HomeMy Public PortalAbout6034 LOMA AVE_Electrical__ 76AG63 DBS 5A iJso APPLICATION FOR PERMIT
DEPARTMENT.OF BUILDING AND'SAFETY 1
COUNTY OF LOS ANGELES CTR I C I
WILLIAM J. FOX-CHIEF. ENGINEER'
FOR APPLICANT TOFILL IN DISTRICT NO. GROUP ZONE. ' PERMIT NO:
ELECTRICIAN -41//
p._ _ R EIVED BY READY FOR DATE ISSUED
ADDR/ESS'a Yl I �� /+ �'•"'°r �-7 FIRST INSPECTION
CITY j'. q TEL. NO.f9O //vtf'-/ � / )--2--s
COUNTY LICENSE NO. /� 1-/ EXPIRES 3 (/��� BUILDING '
PERMIT FEES - ADDRESS 13 T -
c �C
. .FEE -./.fi!
' NUMBER EACH LOCALITY ..c.-
G f�
LIGHT OUTLETS ` NEAREST
/ ��� CROSS ST.,
RECEPTACLES
WALL SWITCHES OWNER
TOTAL OUTLETS _ 5`C s MAIL
ELEC. RANGES P5-! ADDRESS / p�-�(�•"" - `��
ELEC. HEATERS '25 CITY TEL. NO.
FIXTURES '- 'S' 1 HEREBY ACKNOWLEDGE' THAT 1 HAVE .READ THIS
MISC., I- APPLICATION AND STATE THAT THE ABOVE,.IS CORRECT
NUMBER OF LIGHT"CIRCUITS 4 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS - AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER - HORSEPOWER - ANGELES COUNTY LICENSE, OR i AM THE LEGAL OWNER
FEE OF THE RESIDE IAL DESCRIBED ABOVE.
NEW MVD. HP OVER_ I INC. EACH
1/a.&LESS $ .25 SIGNATURE OF
.1A 2 'S0 PERMITT% .!!!��' X✓lib. .. .
2 5 1.oo INSPECTION RECORD.
,. 5 •15 1.50 -
15 50 -2.50 -
50 200 5.00 - .
200 500 10.00 ,J
Soo 1000 15.00 - Z
OVER 1000 20.00 - (�
M. G. SET/FREQ. CHANGER-HP
WELDERS: AC-KVA - ' 0
GENERATORS-KW -
TRANSFORMERS-KVA
r
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: -
CONDUIT
WIRING $1.001, WIRING -
FIXTURES $1.00
SUPPLEMENTARY - :50 FIXTURES
r POWER. .
:TOTAL.FEE • - _ $ 5 UTILITY CO..NOTIFIED`
FINAL
7GA663 DBS.SA 11-50 APPLICATION FOR PERMIT -
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PE lm I $
WILLIAM J. FOX,' CHIEF ENGINEER
FORAPPLICANT TO FILL'IN DISTRICT NO. GROUP . ZONE PERMIT NO.
ELECTRICIAN
7 RECEIVED BY READY FOR DATE ISSUED
ADDRESS 3 - / - .FIRST INSPECTION
CIT ).q TEL. N0,8a Y �.,�►`N,A. i�� _�"�.` ...�
COUNTY LICENSE NO. EXPIRESh/ �� �~�' BUILDING [� '
PERMIT FEES
ADDRESS7
1
NUMBER EAC'HI
FEE LOCALITY.
LIGHT OUTLETS NEAREST
CROSS ST. V
RECEPTACLES
WALL SWITCHES /9 OWNER
TOTAL OUTLETS 5c $ 17 MAIL
ELEC. RANGES .25,E_ ADDRESS _
ELEC. HEATERS . 25 _
CITY_ TEL. NO.
FIXTURES S . -
IHEREBY 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 CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS - I CERTIFY THAT 1 POSSESS THE ABOVE VALID 'LOS
_ ANGELES COUNTY LICENSE, OR I.AM THE LEGAL OWNER
NUMBER HORSEPOWER FEE
NEW MVD. HP OVER INC.
EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
1/]&LESS $ .25 SIGNATURE OF
1/2 2 .50 PERMITTEE % -
fl V
2 s 1.00 (,INSPECTION RECORD
s 1s - 1.50 - - - - -
15 50 2.50
s0 200 5.00
200 Boo 10.00
Soo 1000 15.00 /r^ (�(/C 1 TC�JI,/ [ _ `Jfi �1 ?
•' OVER 1000 20.00 rA�/G—iiz /J X J rTHV b l a I �
M. G. SET/FREQ. CHANGER-HP _ / Q
WELDERS: AC-KVA - I (( !f' ,j�f
GENERATORS-KW . . I ��� O�' ��• All R/L'6�(�l.''
TRANSFORMERS-KVA
TEMP. MOTORS (75%OF ORIG.) 6 ( _ TICJ.A�Af� •
MOVED MOTORS (75%OF ORIG.) I ,
MISC. .
SIGNS
NO.. NO. TRANS.. I -
NO. APPROVAL
NO. LAMPS S
DATE INSPECTOR'S NAME
FOP.EACH PERMIT: I
CONDUIT V t n
J �.
WIRING $1.00 0 Q •((�7.�/�G
FIXTURES $1.00 �— WIRING C•
.SUPPLEMENTARY .50'. FIXTURES
POWER I ..
TOTAL FEE $13 UTILITY CO. NOTIFIED }.✓I re 1 1 L° e1
O FINAL
~PWORKERS'COMPENSATION DECLARATION 76-663 .10/81
CE-806G, APPLICATION FOR ELECTRICAL PERMIT
fflrri�hd[ I V'ave,a'certificate of"consent to self insure,
-", •,cer 1 icate 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.hereby,furnished New Residential Bldgs..& P . EACH Nor,- FEE TY
ADDRESS
'LOCALI /y v
Certified 'copy,Is filed;with the County building'inspection 1 & 2-Family,Sq..Ft. $ — $
.department ": Multi-family Sq.Ft." —
..
i CROSS ST
�Iiplicant Residential,Swimming Pools
OWNER.OR
FIRM.NAME
CERTIFICATEMAIL..
�CJ.
J
OF EXEMPTION FROM'WORKERS:• `Outlets:Rec—'Light Sw. �
MAIL
COMPENSATION INSURANCE, ` ADDRESS
�r ESS
(This section heed not be 'completed if the work-involved by the First 20 iY '
permit is for one hundred dollars($100);or less.)
Notal No. Additional /73
CITY Tel.No.
1•6
ertify that in the performance,of"the,work.for which this.permit PLAN-CHECK
is'fissued; I.shall not,'employ.any•person:in.•any,manner.so as to _ APPLICANT- :C j .4
become subject to;the Workers'Compensa' ..Laws., Lighting Fixtures, First 20 ADDRESS
;. Additional
Date ) Total No. CITY,Z -. Tel.No.
-Appli n Fixed Appliances Not Over 1 HP f G
NOTICE,-T AFRLICANT: I;• after ,making :this.;Certificate of PERMIT
.iExemption,you should.become.subject to,the.Workers'Compensation Range Heater_ 0.W. _ - APPLICANT C
::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. —
CITY Tel`'No.
LICENSED CONTRACTORS DECLARATION Hood Fan ._ Other
I.hereby, affirm Ghat.I am licensed,under,provisions of Chapter 9 Dis ` LICENSE OR
(commencing with Section 7000) of Division 3.of.the,Business and P' Room Air Cond, REG.'NUMBER' Class.
Professions Code;.and'my license is'in full force and effect. Apparatus& Large A liances DISTRICT NO. PROCESSED
Power A 9 pP _
Size &Type HP,KW,KVA,or,KVAR ' �.
L•icense`Number Lic.Class ' '
Up to 1 Incl.:' FINAL U
Over 1 to 10 Inc]. - Ix
DATE
Contractor Date Over 10 to 50 Incl. O
ALI TION
❑ _ FIN
U
I am exempt under Sec: = Over 50 to 100 Inc. ,. •_ W
BAP.C.for this reason Over 100
Services,Swbd.,MCC & Panelboards
Date: 0= 200-Amp:Under 600 V l �'� V Z
Signature. 201 = 1000 Amp.Unde�:600 V
❑" Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Tem •Power Pole & A g 1
• p. ppurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit #.0 0 0' 10-2
hereby affir that I am exempt from the Contractor's License Law
for the foll .ing reason(Section 7031.5, Business and Professions Additional-Sign Branch Circuits.
50
Code): o 5,Q'�
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) ® 0 al 4—88
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.n(Sec.3097; PERMIT FEE-
(Sub'-Total)
Civ. C.). „
PLAN CHECKING FEE
Lender's Name 1 6.3 A
aPERMIT ISSUING FEE
Lender's Address' # 0 0 0' o 0'2"
I certify that I have read this applicafion•and state that the above TOTAL FEE
information is correct. I agree to comply with all County'ordinances .,° 1 6.3 5 O `
and State laws. regulating Electrical wiring,'and hereby authorize
representatives of this County to enter.upon the above-mentioned ': °''1 6 3,`•5 0 30
property for.in ection purposes. `
SEE-REVERSE FOR EXPLANATORY LANGUAGE ' O ,1 4"'8 8
V.
�Si n u ".of Permittee Date