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HomeMy Public PortalAbout4967 LOMA AVE_Electrical__ �• COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer DISTRICT NO. 1IROUP ZONE PERMIT NO. FOR APPLICANT TO FILL IN 5- � 4 - / - / � '/ ELECTRICIAN F-� T / L_ /`I FIRSINSPECTION RECEIVED BYREADY DATE ISSUED ADDRESS p CITY C '� s TEL NO. COUNTY LICENSE NO. EXPIRES BUILDING / , PERMIT FEES FEE ADDRESS NUMBER EACH LOCALITY LIGHT OUTLETS NEARES RECEPTACLES T may,t CROSS ST. WALL SWITCHES OWNER Ll tq VE lticl-- TOTAL OUTLETS Sc $ 0 MAIL ,,'' ELEC. RANGES 25 ADDREBB Inery v f- ELEC. HEATERS 25 _ CITYrf PIE - TEL. NO. FIXTURES _ 5 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE 18 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 LOP, NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AME LEGAL OWNER NEW I MVD. HP OVER INC. EACH OF THE RESIDENTIAL PRO PE TY DE IBED AB VE. 6 LESS $ .25 L6S SIGNATURE OF I1/ 2 .50 PE R M =�--- 2 B 1.00 INSPECTION RECORD s is 1.50 _ is s0 2.50 so 200 5.00 200 500 10.00 J 500 1000 15.00 Q Z OVER 1000 20.00 M.S. SET/FREQ. CHANGER-HP WELDERS:AC-KVA O GENERATORS - KW TRANBI-ORMERS - KVA TEMP. MOTORS (75% of ORIS.) MOVED MOTORS (75% OF ORIO.) MISC. SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: _ DATE INSPECTOR'S NAME WIRING $1.00 QQ CONDUIT / / / FIXTURES $1.00 WIRING / .l�.lA— ell,7'1)3 i SUPPLEMENTARY .50 FIXTURES POWER �7 _ TOTAL FEE UTILITY CO. NOTIFIED FINAL Y 76A663 DBS.#5A 4-52 r r 76A663 CE-806(6/78) APPUCLr"11MI1 W W FOR E�L u ECTMICAL PERMT _ COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB New Residential Bldgs &Pools EACH NO FEE ' ADDRESS 14c1 6 9 ,11 • Lo sin a i4U r l,&2 Family,Sq Ft $ 025 — $ LOCALITY g eu—S 1 Multi family Scl Ft 02 — NEAREST Residential Swimming Pools 25 00 CROSS ST T OWNER OR C � FIRM NAME C� Outlets Rec Light Sw MAIL First 20 -50 'ADDRESS 6 IJ \VIA79 ?*A-J i Total No Additional 30 CITY TL yNA Pte--Lr Tel No PLAN CHECK APPLICANT Lighting Fixtures First 20 50 ADDRESS L4 AT, L_OU } "L Additional 30 t/ Total No CITY "TL�yr^j7LL,. C I Tel No Fixed Appliances Not Over.1 HP PERMIT Range_Heater_D W APPLICANT Oven—Dryer_W M— -ADDRESS �,.1r.%_S Top _FAU — W H CITY Tel No Hood_Fan _Other_ LICENSE OR Disp —Room Air Cond 2 50 REG NUMBER Class I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE,TO Size&T COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ype HP, KW, KVA,or KVAR ! REGULATING ELECTRICAL WIRING 41 Up to 1 Incl 2 50 1 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl 5 00 LICENSED AS RE RED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl 12 50 CALIFORNIA OR AT AM THE LEGAL OWNER OF THE ABOVE 09 25 00 DESCRIBED RESI NTIAL PROPERTY Over 50 to 100 Inc PERMIPEE Over 100 4000 SIGNATURE Services DISTRIC COQ ROCE SED B 0 200 Amp Under 600V 12 50 Q ` a' / 201-1000 Amp Under 600 V 25 00 Over 1,000 Amp or Over 600 V 5000 Z O - Temp Power Pole&Appurtenances 1000 Q Sign with One Branch Circuit 1000 Additional Sign Branch Circuits 200 INSPECTION > INFORMATION Misc Conduits&Conductors 1000 ON REVERSE S 24 5 4,7 A Other(See Complete Fee Schedule) SIDE u Z # o o o o o 2 202200 PERMIT FEE (Sub Total) o o o 2 2 0 05 PLAN CHECKING FEE (One-Fourth Permit Fee) A 0 5 2 3-7 9 PERMIT ISSUING FEE $7 00 c G J TOTAL FEE 2 Z� > INSPECTION LED / w W dote .5.3 J6g1' By 6 ©s iY (�RKERS;COMPENSATION DECLARATION�Y �7,E-806 �o78i APPLICATION ®R ELECT®"�,/+A,p PE®,pp��;.•_ R' ' f01ie Feby� rm,that-I'Fiave a certificate of consent to'self insure;, CE-Bose Ifs �1.i9i 1� IfI N!!II ; Fora certifica'e-;of Worker'„Compensation Insurance;or a.certitied COUNTY OF'LOS ANGELES_ BUILDING AND,•SAFETY ” '. "copy 11ereof,'(Sec 3600;Lab,C) F• Policy No 'Company' _ FOR,APPLICANT'TO'_FILL INS' °' .'", JOB ,Q i - x❑, Certified co is hereby furnished '' ,°• EACH'•, NO FEE ADDRESS__(a� Certified, py y , i New'Residential Bldgs & Pools ` �LOCALITNY i ;i1 Certified,copy is filed:with'the-courity building inspection=' 1 & 2-Family,Sq Ft' $ — $ ` department" Multi-family Sq Ft — NEAREST e, '' q CROSS ST Date t s Residential Swimming Pools l � �/ OWNER T E APPIiCarit t r ..- �" , .y �� .r: ••FIRM NAME� r� x CERTIFICATE'OF'EXEMPTION FROM WORKERS', ^ Outlets Rec `` Light.'Sw, �' ADDRESS y; .,COMPENSATION INSURANCE F y - - f (This-section need notbe completed if the work involved b the �J�(( First 20 P Y LLJJ-- f " iCITY ` +f ,Tel No permit is for one hundred doIlars'($100)or less.), Total No Additional, a t ., - e, - PLAN,CHECK - ",M' ,_ �, ' ,• °I certify that in,the.,performance.of the work foi-,which this,permit "APPLICANTr ' is,issued, l shall•not.,employ any,person.in any manner,so'as to , ' ,become subject to the Workers'Compensation Laws-r Lighting Fixtures First 201,—, ADDRESS, - 3w... Additional , ti ,Total No r CITY' °" 'iel No Date Alicant` 0 ' „ • =, n Fixed Appliances Not Over, 1 HIP PERMIT T ! i NOTICE 'TO”API NT If, after making ,this Certificate of ;-n t Exemption,you should become subject;to the Workers Compensation _ Range_ Heater y D W APPLICANT provisions of the„Labor Code,,you rridst forthwith comply with such ` Oven Dryer,_' W M _- ADDRESS provisions or this,permit_shall be deemed revoked �. Top FAU WH _ ', _ a „ LICENSED CO1-1 NTRACTORS DECLARATION', Hood — Fan Ottier_ CITY ” ,Tel'No (,hereby,, affirm'that.l.+am_licensed°under,provisions of Chapter 9 UCENSE OR (commencing.wdh Section 7000)'of•division 310f,the'Busine`ss and Disp Room'Air Cond Class - REG NUMBER- Professions Code,and,rny license is}ui full forcand!effect'j _ DISTRICT NO PROC BY, Powe'Apparatus& Large Appliances -- �: Size& Type:HP,KW,KVA,,or KVAR License Number t' Lic Class '' Up to,1 Incl 'FINAL V w 1 Over-1'to'10 Incl. DATE ✓ (� Contractor Date A VALIDATION L Over 10 to 50 Incl ' FINAL ❑-r.l am exempt under Sec ,Over 50 to 100.19q BY `N B&P C for this reason Over 100" ;�° ' '• - - - fi r' , r = Services:1Sw1bc,MCC&,Panelboards ,, F •, z Date 0- 2O0 Amp Under 600�V Signature y 201-1,000 Amp°-Under-600 V Over 1000 Amp or Over 600 V El Exemption for Reg Maint:Elect SINGLE FAMILY r' Temp'Power Pole-8 Appurtenances HOME OWNER-BUILDER DECLARATION "`" Sign with One Branch Circuit,' I hereby'affirm that I am exempt from the Contractor's License Law •• for the,following reason(Se(Section7031'5,'Business and Professions Additional_Sin.Branch Circuits g Code) . �r7 Misc Conduits& Conductors y ar ,I,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)' .( " bt* ;` ;1011 t CONSTRUCTION LENDING AGENCY Thereby affirm that there is a construction lending agency for the performanPERMIT-FEE­work for'which this permit is issued(Sec 3097, . . PERMIT-FEE •- Civ C) _� .. i7 PLAWCHECKING FEE Lender's Name PERMIT ISSUING FEE _ •.. /v 1 _ �ir. �' Lender's Address' " I certify that I have read,this application and stare that the above' TOTAL FEE information is correct I agree to "' with all,County ordinances and State laws regulating Electncal in aid and hereby authorize representatives of this County'to e upon the above-mentioned r " property for'insp tion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sign of emSiftee Date ,