HomeMy Public PortalAbout6153 LOMA AVE_Electrical__ .L ai.•
WORKERS',COMPEI SATION`DECLARATION CE-663 D 81 APPLICATION FOR ELECTRICAL PERMIT
hereby ism that I have a .certificate of consent to self insure, CE-Bose
o(.a•certificate•Df Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy'there,G4(Sec.3800,L ab-C.)
"Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified Dopy is hereby furnished. New Residential Bldgs. & Pools
EACH NO. FEE ADDRESS
Certified copy is •filed with the county building inspection 1 & 2-Family,Sq.Ft. $. $ LOCALITY
department.' Multi-family Sq.Ft. — NEAREST
CROSS ST. Lc mvk_
Date Applicant Residential.Swimming Pools OWNER OR
• �� � FIRM NAME S
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL,
Outlets:Rec— Light Sw:— .� �" '
COMPENSATION INSURANCE ADDRESS 40 yv,
(This section need not be completed.if the work involved by the First 20
Total No
permit is for one hundred-dollars($100)or less.) .�p Additional d CITY re,txE �t Tel.No ��
PLAN CHECK
1,certify that in the performance of the work for which this-permit
APPLICANT
is issued, I shall notemploy any person-in any manner so,as J .
become subject to the Workers' perlsation L s Lighting Fixtures First.20 g ADDRESS
TTa�i Additional
� �. Total No. �w - CITY Tel.No.
Date Applica 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
62
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.
LICENSED CONTRACTORS DECLARATION Hood — Fan Other_
/ CITY Tel.No.
I hereby affirm that I am licensed under provisions of Chapter'9
Disp. — Room Air Cond. 3' LICENSE OR 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. DISTRICT NO. PROCESSED BY
Power Apparatus& Large Appliances /i
Size & Type HP,KW,KVA,or KVAR O�U[ 0
License Number Lic.Class Up to 1 Incl. L ° FINAL U
Over 1 to.10 Incl. o DATE 3 D VALIDATION M
Contractor Date
Over 10 to 50 Incl. V
FINAL
❑'
am exempt under Sec. Over 50 to 100 Inc. BY W
Over 100 0••'
B.&P.C. for this reason [n
Services,Swbd.,MCC&Panelboards ► 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 Pole.& Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law PfPio Y44T.
for the following reason (Section 7031.5,Business and Professions Additional Sign Branch Circuits 7t� t
Code): r 38050
I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors 1 ITEt�.S
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) �IGIh7 gg
and Professions Code). , TOTAL 3O.��p50
CONSTRUCTION LENDING AGENCY CKCK 38.50
1 hereby affirm that there is a construction lending agency for the •
lily
.. ...... ..._
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.). p
PLAN CHECKING FEE + 6/148p
Lender's Name
PERMIT ISSUING-FEE } O L� e
Lender's Address -� 3963 1 Am7��5
I certify that 1 have read this application and state that the above .TOTAL FEE �w
information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representativ s of this Count to enter,upon the above-mentioned
property f spection p oses.
Q� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Vemittee' Date
76A663 DBS 5A 11-49 '- APPLICATION FOR PERMIT
DEPARTMENT
-
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC
�����'
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN A DISTRICT NO. GROUP _ZONE PERMIT NO.
36
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDRESS ZZ- r FIRST INSPECTION
v
CITY //yy TEL.NO. 67t'j�� A/S A
COUNTY LICENSE NO. —cD EXPIRES BUILDING //J/IJ
—[ (S
PERMIT FEES ADDRESS
NUMBER OUTLETS EACH FEE LOCALITY
LIGHT Sc $ NEAREST
CROSS ST.
RECEPTACLES 5
FIXTURES 5 OWNER
WALL SWITCHES 5 MAIL
ELEC. RANGER 25 Z. ADDRESS
� ,
ELEC. HEATERS 25 CITY TEL. NO.
MISC. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER OF CIRCUITS INSTALLED:
TOTAI APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING.
NUMBER HORSEPOWER +FEE I CERTIFY THAT i POSSESS THE ABOVE VALID LOS
NEW MvD. -HP OVER INC- EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED
ABOVE.
1/ 2 .513 SIGNATURE OF
2 5 1.00 PERMITTEE
5 is 1.50 INSPECTION RECORD
is 50 2.50
513 200 5.00
200 500 10.130
500, 1000 15.00 Q
OVER 1000 20.00 - Z
M.G. SET/FREQ. CHANGER-HP C9
WELDERS:AC-KVA
O
GENERATORS - KW
TRANSFORMERS - KVA '
TEMP. MOTORS (75% OF DRIG.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
TYPE: NO.TRANS.
TYPE: NO. LAMPS APPROVALS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1,00 (� 0 CONDUIT
FIXTU RE9 $1.00 WIRING A
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE 1 UTILITY CO. NOTIFIEDI 1A
751 FINAL / � / V
oes SA zsnl sEre 2-47 .. "PLICA ION FOR PERHM'
DEPAR E `. �U�.Dfl'i �� SAFETY v
COU Og' LOS GIANANGELES
wM. J. FOX-CHIEF ENGINEER � ��^'
a NAME DISTRICT NO. G_ROUP"ZONE PERMIT NO.
ADDRESS
uUl CITY TEL.NO. RECEIVEDY
J-, COINF.Y. FIRST INSPECTION
B READY FOR FDATE+ISSU D
G/� F N
W
CERT.NO. EXPIRES"'
APPLICANT FILL W HEAVELY OUTLINED POI ON OI�tI.�' s�
DESCRWTION OF-=WOE A DRES -
_ F _
NUMBER OF OUTLETS-ON CIR♦r'ITS - LOCALITY
' LOCATION BY ROOMS 14EAREST D i ff
LIGHT OUTLETS SW:� PLUGS FniT CROSS ST. i -
CIRCUIT A C3 C D I F• G H NAME
Z MAIL
ADDRESS " ?
O '
CITY r TEL.NO.
1 ;AM THE L AL PO ESSOR OF THE ABOVE.=LOS
ANGELES COUNTY. CERTIFICATE OF_QUALIFICATION..'.
" ELECTRICIAN. -
I.AM THE"GAL OWNER OF THE PROPERTY DES-CRiDED
F ABOVE . `
C]
IL
:.Q.
t.
TOTAL.
No. of OUTLETS $ APPRO"LS.
NO. OF FIXTURES" $ DATE INSPECTOR'S NAME
5 :NO. OF MOTORS H.P. _ $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER _
PERMIT FEE $ : UTiLITYCO-NOTIFIED
TOTAL FEE - FINAL '