HomeMy Public PortalAbout5742 LOMA AVE_Electrical__ �.�DIBS 12-44 - APPLICATION FOR PERNU
ART11IEld'I' OF BUILDING AND SAFETY
COIJIliTY OF LOS ANGELES � �i�� I`� :z��,OMD
W . J. FOX CHIEF ENGINEER
/ '�• ' DISTRICT NO. GROUP ZONE PERMIT NO.
Q NAME f �� /' (,�, / Gf
U—a, ADDRESS".. ` - %:. �iGf //�`% �% lX�G.�°C. 45
/I^ / e !
W CITY 7 / TEL.NO. Y ' r f/ S RECEIVED BY READY FOR DATE ISSUED
j FIRST INSPECTION
.1 COUNTY �" ' � ,f�r/6
W CERT.NO. I��,F� �`� EXPIRES''
1--
Fl
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
(DESCRIPTION OF WORD ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY z_ /,�
LOCATION BY ROOMSNEAREST _7
OUTLETS- lsw. PLUGS F!
?XT CROSS ST_ 'ter "`% ��✓�" f�J"�'
CIRCUIT A B C' D E F G 10 R NAME
Z
/ MAIL
• /•,d ^� 3 ADDRESS 1'-- :a"!;—;z YL�d
O
CITY
r• 1 AM THE L AL POSSE4dSORTHE ABOVE LOS
ANGELES COUNTY CERTIF14;6TE O QUAL! T N..
7" 4
ELECTRICIAN.
I AM THE I EGAL OWNER OF,THE PROPERTY DESCRIBED
l ABOVE
OWNER.
CORRECTIONS
(?
w
IL
F
Q
U_
J
a
' o
TOTAL
No. of ounErs
$ / S APPROVALS
NO. OF FIXTURES $ X� 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 "51/ $ •�t ' UTILITYCO.NOTIFIED 3
TOTAL FEE J FINAL
COUNTY OF LOS ANGELES - APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER
DIVISION OF BUILDING & SAFETY ELECTRIC I
WILLIAM J. FOX, COUNTY ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN ® F � �E�I t S -%o 4-C�J
ADDRESS " RECEIVED BY READY FOR DATE ISSUED
_ FIRST INSPECTION `�
CITY e TEL°. :NO. 7 1 Z �' l-S
COUNTY LICENSE NO. EXPIRESMI 'BUILDINCiJ �p
PERT FEES ADDRESS O 4 v
NUMBER EACH FEE
LOCALITY
LIGHT.OUTLETS NEAREST
RECEPTACLES .
WALL SWITCHES
OWNER
TOTAL'OUTLETS 5c $
MAIL
ELEC. RANGES 1 25 Z. . ADDRESS -
ELEC. HEATERS 25 .
FIXTURES 5 CITY TEL. NO.
MISC. - I HEREBY 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 CIRCUITSAND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I 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 AS VE. U
I/2 6 LESS $ .25
SIGNATURE OF �p
I/2 2 .50 PERMITTEE 1 1 ®fA
2 5 1. 0
5 15 1.550 - INSPECTION RECORD
15 50 2:50 M
50 200 5.00
200 500 10.00 J
500 1000 15.00 Q
Z
OVER1000 20.00 .
M.G. SET/FREQ. CHANGER-HP
WELDERS: AC-KVA - Q
GENERATORS -KW
TRANSFORMERS-KVA
TEMP: MOTORS (75%OF ORIG.) -
MOVED MOTORS 5% OF ORIG.) _
MISC. 4—/,.L
SIGNS fcT
NO. ., NO. TRANS. APPROVALS
NO. NO:LAMPS
FOR EACH PERMIT: , ' - - DATE INSPECTOR'S NAME
WIRING $1..00_ lJ CONDUIT '
FIXTURES' $1:00 WIRING
SUPPLEMENTARY .50 FIXTURES
_ POWER p
TOTAL FEE $ ?, _ UTILITY CO. NOTIFIED
FINAL
76A 663 DBS# SA. 4-82 - "
"`+WORKERS'COMPENSATION DECLARATION 76A,663 10/81
CE-806G APPLICATION P�i.RItl..11T .
'1 hereby affirm that'I have•a certificate of consent to self insure,
or a certificate of Workers' Compensation Insurance, or a certified " : SAFETY*
copy thereof(Sec.3800,Lab. C.) C"OUNTY OF LOS ANGELES BUILDING AND
Policy No.:. Company'
_ ��� FOR APPLICANT TO'FILL IN JOB
Cer,tified.co is herep furnished.
EACH NO. FEE.
'
,• ADDRESS � _
❑. PY. Y' s New Residential Bldgs.-9Pools
CA ,
Ge'rtified copy is filed'with the.county building inspection i'& 2-Family SgsFt
,_ NEAREST, a^CROSS St. d ,
department' ='+ Multi-family Sq.Ft, V
Residential'Swimming Pools
•Date Applicant - - ,- OWNER OR: J
j o
.. - - w a - �a' FIRM NAME _ '/,CO� �i
CERTIFICATE-,.OF EXEMPTION.FROMeN10RKERS'' MAIL
Outlets Rec, Light Sw.
04 COMPENSATION INSURANCE <. ADDRESS Z '
This section rieed',not be,-com'lete'd if•the.work involved b the " g � First;20
( P Y ® CITY, Tel.No:.
r less.): Total No.57�` Additional `
IPcePLAN CHECK
rtrf 'thatr.in the Uerformance of,the,, for.which this permit APPLICANT.
y' P
is:issued„I shallSnot,employ,_any.persontin"a6y manner,;so as to-
become subjert loans Workers'Compensation'Laws. "Lighting Fixtures First 20 ADDRESS {�
c Additional
Total No, CITY ;T I'No.
DNOTIC Applicant Y
E ,TO APPLICANT:,.If;,after s making .this-'Certificate-'.of',
Fixed Appliances Not Over 1 HP PERMIT
PCA Y
Ezemption,,you should become suplect to-the Mrkers'Compensation, Range_ Heater_ D.W _
';provisibns-of'Uie`Labor:Gode`youmust,;forthwith comply with such . Oven ._'Dryer--_ W.M ADDRESS
provisions or this'--permitshall be deemed•,revoked, ,Top FAU.,--- : W.H - -. .
t` LICENSED CONTRACTORS DECLARATION. oil i_' F Tel No
Ho an, Other_ r-
I„herebys affirm that 1'am licensed funder provisions,of Chapter 9 Dis . ”—. Room-Air-Cond. 'Class
CITY
(commencing with;Section 7000) of Division 3 of-the Business and P „
LICENSE
Professions Code,land my'license is in full force and effect. er u s
dPow Apparatus&Large Appliance ,.�^•
REG NUMBER
Size & Type HP;KW,KVA;or,KVAR
DISTRICT .� P OC SED BY
License Number' Llc Class Up to 1 Incl, FINAL
z Over-1 to 10 Incl
_ DATE /� /d _VALIDATION. .; ,IlkContracto
- r ate. D
Over 10 to 50 Inc]. FINAL
U
I.am:exempt Under Sec, ^. Over50to 100 Inc. BY � i�� - LIJ,
Over'100 (L
BAP.0 for this reason to
& Panelboa _ ..
Services Swbd. K/ICC rias Z
Date;_ 0- 200 Amp.Under 600 V
Signature'` 201 - 1000 Amp.Under 600 V,
_ Over 1000 Amp:or Over 600 V
❑. Exemption for Reg.Maint.Elect:' •'
SINGLE FAMILY Temp.Power P
" •. ,� :, ole& Appurtenances
"HOME OWNER-BUILDER DECLARATION Sign With.One'Branch Circuit
;I hereby affirm that 1.6m exempt from the Contractor's License Law f�s,.•Ca
for the following reason(Section'7031.5, Business and Professions Additional Sign Branch Circuits ('
- Code): * � •
MS
I,as owner of the'property,will.do the work.
TOTAL the structure
d
Mthc. on
uits& Conductors
p y,' cture
Other See.Complete Fee Schedule) :
" a��
s not intended,or,-offered for sale (Section 7044, Business' �I s H�
and.
Professions Code):
CHECK
28,00 .
CONSTRUCTION LENDING AGENCY
I;hereby affirm
that,there,�is a construction lending agency for the CHAKE
per
of the,;wbrk for which this permit'is issued:(Sec.3097, PERIv11T FEE (Sub Total)
,Civ.C.).
,PLAN CHECKING'FEE• Inil3 :61C°1 .� IsY
Lende'r's Name ', c i80-55.
PERMIT dSSUING"FEE "t, .19 .5 I Ari
Lerlder,s Address
TOTAL FEE
;I;oertify that I have'read'this application and,state that-the,above � •";--� .- ., -,
r .
information is_correct.I agree to,,comply withialI`County ordinances
W
and. State laws regulating.Electrical wirrng,•:and 'hereby authorize -.
representatives of,this County to enter upon the above--mentioned '
property'for Jhspection purpo s.
SEE REV ERSE.FOR.EXP.LANATORY LANGUAGE -
r�
- a� ' ° .
gna re of`Perm tee ,,. . - -.• afe ,