HomeMy Public PortalAbout10671 LORA ST_Electrical__ 6B5 5-A.-12-44 - 1 CATION FOR -PER=
DEPARTNNIP!INT •OF BUILDING AND SAFRIT I
COUNTY OF LOS ANGELES ELECTRIC
WM. J. FOX CHIEF ENGINEER
Z
Ji � STRICT NO. GROUP ZONE PERMIT NO. -
Q NAME :S .� gr�A�� DI `'�
AIDDRESS 9 1Vv I / -CJ '3 e)4 `
-7 Is RECEIVED BY READY FOR DATE ISSUED
CITY TEL.NO
.1 e FIRST INSPECTION
W •CE T.NO. -•19�4 EXPIRES e d 4
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
DESCRIPTION OF PORK ADDRESSADDRESS
'NUMBER OF OUTLETS ON CIRCUITS .' LOCALITY'
..LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. .r
CIRCUIT A B •C D E F G H a NAME ja.
y MAIL
ADOREBB
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CITY' . -TEL.NO.
1 AM THE LEGAL POSSESSOR iOF THE-ABOVE LOS
ANGF_L"ES COUNTY_ CERT FICA°TEOF•QUALIFICATI N..
ABO 6�I .OafN1ER OF THE P.RQPERTY DRI
'ESCBUD
OWNER.
CORE.EMOINS
'.4- li �C.ECSQ P Er��x�t r' .
7= /O rfCa p �.+ mer satL _t4
ts`i�34sr� t�.Nr
I
J .IB' 61
TOTALLl G 6 6
NO. OR OUTLETS AY �'-Lam'' APPROVALS.-
NO. OF FIXTURES DATE INSPECTOR'S NAME
'NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS.'.. R WIRING
NO. OF-RANGES OR HEATERS S FIXTURES -
MISCELLANEOUS $- POWER
.PERMIT FEE ♦ R / �f"r� UTILITY CO.NOTIFIED
TOTAL FEE �` AT I FINAL d-O 7d
• WORKERS'COMPENSATION DECLARATION "�, `'? �j + 1079t+ APPLICATION FOR ELECTRICAL PERMIT
w " n E-806E+ •�
It I hereby affirm that 1 have a certificbte o�„consent'to,self j�
insure, or a certificate of Workers',Compensation Insurance., ICOUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Ser. 3800, LoG. C.) i „
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS 7 - a
Certified copy is hereby furnished,.e New Residential Bldgs,6Pools , EACH NO.1 FEE
.Certified copy is filed with the county-building inspec- •1 '&2-Family, Sq. Ff. $ — $ LOCALITY of 8 t f, P i �!
tion department, 1 Multi-family Sq. Ft. — CREASE ST
Date Applicant esidential SwimmingPools T.
OWNER OR T" I
T_ r :"V FIRM NAME �,y'a;
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL v t
Outlets: Rec Light Sw: ,i
' COMPENSATION INSURANCE ADDRESS �
This section,need not be completed if the work involved b �..y� First 20
( P Y Total No. �✓ Additional CITY 1 i, ��Jrf 7 . No.(f tit;
the permit is for one hundred dollars($100)or less.) PLAN CHECK (- / [ i 1
I certify that in the performance of the work for which this APPLICANT
CHET / 17;7
permit is issued, I shall not employ any person.in any manner 1
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 AaADDRESS
Al Total No. � Additional
Date pplicant, r ' �(� Fixed A Iia cert s Not Over'1.HP CITY Tel. No.
r pP PERMIT
NOTICE TO' APPLICANT: if, after making this Certificate of"`' ) ,
Exemption, you should become subject to the Workers' Range_ Heater_D.W. APPLICANT
Compensation provisions of the Labor Code; you must forth- Oven _Dryer _W-.M.— i ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. — CITY Tel. No.
deemed revoked. Hood _ Fan _Other—
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. I REG.NUMBER Class.
(commencing with:Section 7000)of Division 3 of the Business �' DISTRICT NO. PROCESS. BY
and Professions Code,and my license is in full force and effect. 'Power Apparatus&Large Appliances
Size&Type HP, KW, KVA, or KVAR'
License Number Lic. Class
_ Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE _AA VALIDATION
Contractor Date Over 10 to 50 Incl.
FINAL
❑ �y
I am exempt under Sec. Over 50 to 100 Inc. BY
B\'&P.C.for this reason Over 100 t
r Date: Services,Swbd.,MCC&Panelboards
�1 0 -200 Amp. Under 600 V
Signature n --+ 13 .• 201 '- 1000 Amp, Under 600 V
❑ r y r Over 1000 Amp, or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY i Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION ,'Sign with One Branch Circuit
Ihereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits '
Law for the following reason (Section 7031.5, Business and ,
Professions Code):
Misc. Conduits&Conductors
yam+ I, as owner,of the property, will do the work and the j 7 c 'o (;r•
structure is, not 'intended :or .offered for sane (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). j , c ,n ; i r _
CONSTRUCTION LENDING AGENCY 'r'- C'
1 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)
(Sec. 3097, Civ.'C.).
PLAN CHECKING FEE i
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the TOTAL FEE 'e
404
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and r..
hereby authorize representatives of this County to enter upon (,
the above- entioned prop for inspe tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Y�,S1gn tune of erm ee
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