HomeMy Public PortalAbout4973 LOMA AVE_Electrical__ pp,
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER
DIVISION OF BUILDING & SAFETY Lol
WILLIAM 1. FOB, COUNTY ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN)
ADDRESS A p ( RECEIVED BY READY FOR DATE ISSUED
CITY TEL. NO.
9ft�1 FIRST INSPECTIONA401-11-
/
(CENSE NO. Zb EXPIRES BUILDING
PERM FEES ADDRESS
FEE e
NUMBER EACH LOCALITY '
LIGHT OUTLETS �� NEAREST
RECEPTACLES CROSS ST
WALL SWITCHES
OWNER
TOTAL OUTLETS 5C $ (% L
- MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
FIXTURES t 5 CITY TEL. NO.
MISC. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS I AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUM13IR HORS FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER I INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
_
1/2 d LESS $ .25
1/2 2 .50 SIGN ERM(IT ATURE. F A.d i vr'
2 5 1 00 INSPECTION RECORD
'5 15 1.50-
I s so 2.50 f')"-f-z 1 :9,
50 200 5.00
200 Soo 10.00 .J
Soo 1000 15.00 Z
OVER 1000 20.00
M.G. s6T/FREQ. CHANGER-HP
WELDERS( AC-KVA O'
GENERATORS -KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75 OF ORIG.)
MISC.
SIGNS
NO NO. TRANS.
APPROVAI`rS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 0--?j� CONDUIT
FIXTURES $1.00 �i1J WIRING /O S
SUPPLEMENTARY gp FIXTURES
- POWER I
TOTAL FEE $ UTILITY CO. NOTIFIED /�O
FINAL
7YA 868 DES# 5A. 4-E2
j-1, WORKERS' COMPENSATION DECLARATION 76A663 10/81 nnp p /�
hereb'ffirm that I have a_certificate.of consent to self CE-806G Af!-�L���b'�1 ° ®Ii CI If-®R EL56CT111k��AL� P�,II�UVp�7
insurb, ora 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
ADDRESS
Certified copy is hereby furnished New Residential Bldgs & Pools,_ EACH NO FEE r
ZnU,4 AV,
F] Certified copy is filed-with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY '
tion department Multi-family Sq Ft — NEARESTr
Residential Swimming Pools CROSS ST C
Date Applicant OWNER OR
FIRM NAME At/�
-)RA AA WbE
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec,;2+ Li ht�Sw� MAIL
COMPENSATION INSURANCE g First 20 S- ADDRESS -03 1 Ah ) i
(This section need not be completed if the work involved by Total No Additional Z CITY. Tel No Q jQ
the permit is for one hundred dollars (;100)or less.)
CK
I certify that in the performance of the work for which this APPLICANT,
PLAN C E ,
permit is issued, I shall not employ any person in any manner
so as to�become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS
Total No Additional
Date Applicant CITY Tel No
NOTICE TO APPL CANT'If, after makingFixed Appliances Not Over 1 HP PERMIT this Certificate of T f
Exemption, you should become subject to the Workers' Range YHeater� APPLICAN
D W 1610*
Compensation provisions of the Labor Code, you must forth- Oven Dryer _ W M ADDRESS �- ��;nfQ 'ok
with comply with such ,provisions or this permit shall be .Top. FAU, —WH —
,deemed revoked. Hood Fan _Other_ CITY �� ��� (i Tel No $J
LICENSED CONTRACTORS DECLARATION LICENSE 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 Power Apparatus& Large Appliances DISTRICT NO PROCESSED BY 0-
and Professions Code,and my license is in full force and effect D U
Size &Type HP, KW, KVA, or KVAR
License Number Lic ClassUp to 1 Incl FINAL lb'
Contractor Date Over 1 to 10 Incl DAT VALIDATION O
ElOver 10 to 50 Incl FI
I am exempt under Sec Over 50 to 100 Inc BY C-
- - to
B 8P C for this reason Over 100 Z
Date Services, Swbd , MCC& Ponelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V- -
aOver 1000 Amp or Over 600 V
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that 1 am exempt from the Contractor's License Additional Sign Branch Circuits
for the following reason (Section 7031 5, Business and
Professions Code)
1, 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)_ D 9 3 7 2:1 'A,'
7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY # o o • o e 2
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 ) �- o 0 7.QS 0
PLAN CHECKING FEE 0007Q5os
PERMIT ISSUING FEE 2 2 7=8 5
Lender's Address
1 certify that I have read this application and state that the TOTAL FEE
above information is correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize rep resen es this Co ty to enter upon
the abo - entioned p p r insp n purposes
• ���J�SSEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date