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HomeMy Public PortalAbout6019 LOMA AVE_Electrical__ 76A663 DBS SA 11-60 ` ' , - APPLICATION FOR •PERMIT DEPARTMENT. OF BUILDING AND' SAFETY COUNTY OF LOS ANGELES 11. TR WILLIAM J. FOX, CHIEF ENGINEER ELEC FOi�Rj APPLICANT TO FILLAN DISTRICT NO. _ GROUP I ZONE PERMIT NO. ELECTRICIAN / ra, ,.�, y ��•y�. RECEIVED BY 'READY FOR -•DATE ISSUED , A'DDRE,/SSS�� ,,y�Q�//p.,,}��{ i 2.j � .,d �.� fd'^'/,�pr��a��y.J�- � (/(}�/�/J� 1 FIRST INSPECTION 2 CITY�.ds Jrj4" /p��fA c'' TEL. NO:Idf�./- �`D99� �.•-`�"p"�`+. �'Ir J'_� �s COUNTY LICENSE NOT rt.. /. ih- EXPIRE BUILDING AE PERMIT FEES I u' - EE- NUMBER EACH F - O LCALITY �!✓ �5.._.i�} LIGHT OUTLETS GV - -NEAREST CROSS ST:,V�' _ RECEPTACLES WALL SWITCHES OWNER TOTAL OUTLETS.• Sc '$ 40 MAIL ' - ELEC.'RANGES ADDRESS� 25 - _ ELEC. HEATERS .25' - ��// �ry CITY TEL. NO. FIXTURES S'... .(� - I HEREBY; ACKNOWLEDGE THAT '1 HAVE READ THIS MISC: APPLICATION AND STATE ,THAT THE, ABOVE IS .CORRECT NUMBER OF .LIGHT`CIRCUITS AND. AGREE TO COMPLY_WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE-CIRCU ITS AND STATE LAWS,REGULATING ELECTRICAL WIRING. MOTORS'. 1• CERTIFY THAT 1 POSSESS THE ABOVE ;VALID LOS NUMBER HORSEPOWER 'ANGELES COUNTY'LICENSE,= OR�1 AM THE' LEGAL OWNER `NEW MVD. HP OVER INC. -- EACH' OF THE RESIDENTIAL PROPERTY "DESCRIBED ABOVE. . I� . 1/2 &.LESS $' '.25 :SIGNATURE OF - . ".50 +'PERIN 1/2 2 ITTE i . r 2 : 5 'i.00 INSPECTION RECORD` .5. 15 I '1.50 50 . 200 •5.00 200." 500 10.6,01.. 0Uy"L •;', �t-1/' t� J 500 1 000 15.00 �''!V�Y9F z .I OVER 1000 20.00 M. G. SET/FREQ. CHANGER-HP O WELDERS: AC-KVA GENERATORS TRANSFORMERS-KVA - TEMP. MOTORS (75%OF OR1G.) MOVED MOTORS (75.%OF ORIG.) MISC. SIGNS. I' ,NO. , NO. TRANS. ' APPROVAL'S. NO.-. NO. LAMPS - - DATE " I NSPECTOR'S.NAME FOR-EACH PERMIT: r WIRING $1:00 �' I( CONDUIT. j FIXTURES $1.00 i I �j(„ ,,! WIRING .L. SUPPLEMENTARY - •50 I FIXTURES POWER TOTAL FEE UTILITY CO. NOTIFIED ® .. I FINAL /� ✓Il'fL (UU =1'iGG DSS.S-A-6-46 - Mg s ICATIO\ FOR R Y E&LLM,.N. DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC WM..J. FOX,-CHIEF ENGINEER t NAME zjerlDISTRICT NO. GROUP ZONE PERMIT NO. rr ADDRESS .""p'•� liY l"!. "l�L ? r�� /El CJ��� / �" jj� RECEIVED BY READY FOR DATE ISSUED U CITY (_ ;1 STEL.NO.F,d�3 / CSG // FIRST INSPECTION t6 IJCOUNTY J CERT.NO. "„y EXPIRES- APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORD ADDRESS �X/S 14� i•"��/ NUMBER OF OUTLETS ON CIRCUITS LOCALITY _-= 'L2 £ � - - LOCATION BY ROOMS NEAREST - LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. � e�Cyy'lRCUly7 A/ B C D E / F G H I NAME Z MAIL ADDRESS CITY EL.NO. 1 AM THE LEGAL POSSESSOR.OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE. OF QUALIFICATION.. - K. ELECTRICIAN. I AM THE B•EGAL OWNER.OF THE PROPERTY DESCRIBED ABOVE OWNER. CORRECTIONS i T: Q j Z Lo f � O TOTAL NO. OF OUTLETS .` ' APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT n NO. OF SIGNS TRANS. $ WIRING l'1 L I&tW NO. OF RANGES,OR HEATERS $ FIXTURES MISCELLANEOUS _ $ C POWER PERMIT FEE $ pr .� UTILITY CO. ,17 TOTAL FEE ^`- C FINAL. 2L a'. B S-A 12-43 25M DIDEPAI$TDIENT ®I' BUILDING ANDSAFETYAPPLICATION FOR PERNU . "COUNTY OF LOS ANGELES 'ELECTRIC I WM. J. FOX CHIEF ENGINEER- zz NAME ► DISTRICT GROUP ZONE PERMIT/NO. U .P / �d � • ADDRESS,9�•7` {,/ T .. U CITY A ,+ TEL.NO. RECEIVED BY READY FOR DATE ISSUED W CERT.NO. oe ZZ EXPIRES � '�� ��r�� FIRST INSPECTION P/ j COUNTY APPLICANT FILL IN HEAVILY OUTLINED PORTION.ONLY JOB (DESCRIPTION OF WORK ADDRESS W46 A1 /7,d IM 14 NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST + ' !' LIGHT OUTLETS 1SW.1 PLUGS FizT CROSS ST. CIRCUIT A B C D E F G I H It: NAME W MAIL - - j3 ADDRESS p� O A_/ CITY TEL.NO. t AM THE LEGAL POSSES �SOR OF THE ABOVE'LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION.. fro1 13 . - � ELECTRIGAN. I AM THE LEGAL OWNER OFTHE PROPERTY DESCRIBED ABOVE OWNER. CORRECTIONS . J Q _Z D lY D TOT L NO. OF OUTLETS $ D APPROVALS NO. OF FIXTURES $ ® ' DATE INSPECTOR'S NAME ;Y NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS . TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES �p 1�•`� P MI CELLANEOUS $ POWER PERMIT FEE $ UTILITY CO.NOTIFIED `V�? T016L FEE 71 �/ �'� FINAL WORKERS' COMPENSATION DECLARATION 76-663 10ie1 APPLICATION FOR ELECTRICAL PERMIT I I hereby 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.) of y No. ' Company FOR APPLICANT TO FILL IN JOB j. 0 Certified ca is hereby furnished. EACH NO. FEE ADDRESS PY Y New Residential Bldgs. & Pools ❑ — $ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ LOCALITY department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant" Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light — Sw. '— MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars ($100)or less.) Total No. Additional CITY Tel.No. I certify that in the performance of the work for which this permit PLAN CHECK is issued, 1 shall not employ any person in any manner so as to _ PPLICANT become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: 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. No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY Tel. -'�.'}• I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. Room Air Cond. REG.NUMBER ,% Class. (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO f PROCESSED BY O Size & Type HP,KW,KVA,or KVAR i _ License Number Lic.Class W Up to 1 Incl. FINAL J Over 1 to 10 Incl. DATE VALIDATION Lt. Contractor Date Over 10 to 50 Incl. ❑ I am exempt under Sec. Over 50 to 100 Inc. FINAL BY � BAP.C. for this reason Over 100 0 Services, Swbd.,MCC& Panelboards , �- Date: 0- 200 Amp.Under 600 V LLJ 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 for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): ❑ 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). 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) iv. C.). PLAN CHECKING FEE ` :�, �t.+ ti rider's Name PERMIT ISSUING FEE er's Address _. tify that I have read this application and state that the above TOTAL FEE ation is correct. I agree to comply with all County ordinances tate laws regulating Electrical wiring, and hereby authorize entatives of this County to enter upon 4he above-mentioned tyfor inspection purposes. �,,, �• d ` 1 SEE REVERSE FOR EXPLANATORY LANGUAGE of Permittee Date y ^OR, COMPENSATION DECLARATION 76A663 1 0 /81 ®< •'� - .. CE-806G 0 �'APPLICATI®� PO LE:CTRICAL. PERMIT . or a certif tate of Workers' Compensation_f consent to self msure, COUNTY.OF LOS ANGELES BUILDING AND SAFETY- or affrm th. I have a certificate o Insurance, or.a certified'_. ' copy thereof.(Sec. 3800,Lab.C.) •» - -APPLICANT TO FILL' IN '- JOB' - Policy No.' Company OR a{(a F // / y� Certified,copy is hereby:furnished. New Residential'Bldgs.& Pools EACH . NO FEE ADDRESS:"'(Q. & 2-Family, Sq.Ft $ Certified copy Js flied with the county building inspection . Mulfi family Sq.Ft. NEOAREST $ C department.'•O ©� Q ., Residential Swimming Pools" ti q > OWNER OR Date Applicant `1µg �t iaac.`1 F1RM NAME. ©�(/i / e / G7� f CERTIFICATE-OF EXEMPTION FROM'WORKERS' . i' Outlets Ret Light JSw t� -'' ` s + MAIL � " COMPENSATION INSURANCE. " First m'. y.', qq ADD S317V'I /� 1 (This,section,need not becom Ieted If the viork involved.by;the.- CIT RE Te.No p Total No Additional .; 1J `/ perniitis.for one_hundredAollars ($100)or less:)' �' Itcertif that in the performance.of,the work which this, ermit.: APPLICPLAN HECt<`. / y P _' APPLICANT" ' is;issued`,.11 shall'not employ any person in,any mannerso as to :become s6blectA6,.the Workers Compensation.Laws. ;Lighting Fixtures First 20 ADDRESS .-r - Additional 7 �) jGJ� Total No. CITY Tel}lto. ' ( —GG —dL n yan,/� c/ Date �o' APPlicant�u•!�(.. - /�f/f3 / NOTICE •TOAPPLICANT: ,If,,,after ,making- this Certificate of Fixed Appliances Not•Over 1 HP PERMIT �' Exemption,you.should become subject to the Workers Compensation Range_ Heater 'D.W. APPUCANY provisions of the;Labor'Code;you must forthwith comply with such 'Oven Dryer W.M. t 'ADDRESS provisions,or this permit.shall be deemed revoked. Top _`FAU :_-W.H. LICENSED CONTRACTORS•DECLARATION Hood Fan Other_ CITY V -Tel.No. N R I:herebyc affirm that I am licensed.under provisions,of;:Chapter g. Dis Room AirCond. x LICENSE O Class. (commencing with Sect ion.•7000) of Division 3 of,the Business and P REG.NUMBER .Professions Code,and m license is i'uil force and effeot. DISTRICT NO. PROCESSED BY ' y Power Apparatus&,Large.Appliances Size&Type HP,KW;KVA,or.KVAR L V' License Number` Lic..Class Up,to 1 Incl. •FINAL.,.. Over, 1 to 10 Incl.`' '✓ 0 ., DATE V L1DATION. Contractor Date ' ' Over 10'to 50 Incl. FIN V 0 I am exempt under Sec:. Over 50 to 100 Inc BY AL LLI 17.. B:&P C for this reason Over 100' N Services,Swbd,MCC&.Panelboards _ ` Dater �, 0- 200 Amp.Under 600 V- , Signature 201 - 1000 Amp.Under'600 V Over 1000 Amp.or Over 600 V' .i Exemption for Reg.'Maint Elect. 8 2 4:A .- . SINGLE FAMILY`` !.� Temp.Power Pole& Appurtenances # F HOME OWNER'BUIL•DER DECLARATION Sign with One Branch Circuit e I hereby.affirm that I am exempt from the,Contractors;License,:Law. O: 'for the following reason(Section 7031:5 Business and Professions Additional Sign Branch Circuits J to,o 4 7_0 `Code): Y,: o 0.(0[4 ].D c=i 'Mist.Conduit`s& ConductoPs L1CJ I,as owner of'the property will do the work and the structure, 8,�, isnot intended or offered for sale-(Section 7044, Business to F c �.,a2 Other(See Complete Fee Schedule) and Profe"ssions Code), _ CONSTRUCTION LENDING AGENCY I hereby 'affirm'that.there,is a construction lending agency,for'the e performance of the work for-which.this permit is issued(Sec.3097, PERMIT`FEE (Sub-Total) Civ. C.).. PLAN CHECKING FEE.. Lenders Name -PERMIT ISSUING FEE AMU Lender's Address', y I certify that'd have read this',application and state that,the above .. ,TOTAL FEE` 'i '• information is correct.1'6gree to comply with all County ordinances'' and State laws.reg'ulating'Electrical wiring',:and hereby authorize representatives`of this County to enter, upon'the'above-mentioned property'for'inspectio urposeS. SEE REVERSE FOR EXPLANATORY;LANGUAGE • ,S gnture Of-: ermittee : .Date , -