI LIGHT OUTLETS NEAREST U I CROSS ST. A RECEPTACLES WALL SWITCHES l� OWNER TOTAL OUTLETS 5C S (19 MAIL (/ ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES B t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE 18 CORRECT NUMBER OF LIGHT CIRCUITS 33 _ '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 HORSEPOWERANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER FEE NEW MvD. HP OVER INC. EACH OF THE REBIDENTIAL PROPERTY DESCRIBED ABOVE. %2 a I.¢BB !S .25 91 SIGNATURE OF PERMITTE (I - -A /', S V2 2 .50 A 2 5 1.00 (,'INSPECTION RECORD 5 75 7.50 15 50 2.50 50 200 5.00 200 500 10.00 J 500 1000 15.00 Z OVER 1000 20.00 M.G. SET/FREQ. CHANGER-HP WELDERS:AC-KVA - O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG•) MOVED MOTORS (75% of CRIB.) ` MISC. SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: DATE INSPECTOR'S NAME - WIRING $1.00 ig 0 CONDUIT / FIXTURES $1,00 O WIRING 'V � SUPPLEMENTARY .50 FIXTURES POWER TOTAL FEE !8� (� UTILITY CO.NOTIFIED FINAL DECLARATI WORKER'S I COMPENSATIONto of consent to 20-0019 DPW(12-91) APPUCATIO F®� ELECT AL PERNT 76A663 g � {� ��J� �f I hereby affirm that I have a certificate of consent to self sure, � r or a certificate of Worker's Compensation Insuranc a certified COUNTY OF LOS AMStLES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) e - Policy No Comp FOR APPLICANT TO FILL IN JOB ! v2 ADDRESS Certlfled copy,is`her furnished New Residential Bldgs &Pools NO EACH FEE LOCALIT - Certlfled c s filed with the county building inspection 1 &2-Family,Sq Ft — $ $ NEAREST L� depart t Multi-family Sq Ft CROSS ST Date t' Applicant Residential Swimming Pools ASSESSOR U MAP,BOOK PAGE�� PARL'EC CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE .i Outlets Rec Light Sw C/ FIRM NAME L / / � %��,� , •,� •.�•�T vwV (This section need not be completed if the First work involved by the' Total No Additional MAIL nal ADDRESS permit is for one hundred dollars($100)or less) I certify that in'the'performance of the work for which this permit CITY Tel No is issued, I shall not employ any person In any manner so as to PLAN CHECK r become,subject to the Workers' Compensation Laws Lighting Fixtures First 20 APPLICANT Total No 4- Additional Cj� ADDRESS Date'' DD Applica RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO•APPLICANT If, r aking is-Certificak�e o CITY Tel No Exemption,you should become subject to the Workers'CompensattQijl 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 "A"LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS .L I heret y 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 L�b, Tel No', Professions Code,and my license is infull force and effect "Over 10 to 50 Incl Over 50 to 100 Incl LICENSE B Cl Class a /� /`�+ Z 7 /� REG NUMBOver 100 DISTRICT NO O ER `YID/ License Number 4:7 I-I�_q� pp�� LIC Class r �( R ESSED BY U //� `` Services,Swbd,MCC&Panelboards (/� cc Contractors�-�{ !� � Data y' b 4 �+ 0-399 Amp Under 600 V DATE 400-1000 Amp Under 600 V VAIJD/k�ION V I am exempt under Sec 6•j_- W Over 1000 Amp or Over 600 V FINAL __ B&P C for this reason�/G �m-ar BY i�' i c_` BRANCH CIRCUIT FEES �..r Date 4= p>��y 15A,or 20A,420V,Lighting or-Recept �f f 1 To 10 Branch Circuits r t Signa t 11 To 40 Branch Circuits 41 Or More Branch Circuits - 3 ❑ Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br-Circuits CHECK SINGLE FAMILY Temp Power Pole&Appurtenances -�i;��' G r: • HOME OWNER-BUILDER DECLARATION Sign with Orie 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 Code) [31-100_f"12131 41 =/5i= ❑ Misc Conduits&Conductors _ I,as owner of the property,will do the work and the structure r?•' {i is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) -- �' H 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 (Sec 3097, PERMIT FEE (Sub-Total) Civ C) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I cert / certify that I have read this application and under penalty of purjury state TOTAL FEE (� 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 pQ SEE REVERSE FOR EXPLANATORY LANGUAGE 4— L IATURE O MITTEE DATE WORKERS'COMPENSATION DECLARATION 76 -663 to/61 CEAf�pll"�plL CATT ON FOR E LECTRtAIL PERMIT I,hereby.-,Y'flrm that I have a certificate'of consent•to self Insure, CE-Bose IT U' for a certlflca`e of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy Mereof(S-ec 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,Sq Ft $ _ $ ' LOCALITY Certified copy is fded'with the county build inspection department - - •q Multi-family.Sq Ft NEAREST Ir •• Residential Swimming Pools CROSS ST Date Applicant , OWNER OR Yf, ri. Nz 45, • FIRM NAME 1, 1,• CERTIFICATE,OF,EXEMPTION FROM WORKERS', Outlets Rec Light'—I Sw.— MAIL �. COMPENSATION INSURANCE - •• ADDRESS Tries section need not be•com leted if the work involved b the First 20 ( p y •Total No Additional CITY-F4Tel No permit is for one hundred'dollars ($100)or less) I,certIf that ih-the erformance of the work for,which this permit PLAN CH CK Y P P, 1 APPLICANT ' is issued, I shall n employ any person in any manner.so as to l t t h become sube Workers''Com satio Laws Lighting Fixtures First 20 •ADDRESS ' , Addition x al CITY Tel No 7^ " Total No Date /` Apphc Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT ,If, after making this ,Certificate 'of Exemption,you should become sublect,to the Workers'Compensation Range_ Heater DW APPLICANT provisions of the`Labor Code, you must forthwith comply,viith such Oven Dryer'•_ W M _ ADDRESS , provisions or this permit shall'be deemed revoked Top FAU , WH _ LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY Tel No " I hereby affirm that I'am licensed under provisions of Chapter 9LICENSE OR Disp — Room Air Cond _ „Class (commencing with Section 7000) of Division 3 of the Business and, REG NUMBER Professions Code,and my'license is in full force and effectDISTRICT NO PROCESSED-BY' Power Apparatus& Large Appliances � ,\ - Size& Type HP,KW,KVA,or KVAR U �' License Number Llc Class Up to 1 InclFINAL U Contractor" i Date f Over 1 to 10 Incl DATE f _ VAL TION 0 Over.10 to 50 Incl ❑ 17— I am exempt under Sec Over 50 to 100 Inc g N , _�- 8,2 9 7 A? U Over 100 ..• - - - -• _ , , - .. OW.. B&PC,for this reason ' Services,Swbd,MCC&Panelboards• # 0 0 Q-0,0 '2 ' Date o- 200 Amp Under 600 v. I 0 2 5 5,0 'i Sig iature e 201 - 1000 Amp Under'600 V v ❑ : ' over 1000 Amp or over 600 V o 0,0 2'�5,Q 0 Exemption for Reg'Mamt Elect r:., SINGLE FAMILY Temp Power Pole&'Appurtenances - HOME OWNER-BUILDER DECLARATION " '�,O 5 ' -8 7 Sign with One Branch Circuit I Hereby•affirm that I am exempt from the Contractor's License Law Addihonal,Sign Branch Circuits for the following reason (Section 7031 5, Business and Professions , Code) ❑ Misc-Conduits& Conductors 1,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) - and Professions Code) CONSTRUCTION LENDING AGENCY x q I hereby affirm that there is a construction lending agency for the performance of the work foFwhich this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) Civ C) , PLAN CHECKING FEE L'ender's Name PERMIT ISSUING FEE O Lender's Address I certify that I have read this application and state that the above TOTAL FEE' �S 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=m tioned pro for inspection poses_ SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of er ttee ate