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Home My Public Portal About5761 LOMA AVE_Electrical__ 76AS63 DBS SA 8-49 ® APPLICATION FOR-PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF.LOS ANGELES ELECTRIC , WILLIAM J. FOX, CHIEF ENGINEER DISTRICT NO. GROUP ZONE PERMIT NO. FOR APP "CANT ILL IN S / / 7 fy ELECTRICI4 9 / RECEIVED BY READY FOR DATE ISSUED ADDRESS, FIRST INSPECTION CITY ® � 4 COUNTY LICENSE NO. EXPIRESBUILDING �I PERMIT FEES r ADDRESS .CJW n FEE NUMBER I OUTLETS EACH LOCALITY ' LIGHTS 5c I� NEAREST ' --If s RECEPTACLES 5 CROSS ST. FIXTURES 5 I OWNER 9, I v WALL SWITCHES 5 MAIL ELEC. RANGES 25 I ADDRESS r F � � ELEC. HEATERS 25 I CITY TEL. NO MISC. �� I HERE ACKNOW,^ DGE THAT 1 HAVE READ THIS NUMBER OF CIRCUITS INSTA ED: APPLICATION AND S E THAT THE ABOVE IS CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWER I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVD. HP OVER I INC. EACH I I OF THE RESIDENTI P PERTY;DESCRIB BOVE. '/z&LESS $ .25 _ 1/2 2 .50 SIGNATURE OF P 2 5 1.00 ERM ITTE 5 15 1.501 INSPECTION RECORD 15 50 2.50 50 200 5.00 200 500 10.00 J 500 1000 15.00 Q OVER 1000 I 20.00 Z M.G. SET/FREQ. CHANGER-HP ll: WELDERS: AC-KVA Q GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF ORIG.) I� MISC. SIGNS TYPE: NO. TRANS. TYPE: NO. LAMPS APPROVALS DATE INSPECTOR'S NAME FOR EACH PERMIT: CONDUIT WIRING $1.00 2-5 FIXTURES $1.00 WIRING SUPPLEMENTARY .50 FIXTURES ` POWER TOTAL FEE $ / 2 UTILITY CO. NOTIFIED ,/- FINAL - - I . ,� CE-806G iRKERS'COMPENSATION DECLARATION -663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby gffirm that I have a certificate of consent to self insure, CE or a Cfartificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is herebyfurnished. EACH NO. FEE ADDRESS A .� New Residential Bldgs.& Pools F-1ck $ _ $ LOCALITYDEVIL late- Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. Multi-famil S Ft. NEAREST department. y q CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CL+ C CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light — Sw. MAIL COMPENSATION INSURANCE ADDRESS This section need not be completed if the work involved First 20 ( b p Y the CITY L. Tel.No. permit is for one hundred dollars ($100)or less.) Total No. Additional PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT is issued, I shall not employ any person in any manner so as to become 1;bje c to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS efn� 5 �(„� Total No. CITY Tel.No. Date Applicant Additional Fixed Appliances Not.Over 1 HP NOTIC TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. ADDRESS �1 n provisions or this permit shall be deemed revoked. Top — FAU _ W.H. Y LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ CITY Tel.No. I herebyaffirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. — Room Air Cond. � (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Class. Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESS D-BY Power Apparatus& Large Appliances ..--• �(/ Size& Type HP,KW,KVA,or KVAR /�'1rX1 U License Number Lic.Class Up to 1 Inc]. FINAL / Over 1 to 10 Incl. DATE i0 Contractor Date FINAL- '� VALIDATION V ❑ Over 10 to 50 Incl. I am exempt under Sec. Over 50 to 100 Inc. / LLJ B.&P.C.for this reason Over 100 BY/ G i0. Services, Swbd.,MCC& Panelboards Z Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V SINGLE FAMILY Temp. Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 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 Circuits Cade): Misc.Conduits & Conductors I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) , •f and Professions Code). i CCT. CONSTRUCTION LENDING AGENCY 14.011 1 hereby affirm that there is a construction lending agency for the 3307 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) J ITEMS Civ. C.). PLAN CHECKING FEE TOTAL Lender's Name AO —14.00 PERMIT ISSUING FEE ) G CASH Lender's AddressCHANGE o 1= I certify that I have read this application and state that the above TOTAL FEE _ 0 •� - information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize j�{� representatives of this County to enter upon the above-mentioned {][tfifl-[RCICI i, �.2 � ro ert for inspection p rpo es. 3 8 o p p SEE REVERSE FOR EXPLANATORY LANGUAGE ('173 j, Ail �o2,._6 9 J �C� ig atuhe of Permitt e Date WORKERS'COMPENSATION DECLARATION 76-663 to/at APPLICATION FOR ELECTRICAL PERMIT I Ntereby affirm that I have a certificate of consent to self insure, CE-Bose or,a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ EACH NO. FEE ADDRESS ��- _ Certified copy is hereby furnished. New Residential Bldgs.&Pools � ❑ Certifie _d copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ $ LOCALITY department. Multi-family Sq.Ft. NEAREST CROSS ST. co Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' ` MAIL COMPENSATION INSURANCE Outlets: Light 7— 16 1 10 ADDRESS J (This section need not be completed if the work involved by the �/J� Firstt 2 20 permit is for one hundred dollars($100)or less.) Total No.S� Additional CITY Tel.No. PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT is issued, I shall not employ any person in any manner so as to become subj ct to he Workers'Comp ns tion Laws. Lighting Fixtures First 20 ADDRESS ujUey— •-+ S` • Additional Total No. CITY Tel.No. Date Applicant SA Fixed Appliances Not Over 1 HP PERMIT NOTICE vrdAPL CA T: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITYTel.No. (RLT LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm. that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. WESaA Size& Type HP,KW,KVA,or KVAR C Q License Number Lic.Class Up to 1 Incl. FINAL kU Over 1 to 10 Incl. �— DATE r VALIDATION 0 Contractor Date Over 10 to 50 Incl. FIN U ❑ I am exempt under Sec. Over 50 to 100 Inc. g W Over 100 CL B.&P.C.for this reason f/) 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 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law additional Sign Branch Circuits for the following reason(Section 7031.5, Business and Professions Code): ❑ Misc.Conduits& Conductors I,as owner of the property,will do the work and the structureijy is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ and Professions Code). ( 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) =)' m Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address '3 I: I certify that I have read this application and state that the above TOTAL FEE 0 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 a ove-mentioned Vproey for inspec i p pose . SEE REVERSE FOR EXPLANATORY LANGUAGE FTIdtlature of Permittee at r'` WORKERS'COMPENSATION DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-806G or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB , �,� F-1Certifiedcopy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS ❑ — $ LOCALITY 9!'�1 w Certified copy is filed with the county building inspection 1 & 2-Family, Sq.Ft. $ — :� 1 17sj department. Multi-family Sq.Ft. CROSS ST. t / NEAREST Date Applicant Residential Swimming Pools OWNER OR FIRM NAME •,� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. — MAIL 4 COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 Total No. Additional CITY � Tel No. permit is for one hundred dollars ($100)or less.) go I certify that in the performance of the work for which this permit PLAN APPLICANT CHECK is issued, I shall not employ any person in any manner so as to becomes s ubject to the Workers'Compen at' n Laws. SQ,Lighting Fixtures First 20 ADDRESS .e4-` VA)Q, _ Additional IF Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions df the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY V Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ OR I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE (commencing with Section 7000) of Division 3 of the Business and Cisp. — Room Air Cond. REG.NUMBER ER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESS BY 5 o � CL Size& Type HP, KW,KVA,or KVAR 0 License Number Lic.Class Up to 1 Incl. FINAL 0 Over 1 to 10 Incl. DATE VA TION Contractor Date Over 10 to 50 Incl. FIN V ❑ I am exempt under Sec. Over 50 to 100 Inc. gh I'll B.&P.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards , Z: Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V 2 El Exemption 1000 Amp.or Over 600 V b Exemption for Reg.Maint.Elect. RCCT.7 SINGLE FAMILY Temp.Power Pole& Appurtenances 33075.50 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law ITEMS for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): TOTAL 25- 50 Misc.Conduits & Conductors CASSH 25.50 {1�J I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business , CHANCE and Professions Code). CONSTRUCTION LENDING AGENCY 11/3-9 1 hereby affirm that there is a construction lending agency for the 01000—I�I�� f performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) 07151 1 AM11 :1 `�` Civ.C.). 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 representatives of this County to enter upon the above-mentioned property bpr i�nspectiol ur oses. J SEE REVERSE FOR EXPLANATORY LANGUAGE f Sig ature of Perm tee Date