HomeMy Public PortalAbout9509-9513 LONGDEN AVE_Electrical__ D.S.S.SA asM sEre I13-47 " APPLICATION FOR PER 91'
DEPARTMENT OF BUILD O AND '`���IC
COUNTY OF LOS ANGELES. '
WW. J. FOX CHIEF ENGINEER. Ei,E�✓ ��
Z DISTRICT NO. GROUP I -ZOf$E PERMIT P10.
NAME
U ADDRESS `j Y.V1
CITY TEL.NO. " Z 1 7/ � r
6 6$ RECEIVED READYISSUE
FOR DATE D,
d
FIRST INSPECTION
COUNTY. � d
CERT.NO. �.. EXPIRES r ���
��APPLICANT FILL IN HEAVILY OUTLIIIOiEID PORTION ONLY
DESCiRI aaON OF WORK ADDRESS 0.5' Cn
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHY OUTLETS SW, PLUGS m CROSS ST.
CIRCUIT A B C ® E F Jr. I H 0: NAMS MAIL
L!r
ADDRESS \
O
CIT1f TEL.NO.
9 1 AM THE LEGAL P SESSOR OF THE ABOVE LOS
ANGFLE3 COUNTY GEf: -Q{OFILq ALIFICATION..
ELECTRICIAN.
I AM TM LWUIL OWNER OF THE FROPFtirZTY DESCRIBED
ABOV+3
OWNER.
R ��vvpp�� }�QQ
CO7p�cgJLON-9
0
TOTAL / �y
NO. OF OUTLETS l - 1 Vi APPROVALS
NO. OF FIXTURES E DATE INSPECTOR'S NAME
NO. OF MOTORS M.P.. $. CONDUIT
NO. OFSIGNS TRANS. WIRING
NO. OF RANGES OR HEATERS $ FIXTURES _
MISCELLANEOUS $ POWER
PERMIT FEE 10 ��' UTILITYCO.NOTIFIED
WWAL WWR O FINAL
TION
�I ffirm that
COM/ENSATIONitate f corse CE-806 'IU/9.1 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have•.a certificate of consent to self CE-9066
insure, or a.certificate of Workers'.Compensation Insurance, COUNTY OF LOS ANGELES Tt ftp`a Ci SUILDING AND SAFETY
or a certified copy thereof(Sec.-3800, Lab. C.) ice' I
Policy No, 550115-86ompanya FOR APPLICANT TO FILL IN JOB
13 Certified co is hereby furnished. EACH NO. FEE ADDRESS 9509 & 9513
PY Y New Residential Bldgs. $.p�ols 4
® 1 8 2-Tamil S Ft. U $ — LOCALITY
Certified copy is filed with the county building irispec- Y. q•
tion department. Multi-family Sq. Ft. — NEAREST
��//��-� T,�Y
CROSS ST.
Date 1L/�/85 -Applicant—aTe7Tyr S Ij.1.Rclxic Residential Swimming Pools OWNER OR
FIRM NAME Jwk
CERTIFICATE OF EXEMPTION FROM WORKERS' j Outlets: Rec Light Sw�_ MAIL
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work involved by Total No. CITY Tel. No.
the permit is for one hundred dollars($100)or less.),- Additional 1e Ci
I certify that in the performance of the work for which this PLAN CCANT
permit is issued, I shall not employ any person in an manner
so as to 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 APPLICANT) rS Electric
Exemption, you should become subject to the Workers' Range_.Heater—D.W. _
Compensation provisions of the Labor Code, you must forth- Oven _Dryer —W.M.— ADDRESS 3876 Downing' Ida
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. CIT Tel. IVo.
Hood _ Fan _Other_ Y$11C1�11 Park CA. 338-2558
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I.am.licensed under provisions of Chapter 9 Disp. _'Room Air Cond. REG. NUMBER2599475 Class0—
(cornMencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROC E BY
and Professions Code,and m license is in full force.and.effect. Power Apparatus 8 Large Appliances i
Y @,
Size 8 Type HP, KW, KVA, or KVAR• t l O
License Number 259475 Lic. Class C10—
Up to 1 Incl. FINAL .
IOver*1 to 10 Incl. DATE A Q V ATION .09
Contractor Jemmy S �1 v Im.❑ Over 10 to 50 Incl. FIN d
I am exempt under Sec. Over 50 to 100 Inc. BY
B.BP.C. for this reason Over 100 g
Date: Services, Swbd., MCC&Ponelboards
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V '
❑ .Over 1000•Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and 3 6 7.6 A
Professions Code
❑ I, as owner of the property, will do the work and the Misc. Conduits•$Conductors
structure is not intended or offered for sale .(Section Othero 0 0 0 0(See Complete Fee Schedule)_ ® # 2
7044, Business and ProfessionsCode).
CONSTRUCTION LENDING AGENCY I -11 3370
I hereby affirm.that there is a construction lending agency for o o 133,705
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097,.Civ. C.). 1 217-85
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have.read this application and state that the TOTAL FEE
above information is corp". I agree to comply with all County
ordinanc and State I regulating Electrical wiring,.and
hereb horize rep a tatives of this County to enter upon
the e-mention perty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
12/13/85
Signature of Permitt Date