Loading...
HomeMy Public PortalAbout5333 LOMA AVE_Electrical__ 76A663-CE806 1,90• •APPUC AT ON TOR REC IM, CZ pE6°3MN COUNTY OF LOS ANGELES yDEPARTMENT OF COUNTY ENGINEER BUILDING n BUILDING AND SAFETY DIVISION ADDRESS COLEMAN W. JENKINS SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL�IN NEAREST CROSS ST. OUTLETS NO EACH FEE OWNER RECEPT�f $ $ -' LIGHT,Q ,ADDRESS ✓`•'� ,T7 FIRST 20 205 © / /O �_ OVER 20 7� CITY�c3 / TEL. N0. /' SWITCH PLAN CHECK LIGHTING TO L FIRST 20 25 © •APPLICANT FIXTURES OVER 20 10 ADDRESS APPLIANCES CITY TEL. N0, PERMIT RANGE-DRYERWTR. HTR:_ - APPLICANT �-/ �• ' STA. COOK I- -F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL..NO. CLOTHES WASH. DISHWASH._j_ LICENSE NO. '�-,C>�jCLASS. Cl 0 FAN LOTHER 100 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION' - DO AND STATE THAT THE,ABOVE IS CORRECT,AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING ( WITH ALL COUNTY ORDINANCES AND, STATE LAWS REGULATING IND. HEATERS„ETC HP- KW. KVA. - ELECTRICAL WIRING.' , SIZE & TYPE - OVER TO. .1.HEREBY CERTIFY TH T I A PR PERLY REGISTERED AND/OR 0 - 1 - 100 LICENSED AS RED U IRED Y LO NG L COUNTY AND STATE OF CALIFORNIA OR THAT I THE EG NER OF';AND INTEND TO �.. 1 - lO 300 RESIDE IN, 'THE A E DE RIB D RESIDENTIAL PROPERTY. .a O SIGNATURE u 10.'- 50 500 OF PERMITTEE, aJ 50 - 100 1000 - DISTRICTN CLA ZON PR SS ED BY O 100 -500 1500 W 1. CL SIGN, GAS SIGN AND ONE CIRCUIT 500 NOTES: TUBE, OR ? MARQUEE - ADDITIONAL CIRCUITS 100 SERVICENOTOVER600VOLTSOR200AMP 300 oe_> SERVICE OVER 600'VOLTSOR200AMP - APPROVALS DATE INSPECTOR'S SIGNATURE 1000 _ TEMP.POWER POLE TEMP-SERVICE,POLE, &APPURTENANCES 500 UNDERSLAB WORK - - TEMP LIGHT OR RECEPT. SYSTEM 300 - _ •• ROUGH CONDIUT ,l WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB,TOTAL) - - - UTILITY CO. NOTIFIED - PLAN CHECK FEE 7Z/ PERMIT ISSUING FEE •_ 300 - FINAL JOS PH•C. ROOHAN TOTAL FEE _ -SUPE ISING ELCAL ENGINEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALI T 0`N M o. CASH iGo Q o 5.7-N JAI 21 2 D 2 0n, G SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE _ , WORKER'S COMPENSATION DECLARATION- 200019 DPW,(12-91) L`6���0�6��8®� ®� ���������� ������ 76A663 �J I hereby affirm that I have•a certificate of consent to self Insure, or a cerMicate Of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC 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 - _ _ ❑ Certified copy is filed with the county bud $ $ LOCALITY ding Inspection 1 &2-Family,.Sq Ft. NEAREST department Multi-family Sq.Ft. - CROSS ST Date Applicant Residential Swimming Pools ASSESSOR PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec._Light SW. FFIWNER OR IRM NAME COMPENSATION INSURANCE First 20 (This section need not be completed If the work involved by the MAIL s permit is for one hundredi.doliars($100)or less:) Total No Additional 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 c CK become subject to the Workers'Compen ti n Laws. Lighting Fixtures First 20 APPLICANT ,� Total No Additional • ADDRESS C Date Applican RESIDENTIAL.APPLIANCES NOT OVER 3 HP. [/ NOTIC TO PLICANT. If, at making this Certificate of CITY , Tel.No �( S� l Exemption,you should become subject to,the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. l� 342 provisions of the Labor Code, you must forthwith comply with such PER1T provisions or this pe'rmit'shall be deemed revoked Power Apparatus&Large,Appliances APPLICANT' n F"LICENSED CONTRACTORS DECLARATION _ Size&Type HP,KW,KVA,or KVAR p ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. �a d ll(•••"` (commencing with Section 7000) of Division 3 of the Business and CITY ¢ Tel No D DS6 /,.Professions Code,and my license is in full force and effect. Over 10 to 50 Incl LICENS OR Class •A, 'tea` /] Over 50 to 100 Incl REG NUMBER d License Number_Si / LIC Class 11 Over 100 DISTRICT NO /O P''OC�ES/SED BY Services,Swbd.,MCC&Panelboards1��� cc 0-399 Amp Under 600 V FINAL O Contractor Date _ ❑ 400-1000 Amp.UDATE ' exempt under Sec. Linder 600 V IVALIDATION 0 Over 1000 Amp.or Over 600 V FINAL UJ B&P C.for this reasonBY BRANCH CIRCUIT FEES d 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 Exemption for Reg Maint.Elect. 15A,20A,208V TO 277V Lighting Br.Circuits . SINGLE FAMILY Temp Power Pole&Appurtenances - — y r JL - - HOME OWNER-BUILDER DECLARATION ACCT e F. 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_ 3— f 45.15 Code): - -- ❑' l,-as owner of the property,will do the work and the structure Misc.Conduits&Conductors At ' is not intended or offered for sale (Section 7044,.BTOTAL Other(See Complete Fee Schedule) 1�(Tt"fL �4 5 m 15 and Professions Code). D - CHECK 45.11:5 CONSTRUCTION LENDING AGENCYI f i I hereby affirm that there Is a construction lending agency for the CHANGE performance of the-work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ C.) PLAN CHECKING FEE 00100'J i1 10 25 Lender's Name �O `•j tEt 1 lt1tfi PERMIT ISSUING FEE Lender's Address / I 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 ordinancesaod State laws regulating Electrical wiring,and hereby authorize representatives f this County to enter upon the above-mentioned property for Inspec es SEE REVERSE FOR EXPLANATORY LANGUAGE F-9—F Ut, Zir AT tSFAOF PER TE