HomeMy Public PortalAbout5321 LOMA AVE_Electrical__ DB 5-A 12-43 25M APPLICATION F/'1.D TTtnw,�►n
DEPARTMENT OF BUR DING AND SAFETY l�� 1Y FOR rL��1��1�
COUNTY OF LOS ANGEL,EsyS ELECTRIC
WM. J. FOX CHIEF ENGINEER'
NAME �v DISTRICT O. GROUP ZONE �PERMIT NO.
U ADDRESS ^I � 9
RWEIVED 13Y READY FOR- DATE ISSUED
CITY V TE / FIRST INSPECTION
J COUNTY I �°
41 CERT NO. EXPIRES
APPLICANT FILL IN HEAVQ.Y OUTLINEDPORTION ONLYJOB
DESCRIPTION OF PORK ADDRESS 5/7"// 141L"
NUMBER-OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS V
NEAREST
LIGHT OUTLETS ISW.1 PLUGS FIXT CROSSST.
CIRCUIT A I B C D I E FIG I H a: NAME at S n/^ /�7�P_ 'Al)MAIL
TI
3 ADDRESS 11V/
O CITY �'A JA�(' (s1 1�(/ TEL.NO.
1 AM THE LEGAL 'POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
/l�1 ELECTRICIAN.
I AM THE LEGAL OWNEROFRIBED
, THE PROP t
ABOVE
OWNER.
coRRECTIONs
Q
Z_
L7
O
TOTAL
NO. OF OUTLETS APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $ 6-V UTILITYCO.NOTIFIED
TOTAL FEE • FINAL
COUNTY OF LOS ANGELES- — APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER
� DNISIOId OF BUILDING &'SAFETY
WILLIAM 1. FOX, COUNTY ENGINEER
FOR APPLICA T TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN 9115
ADDR BS RECEIVED BY READY FOR DATE ISSUED
CITY E NO �Q �a�c �� FIRST INSPECTION
y�I _ 1a-7�3
COUNTY LICENSE NO. EXPIRESBUILDING
PERMIIT ADDRESS
FEE �
NUMBER EACH LOCALITY
LIGHT OUTLETS NEARESTo
RECEPTACLES CFtOSS
000, 1 A
WALL SWITCHES OWNER l!
TOTAL OUTLETS 5C $
MAIL
ELEC. RANGER 25 ADDRESS IC�
ELEC. HEATERS 25
C1 44 TEL. NO.
FIXTURES 5 v
mlpc 1 HEREB ACKNOWLEDGE THAT I 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 AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
New MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
_ I/z a L68a $ 25 SIGN /� I
I/2 2 1 50 PERMI'iTE o!
2 5 1 00 INSPECTION RECORD
5 15 1.50
15 50 2 50
50 200 5 00 'Sop POO y- %.4 Cc I.) b �Y••
200 Soo 10.00 t Tm' Al 0 V. J
500 1000 15.00 r a
OVER 1000 20.00
M.G SET/FREQ. CHANGER-HP
WELDERS: AC-KVA
GENERATORS •KW
TRANSFORMERS-KVA
TEMP MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIG.)
MISC
SIGNS
NO NO. TRANS APPROtlAW
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT'
FIXTURES $1.00 WIRING -A.-
SUPPLEMENTARY 5o FIXTURES
POWER
TOTAL FEE $/ UTILITY co NOTIFIED
1 AL
76A 603 DBBA 5A. 4-52
WORKERS'COMPENSATION DECLARATION CE-806G torsi APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, PERMIT
or a certificate of Workers' Compensation Insurance, or a certified 'COUNTY OF LOS ANGELES BUILDING AND°SAFETY
copy thereof(Sec 3800,Lab C) °
JOB
FOR APPLICANT TO FILL IN .
Policy No Company ADDRESS
❑ Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE
❑ 1 & 2-Family,Sq Ft $ — $ LOCALITY '
Certified`copy is filed with-the county budding inspection
department +' Multi-family Sq Ft C NEARSS EST ,
Date Applicant • Residential Swimming Pools OWNER OR '
• �` FIRM NAME
'`CERTIFICATE OF EXEMPTION FROM WORKERS' LMAIL
t • COMPENSATION INSURANCE Outlets Rec Light,* .Sw ADDRESS
(Thrs'section need•not be completed if the work Involved by the First 20 CITY Tel No
permit Is for one hundred dollars($100)or less.) Total No Additional
�`• .
I certify"that iii the performance'of the work for which this'permit. � s_ - -r PLAN HECK
APPLICANT +
is Issued, I shall not employ any person,in-any manner,so as to
become subject to the Workers'Com satlon Laws Lighting Fixtures "First 20 ADDRESS
Total No Additional CITY Tel No
Date Applicant
NOTICEZ40 AP LICANT If, making this C fic of Fixed'Appliances Not Over 1 HP PERMIT
Exemption,you should become, ect,to the Workers'Com satlon Range_ Heater_-DW _ APPLICANT
provisions of the Labor,Code, ou must forthwith comply with such Oven Dryer _ W M _ ADDRE
provisions or this permit shall be«deemed revoked Top FA WH
.i
LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY Tel'Nol�/f/i/�
I hereby affirm'that I am licensed under provisions of,Chapter 9 - LICE E OR
(commencing with Section 7000)of Division 3 of,the Business and Dlsp — Room Air"Corid REG NUMBER % r Class
Professions Code,and my license is i-i full force and effectDISTRICT NO PROCESSED BY
'Power Apparatus& Large Appliances -
Size&Type HP,KW,KVA,or KVAR Q(� / r? Q
License Number G Lic Class & Up to 1 Incl FINAL v
�/�
Over 1'to 10 Incl DATE « VALIDATION
Contractor ate Over 10 to 50 Incl
❑ FINAL U
I exem t un Sec Over 50 to Inc BY
B&PC for this reason Over 100 9842 2 A d
pl Services,Swbd,MCC& Panelboards �� 0 0 0 0 0
Date 0-,-200 Amp Under 600 V # 2
Signature 201 - 1000 Amp Under 600 V I o o 2 S 5 0
❑ Over 1000 Amp,or Over 600•V
Exemption for Reg Maint Elect
0 o a 25,50
SINGLE FAMILY Temp Power•Pole&'Appurtenances
HOME OWNER-BUILDER DECLARATIONSign with One Branch brcwt I 124 8 7
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 Circyits
Code)
❑ I,as owner of,the property,will do the work and the structure Misc Conduits& Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code) D
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)
a
PLAN CHECKING FEE
Lender's Name �I `
PERMIT ISSUING FEE (f
Lender's Address
Lcertify that I have,read this application and state that the above TOTAL FEE r 7 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-mentioned
'pr erty for inspection purposes
qLSEE REVERSE FOR EXPLANATORY LANGUAGE .
Signature of Pertrir5o pate