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Home My Public Portal About5614 LOMA AVE_Electrical__ ' 76A663 DSS SA 7-61 _ _ APPLICATION FOR PERMIT IZEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES gm WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT y0. GROUP ZONE PERMIT NO. ELECTRICIAN A A—/ — RECEIVED BY READY FOR DATE ISSUED ADDRESS /(�� ,� A FIRST INSPECTION I f! CITY_ /id TEL. NO. �l`C/1-M`BUILDING / I J COUNTY LICENSE NO. .10 Gd- EXPIRES j'!; PERMIT FEES FEE LOCALITY NUMBER EACH LIGHT OUTLETSNEAREST RECEPTACLES .CROSS ST. . .:>. v WALL SWITCHES - OWNER. r� TOTAL OUTLETS 1" 5C $' �� (��td MAIL _ELEC. RANGES25 ADDRESS ELEC. HEATERS - 25 ,yf.-.'�/ �— CITY TEL._ NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. ;'�6�Y>✓.r % �• APPLICATION AND STATE. THAT THE ABOVE IS CORRECT NUM13ER OF LIGHT CIRCUITS 6l AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF.RECE.PTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. ' _ MOTORS I CERTIFY THAT I POSSESS THE ABOVE 'VALID LOS Nur.+eEF HORSEPOWER - .ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER FEE NE'w MVD. HP OVER INC. EACH OF THE RESIDENTI L PROPERT4 DESCRIBE- ASOVE. , JI ^L V2 6 LESS $ .25 "< � SIGNATURE OF-- 2 .50 PERMITTEE-7- 2 s 1.00 I / PECTION AEC: D S is 1.50 - - 15 s0 2.50 _ s0 200 5,03 200 .500 10.00 - J 500 7000 15.00 Q Z OVER' 1000 20.00 - O _ M.G. SET/FREQ. CHANGER-HP' WELDERS: AC-KV - O GENERATORS - KW - TRANSFORMERS - KVA TEMP. MOTORS (75% DF ORIG.) -MOVED MOTORS (75% OF ORIG.) - MISC. SIGNS NO. NO.TRANS., I - NO. NO. LAMPS APPROVALS DATE INSPECTOR'S NAME FOR EACH PERMIT: - WIRING- _ $1.00 f �(J� CONDUIT FIXTU REB $1.00 WIRING SUPPLEMENTARY .50' FIXTURES - (�+�• - , POWER TOTAL FEE $ UTILITY CO.NOTIFIED 10 FINAL I �_ NI;7.6A663 CE806 10/72 •APPLICA ,IO . ELM ICAL PERMiIT COUNTY OF LOS ANGELES- DEPARTMEN,T OF COUNTY ENGINEER JOB BUILDING'AN,D SAFETY`DIVISION ADDRESS 7-- `fLOCALITVP/ z Imo. % I - • NEAREST FOR APPLICANT* TO FILL IN -.CROSS ST. - O .LETS NO.' EACH. FEE OWNER.OR FIRM NAMEMAi /�L RECEPT:_• I 5 ADDRESS �-�6°R"�Jra 'FIRST 20. . .25 _ LIGHT TOT L - - - CITY.� TEL. NO,__'X SWI.TCH� "OVER 20. 10, -. - PLAN CHECK ,. FIRST 20 APPLICANT - LJIGHTING - 25 - t.. TOTAL - ADDRESS FIXTURES OVER 20 .i0 - .. - CITY - ;-TEL. NO. RESIDENTIAL A,PPLIANCES;" ., PERMIT RANGE- ' DRYER"`/ W.TRI HTR._ APPLICANT•.. . - - ..STA. COOK I .. DI SP ''- F:A:U. _ , - ADDRESS Al SPACE HTR. - AIR COND. 61-TY TEL:.'NO., - -1__ � LICENSE OR 'CLOTHES WASH. DISH WASH. - - CLASS. „ _ i REG.•NUMBER FAN. OTHER. - - 1.00 ' ��) I. HERESY ACKNOWLEDGE�THAT I HAVE READ THIS APPLICATIPN• t (/ 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. ;S1 Z E,.& TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSED AS"R EOUIRED BY COS ANGELES!COUNTY AND STATE OF CALIFORNIA OR THAI J AM THE' LEGAL OWNER OF THE ABOVE 1 - 10 3.00 DESCRIDED RESIDENTIAL PROPERTY:. PERMITEE 10 - 50 5.00 $,IGNATURE cz 50 - 100 10.00 0 - _ DISTRICT NO:. OCE D BY W, 100 500 15,00 ` n' d SI GN',, GAS SIGN AND-ONE CItRCUIT 5.00 APPROVALS• DATE'. INSPECT 'S'SIGNATURE TUBE,.OR -. . MARQUEE. ADDITIONALCIRC UITS: . 1.00 TEMP.;POWER.POLE ISERVICENOTOVER 600-VOLTS.OR 200 AMP, •3.00 ` UNDERSLA.B WORK 'SERVICEOVER 600 VOLTS OR 200 AMP 10.60 ' ROUGH,CON DUIT - - TEMPSERVI-CE POLE, &APPURTENANCES - 5.00 WIRING � TEMP LIGHT,OR'.RECEPT. SYSTEM .3.00 ' FIXTURES - - ~l POWER AUTHOR].-ZED - •UTILI'TY Co.'NOTLFIED FINAL. - -PERMIT FEE - "(SUB TOTAL) - NOTES: PLA-N CHECK FEE. 1. PERMIT ISSUING-FfE .3.00TOTAL,F;EE n PLAN CHECK' VALIDATfON „r: ,Ci- `. nn:o:r`: A'H PE'RMIT"VALIDATION M.o. CAS SEE BACK OF APPLICATION FOR-COMPLETE.SCHEDUL£ - - WORKER'S COMPENSATION DECLARATION 9 DPW 9/89 76A663 APPLICATION FOR-ELECTRICAL PERMIT 76A66 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 PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sea-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 LOCALITY 1e— 4 Certified copy is filed with the county 1 &2-Family,Sq.Ft. $ $building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR SS SSOK - PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light�Sw. /O. FIRM NAME `z First 20 / -09 (This section need not be completed if the work involved by the MAILTotal No. Additional ADDRESS permit is for one hundred dollars($100)or less.) , No. Tel. .r C I certify that in the performance of the work for which this permit CITY X19 Ci 0,5 9�ca is issued, I shall not employ any person in any manner so as to PLAN CHECK'. become subject o the Workers`Compe/9�s��tion 4aws. Lighting Fixtures First 20 APPLICANT c ryV�� 2 ( Total No: Additional ADDRESSjrffj Dat / ��Applica tf 75 OR 20A,120V BRANCH CIRCUITS NOTI E.TO APPLICANT: If, after making this Certificate of CITY C�� TeLNo. el(gd Exemption,you should become,subject to the Workers' Compensation 1 TO 10 INCLUSIVE EACH PERMIT provisions of the Labor Code, you must forthwith comply with such 11`TO 40 INCLUSIVE EACH APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION - ADDRESS d I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH o (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. V Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR ClassQ Power Apparatus&Large Appliances REG.NUMBER . License Number Lic.Class. Size&Type HP,KW,KVA,Or KVAR DISTRICT NO. PROCESSED BY _Up to3Incl. �� G-�G ri�� UJ a Over 3 to 10 Incl. FINAL Contractor Date - DATE CD F-1 Over 10 to 50 Incl S7 I am exempt under Sec. Over 50 to 100 Incl. �G —� VALIDATION BY AL Over 100 B:&P.C.for this reason Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 -1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V 4 Exemption for Reg.Maint.Elect. -- `t1_'`- - s- SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION 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 �},L, Code): T 4MAL -� r 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). r;:,..::,-•— 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) j,;"cEs_wEJj4_i !ff'7 1 Civ. C.) Art PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize re esentatives of this County to enter upon the above-mentioned /pr p rt r i spec' poses. ///)% 7 SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE -- SIGNATURE OF APPLICANT OR AGENT DATE