HomeMy Public PortalAbout8750 LONGDEN AVE_Electrical__ I}EPARTtifEiv'T. OF BUILDING AND SAFETY APPLICATION FOR r ERMIT,
COUNTY.OF LOS ANGELES � g� �' .
:WITH, J. FOX. CHIEF [NGIN[SR '
NATURE OF INSTALLATION DISTR`'.`!;T-NO. lQRO.UP ZONE ' PERMIT NO,' ;±
WIRIHn _moi Ft%7UR[1 SERVICE .✓ .. �6aj;k
R[CEI D ; I
Y READY FOR PATtSUED' a
RANGE HEATER POWER FIFtVT 1 46PECTION
SfAN• MIlC[LIAN[OUt ..y
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
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�( NAM[ ADOR ElS 7D Crrr4
ll ADDR[7S.�K4 • '�. ►...�/1�' LOCALITY
CITY TEL,NO.I- G���lQ� CROSS tT, P ,x.
d COU
:ERT.NO,t EXPIR[t ��"`:j� NASI
DESCRIPTION OF WORK 3
MAIL � _---
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_LOCATION &YROOM6I CIYY T[L.NO.
LIGHT OUTLETS -IOW.I PLUG• Ifln I AM THE LEGAL POSGESSOR„OF THE ABOVE LOS'
CIRCUIT ACD E I F G I H ANGELES COUNTY C[RTIFICArg / QUALIf TION
LIVING ROOM -� 1 / fa{ ELECTRICIAN. r
-I�-/� I AM THE LIIGAL OWNER or THE PROPERTY DESCRIBED S
Df VINO ROOM 1 I I 1 I / -� L ABOVK
RRFST.RM. �I
BATH
CORRECTIONS
ENT.HALL
i
HALL NO. IL n•
FRONT PORCH
OUTSIO[
SERV.PCH. J.
QDRM.NO, I Z..
CLOSET
TOTAL
// APPROVALS
No. or OUTLETS �b � i `�Q
NO. OF FIXTURES t� f I � DATE INGprCTOR`•
NO. OF MOTORS H.P. ! CONDUIT i
iu
H:. OF C(GNC TRANS. !{ WIRING
_`-
NO.-OK-P,.AAW" OR HVATUs S I FIXTVRE9 _ .#
MIEC[.LLANEOUS` POWER - "• -.
PZRMIT F[;. f % jvr UTILITY CO.NOTIFIED -
Z
`fOTAL.FrX .. .� fINAL'•. .. v` _.Y(J moi.. -
t: , r ` ► .�., `' - a .*+qty y
WORKERS'COMPENSATIONDECLARATION
CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
CE-806
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES ' BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or Ii
a certified copy thereof(Sec. 3800,�Lab. C.
,r �- FOR APPLICANT TO FILL IN JOB
VoliCy No. Compan ADDRESS a19
New Residential Bldgs.&Pools EACH NO. FEE
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. NEAREST 0 y
Certified copy is filed with the county building inspe 'on RCROSS ST M_A ted
department.
esSwimming Pools OWNER OR (1 11
�^77 n/1 FIRM NAME
DateS_:7`- Applicant Outlets: Rec.,,LLight a S.. 2- /LO MAIL
First
First 20 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. Z
��
`L- .S >_
COMPENSATION INSURANCE PLAN CHECK 0-
APPLICANT
APPLICANT O
(This section need not be completed if the work involved U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Additional M
Total Noy O
I certify that in the performance of the work for which this ` CITY Tel No. ♦-
Fixed Appliances Not Over 1 HP
permit is issued, I shall not employ any person in any manner PERMIT U
� LL
so. as to become subject to the Workers' Compensati9a-I^te�s. Range_ Heater_D.W. APPLICANT po �r/ r a
Oven _ Dryer_W.M. ADDRESS
�Date �2 p0ll'-' Applicant �� -" `�"'" Top — FAU _W.H.._
Hood Fan _Other_ CITY CTel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond._ LICENSE OR �� C_C 0
Exemption, you should become* subject to the Workers' REG. NUMBER Class
Compensation,provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT,NO. PROCES ED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW, KVA,or KVAR t,<- �
Up to 1 .Incl
FINAL
Over 1 to 10 Incl. DATE 9 AYC_�
VALIDATION
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. ! ,
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force and
effect. ��//'���� Services
-71
License Number Iv`>" Class LV 0-200 Amp. Under 600 V / 36
f�) _ 201-1000 Amp. Under 600 V
ContractorQ21 ate Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors
❑ I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— f 3 97.0 A
structure is not intended or offered for sale (Section
7044, Business and Professions Code). # o`0 0 0 0 2
CONSTRUCTION LENDING AGENCY .
I hereby affirm that there is a construction lending agency 2 ° o 7.5 0
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec. 3097,Civ.C.). _
Lender's Name ° o'O 1 7.5 0 c)
PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE J" 0 5' 1 2-82
I certify that I have read.this application and state that the TOTAL FEE
above information is correct.I agree to comply with all County /�� O
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
tve-mentioned propert ort ection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date