HomeMy Public PortalAbout10050 LIVE OAK AVE_Electrical__ 76A663 DBS 5A 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
_ COUNTY OF LOS ANGELES 2i
b WILLIAM J. FOX, CHIEF ENGINEER ELECTRXC
1 DISTRICT'NO. GROUP ,ZONE PERMIT NO.
FO, APPLICANT TO FILL
IN r ��S-1/
ELECTRICIA/ �
-V1 _ _ w d
RECEIVED BY READY FOR DATE ISSUED
ADDRESS p (./ ZL) 6�e; � FIRST INSPECTION
CITY22 TEL NO. - v
COUNTY LICENBE NO. 6[Yl Y EXPIRES �C- BUILDIADDRES8 LJ.Lk/GY
PERMIT FEES
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROBB ST. �- �,I �,
WALL SWITCHES OWNER�f /YJ r
TOTAL OUTLETS 5O !B MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS I 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 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB
NUMBER HORSEPOWER ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEw MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVF-
t
( V2 s LIESS Ili .25 BIGNATURE O� t
V2 2 .50 PERMITTEE-
2
ERMITTE
2 5 1.00 (/INSPECTION RECORD-J
5 15 1.50
15 50 2.50
50 200 5.00
200 500 10.00
500 /000 1 5.00 Z
OVER 1000 20.00 Q
M.O. BET/FREQ. CHANGER-HP R'
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF OR10•)
MOVED MOTORS (75% OF OR1o.)
MISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO. LAMPS
D//ATE INSPECTOR'S HAMS
FOR EACH PERMIT:
WIRING $1.00 B d CONDUIT
FIXTURES !81.00 WIRING
SUPPLEMENTARY .50 FIXTURES ���d1 �Q"7'
POWER ,G
TOTAL FEE III 4a UTILITY CO.NOTIFIED / -at -J-I-
FINAL I/` a-p %n- �/• 7•�""I
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91)
76A663 �J��"CPP1� CATION FOR GL�ECTM'liAL PERKT
I hereby affirm that I have a certificate of consent to self Insure,
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF Plt$LIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec 3800 Lab C)
❑
Policy No Company FOR APPLICANT'TO FILL IN'• - JOB ADDRESS
Certified copy'Is hereby furnished ' New Residential Bldgs &Pools NO EACH FEE LOCALITY
❑,,
Certified co' Is filed with the count building inspection 1 &2-Family,Sq Ft — $ $
PY Y 9 P NEAREST 47
department Multi-family Sq Ft CROSS ST
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS" OWNER OR
r" COMPENSATION INSURANCE Outlets Rec _Light Sw FIRM NAME
First 20 �
(This section-need not be complete d if the work Involve_d by the MAIL
ADDRESS A0�Q
permit Is for'one hundred dollars($100)or less:) Total No Additional
I certify that in the performance'of-the'work for which this permit Clrf�-1 Tel No
Is issued, I shall not employ any person in any manner so'as to PLAN,CHECK
becometsubject to the Workers' Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
ADDRESS "
Date 2 Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE'TO APPLICANT If, after making this Certificate of CITY Tel No
Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP
'of the Labor Code,Wu must forthwith complywith such PERMIT
provisions y - Power Apparatus&Large Appliances APPLICANT
provisions or this permit shall be deemed revoked '
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby 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 Tel No
Professions Code,and my license Is in full force and effect Over 10 to 50 InclSE OR I }
Over 50 to 100 Incl REG LICENNUM ER Class a
Over 100 _ DISTRICT NO PRO SSED BY 0
License Number LIc ClassD p
Services,Swb51,_MCC 8 Panelbgards O
�J/9rAIJ/�U/dam 8/J e) FINAL 0
Contractor Date -- i , cc
0-3 m n er 00 V DATE F-
400-1000 Amp Under 600 Vl� V
I am exempt under Sec VALIDATION LU
Over 1000 Amp or Over 600 VPINAL d
B&P C for this reasonBY W
BRANCH CIRCUIT FEES
Date 15A,or 20A, 120V,Lighting or Recept Z
1 To 10 Branch Circuits
Signature - 11 To 40 Branch Circuits
41 Or More Branch Circuits
-0----Exemption•for-Reg.Mamt-,Elect--' --15A,-20A,-208V-To 277V-L-ightmg,Br-Circuits•-=---» - - - - o--SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION P
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits {w -O
Code)
LIVim. . G
I,as owner of the property,well do the work and the structure Mise Conduits&Conductors ,
j ry
is not intended or offered for sale (Section 7044, Business -, Other(See Complete Fee Schedule) D �• _ _, �4•__
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 c�� •
Lender's Address rG>
I certify that 1,have rea this application and under penalty of purjury state TOTAL FEE / JJ
that the a ove inform ion Is correct I agree to comply with all County
ordin �s and Stat aws regulating Electrical wiring,and hereby authorize
repres tatives o is County to enter upon a e-mentioned property
fo I p ction rposes SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATU E OF PERMITT E DATE