HomeMy Public PortalAbout10733 LORA ST_Electrical__ 7sA663 DBB sA 7-81 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY � ��
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CHIEF 'ENGINEER
FOR APPLICANT TO FILL IN DIST�RIIICp�T NO. GROUP ZONE (/P//E�RMM�IT. +NO.
ELECTRICIAN A�ey • RECEIVED SY READY FOR DAT 199
ADDRESS 9 9 f;',r FIRST INSPECTION
CITY �P TEL. NO. `p ,aD "1•r`- /
COUNTY LICENSE NO. L� EXPIRE- Im O ) ej BUILDING
PERMIT FEES - ADDRE-- ��✓G� Soy /�Y}
FEE LOCALITY
NUMBER EACH
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS 9T.
9
WALL SWITCHES _ OWNER
TOTAL OUTLETS 513 .I MAIL
ELEC. RANGER 2S ADDRESS
ELEC. HEATERS 25 A CITY TEL NO.
FIXTURES �. 5 '�°�� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
NUMBER OF LIGHT CIRCUITS 7 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LDS
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. HP OVER INC- EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
4
I/2 A LESS 0 .25 SIGNATURE OF /',;7 h b
I/2 2 .50 PERMITTEE !!�
2 s 1.1313 � y INSPECTION RECORD
_ 5 15 1.50-- _
is 50 2.50A f� ,��/D J/1� a �� �✓
50 200 5.00 /•LIQ (//— SPp CI/(� �01�/
2130 BOB 10.00 J
500 1000 15.00 Z
OVER 1000 20.00 L7
M.G. BET/FREQ. CHANGER-HP 0!
WELDERSI AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% DF DRIB-)
MOVED MOTORS (75% OF DRIB.)
MISC.
SIGNS
NO. N O.TRAN-.
NO. NO.LAMPS APPROVALS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.00 c=� CONDUIT -
FIXTURES $1.00 ® r' WIRING w a ^���
9UPPLEM ENTARY .50 FIXTU REi
Y
POWER
TOTAL FEE UTILITY CO.NOTIFIED
FINAL
firm that I COMPENSATION DECLARATION C-883 10/81 APPLICATION FOR ELECTRICAL PERMIT
cI hereby affirm that I have a certificate of consent to self insure, CE-806G
oral certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
coMthereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB -733
-733 �� �t
_
y EACH NO. FEE ADDRESS 0 St
copy is hereby furnished. New Residential Bldgs.&Pools $ _ $ LOCALITY
Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft.
department. Multi-family Sq.Ft. NEAREST
CROSS 9T.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec-Light_Sw.- MAIL /�
COMPENSATION INSURANCE ADDRESS 049V-L-
(This section need not be completed if the work Involved by the First 20 CITY Tel.No.
permit is for one hundred dollars($100)or less.) Total No. Additional
PLAN CHECK
I certify that in the performance of the work for which this permit APPLICANT
is issued, I shall not employ any person in an manner so as to
become subject to the Workers'Compe tic s. Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, of er maki g this Certificate f
Exemption,you should become subject to the Workers'Compen ion Range_ Heater D.W. _ APPLICANT
provisions of the Labor Code,you must forthwith comply w' such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _
CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter9 Disp. — Room Air Cond. LICENSE OR Class
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT.N0' PROCESSED BY
Size&Type HP,KW,KVA,or KVAR J Cls '] p
License Number Lic.Class ncl. FINAL { 8
Over 1 to 10 Incl. DATE 6lUM VALIDATION -0
Contractor Date Over 10 to 50 Inc[. V
FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY OW.
Over 100
_ B.&R.C.for this reason V)
Services, MCC&Panelboards
200 A /
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
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions
Code):
L I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
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(Sec.3097, PERMIT FEE (Sub-Total) yf
Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE �
Lender's Address TOTAL FEE
I certify that I have read this application and state that the above ,-
Information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives this County to enter po the above entioned
prop y or' e urpQaes SEE REVERSE FOR EXPLANATORY LANGUAGE
Si na re of Pe ee Date