HomeMy Public PortalAbout6237 LOMA AVE_Electrical__ 76A663 DSSSA 11-SM APPLICATION FOR PERMIT
DEPARTMENT OF B=DING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPL-ICANT TO FILL IN ! DISTRIC O. GROPERMIT NO.
UP ZONE
ELECTRICIAN n e� / %-j. . n. ��r.� r RECEIVED BY READY FOR DATE ISSUED
ADDRESS ,lye, Ppp' �.7f / FIRST INSPECTION
CITY Kms, pp p. TEL NO.
COUNTY LICENSE /! BUILDING
O.NQ EXPIRES ADDRESS C/ / �� _Or-PIl✓�id.�_/3._
PERMIT FEES • p�
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROBB ST. � -
WALL SWITCFiE9
- OWNER
TOTAL OUTLETS Y SC s MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 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 CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT I 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.
LE9H $ .25 SIGNATURE EOF
F f� ,a ,p 7
2 .50 PERMITTEE.�`'.1� 4 �"�' '�� � ^��"e p�£�
z 5 1.00 INSPECTION RECORD
5 is 1.50
Y
15 50 2.50
s0 200 5.00
200 500 10.130 J
500 1 ODO 15.00 Z
f OVER 1000 20.00 2
M.G. BET/FRED. CH NGER-HP Ir
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% or onto.)
MOVED MOTORS (7S% or oRIeJ
MISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 7/ CONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE UTILITY Co.NOTIFIED a Al R« !VO Z5�It ��'a L-!3
FINAL V I I m-"'
WORKERS'COMPENSATION DECLARATION 76A663 10/81 //�� nj�nno n (�� 2n 2 00 (�/�
�!I hereby affirm that I have o certificate of consent to self CE-806G !�'illl–l�L��CQ��OUCI FOR EL EC tl UCAL; PLSII�IIC/ T
_.insur�, or,a�certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certlfiied cppy thereof (Sec 3800, Lab C )
Policy No T!Company FOR APPLICANT TO FILL IN JOB w '
Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE
ADDRESS bat /V, Ld
S —
Certified copy is filed with the county building inspec- 1 & 2-Family, q Ft $ $ LOCALITY
tion deportment Multi-family Sq Ft — NEAREST
Residential Swimming Pools CROSS ST
Date Applicant OWNER OR
CERTIFICATE OF EXEMPTION FROM WORKERS' FFIIRAM NAME E
COMPENSATION INSURANCE Outlets Rec1�L�ght Sw ADDRESS
20
This section need not be completedFirst
( ti
if the work involved b y Total No�5 Additional - CITY Tel No
the permit is for one hundred dollars ($100)or less.)
I certify that in the performance of the work for which this PLAN CHECK
APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'C pe ation Laws Lighting Fixtures First 20 ADDRESS
0001, Total No 5 Additional CITY l L
Date Applicont C� Tel No
xe Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, offer 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 I W M — ADDRESS
with comply with such provisions or this permit shall be Top _ FAU I WH —
deemed revoked CITY Tel No
LICENSED CONTRACTORS DECLARATION Hood _ Fan I Other_ J�
Disp _ Room Air Cond ,_ (J LICENSE OR Class
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PRO S D BY }
and Professions Code,and my license is in full force and effect Power Apparatus 8 Large Appliances �r ��/ O-
Size & Type HP, KW, KVA, or KVAR l UX U
License Number Lic Class Up to 1 Incl FINAL O
Over 1 to 10 Incl
DATE VALI TION
Contractor Date Over 10 to 50 Incl W
FINAL
I am exempt under Sec Over 50 to 100 Inc BY a
B &P C for this reason Over 100 N
Date Services, Swbd , MCC& Panelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V ;2 6 5 a 5 A
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maint Elect # o a o 0 0 2
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 Additional Sign Branch Circuits o o b Q 7 5
Low for the following reason (Section 7031 5, Business and
Professions Code) o o o 6 Q7 50'
9—I, as owner of the property, will do the work and the Misc Conduits&Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D 2,26-87
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) Q
(Sec 3097, Civ C )
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE U
Lender's Address LA
I certify that I have read this application and state that the TOTAL FEE b 21
above information is correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby aut orize representatives of this County to enter upon
the abov me oned pro er for nspection purpos—IF/
s p 7 SEE REVERSE FOR EXPLANATORY LANGUAGE
O/
Signature of mittee Date