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Home My Public Portal About5931 LOMA AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer ga DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. BROUP I ZONE PERMIT NO. 1 ELECTRICIAN — 80�4 RECEIVED BY READY FOR DATE IBBUED ADDRESS FIRST INSPECTION CITY77 ' TEL. NO. COUNTY LICENSE NO. EXPIRES SULOgNG D.RE199 PERMIT FEES FEE NUMBER EACH LOCALITY _LIGHT OUTLETS NEAREST — RECEPTACLES CROSS ST. WALL SWITCHES OWNER` TOTAL OUTLETS �. SC _$ MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 2S _CITY �� TEL. NO. FIXTURES 5 - - 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHTfCIRClJIT9 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 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEw MvO. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. I/2 6 LESS $ .25 SIGNATURE 13F I/2 2 .5G PERMITTE _ .— z 5 1.00 INSPECTION RECORD 5 15 1.50 15 50 2.50 _ s0 200 5.00 200 500 10.00 J 500 1 000 15.00 Q z OVER 1000 20.00 E% M.G. SET/FREQ. CHANGER-HP _ Q� WELDERS:AC-KVA - O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG•) MOVED MOTORS (75% OF ORIG.) MISC. SIGNS NO. NO.TRANS. • APPROVALS NO. NO. LAMPS _ DATE INSPECTOR'S NAME FOR EACH PERMIT: WIRING $1.00 D CONDUIT FIXTURES $1.00 WIRING SUPPLEMENTARY :50 FIXTURES POWER TOTAL FEE $ O� UTILITY CO.NOTIFIED - FINAL 76A663 DBS#SA 2-53 WORKERS'COMPENSATION DECLARATION CE-806 -806 1081 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES Tr BUILDING AND SAFETY or a cried cop thereof (Sec. 3800, Lab. C.) Policy No. �ompany FOR APPLICANT TO FILL IN _ JOB Certified co s hereby furnished: EACH NO. FEE ADDRESS PY Y New Residential Bldgs. & Pools .- 1 & 2-Family, S Ft. $ $ LOCALITY Certified''copy is filed with the county building inspec. Y. q — tion department. Multi-family Sq. Ft: NEAREST r ,ir —0ju—�� Residential Swimming'Pools OWNER OR %T Date Applicant FIRM NAME �-i0/L/•�1 Y CERTIFICATE OF'EXEMPTION FROM WORKERS' Outlets: Rec Light • Sw.— MAIL COMPENSATION INSURANCE ADDRESS / L Tis section neenot e completed if the work involved b First 20 ( hd be p Y Total No. Additional CITY ''� ��C T.I. No. the permit is for one hundred dollar's ($100)-or less.) I certifythat in the of the work for which this PLAN CHECK e performance APPLICANT permit is issued, I shall not employ'any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS TAdditional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE'TO APPLICANT: If, after making 'this Certificate of APPLICANT Exemption, you should become subject to the Workers' Range_ Heater_D.W: — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer W.M.— ADDRESS 9Z�� with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood' Fan _Other_ CITY �'�r 'Tel. No. j7-,'� ,_. LICENSED CONTRACTORS.DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter Disp. _ Room Air Cond. REG. NUMBER Class. C J0 (commencing with Section 7000)..of Division 3 of the Business DISTRICT NO. PROCE ED BY.,. and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances �' �/ d - -/_ � f 0 Size &Type HP, KW, KVA, or KV AR- ) d Q License Numb e !r Lic. Class C� Up to 1 Incl. FINAL u of / ��/ Over 1.to 10 Incl. DATE VALIDATION Contractor ` C:C `� &f / FINAL Over 10 to 50 Incl. I am exempt under Sec. Over 50 to 100 Inc. BY / LU B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC.& Ponelboards / ► pry/ 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V z 5 U �i7 A Exemption for Reg. Moint. Elect. SINGLE FAMILY # o o o o o '2 HOME OWNER-BUILDER DECLARATION Temp. Power Pole & Appurtenances Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits 2+° ° 2 5;5 0 Law for the following reason (Section 7031.5, Business and Professions Code):. .° o ° 2S.506 + ' - I, as owner of the property,'will do the work and the Misc. Conduits &Conductors �•9,2 1 8�7J structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ Pilo , 7044, Business 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE ` Lender's Name PERMIT ISSUING FEE D lender's Address 1 certify that l have read this application and state that the TOTAL FEE ___)_5 S� above information is correct. I agree to comply with all County �nceshancl State laws regulating Electrical wiring, and herorize representatives of this County to enter upon endo ed pr t r in tion purposes. se. __ SEE REVERSE FOR, EXPLANATORY LANGUAGE Signature of Perm bate