HomeMy Public PortalAbout10659 LOWER AZUSA RD_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
'FOR P l- ANT ' n ILLI Ili DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIA - c)ci
RECEIVED BY READY FOR DATE ISSU D
ADDRE9 1�..j I. FIRST INSPECTION 1 _
CITY / EL. NO.� { 'a'e I J
COUNTY'LICENSE NO. EXPIRES,/ BUILDING j/I
PERMIT FEES U ADDRE89
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST. ZA
RECEPTACLES i
WALL SWITCHES OWNER1,17
TOTAL OUTLETS Sc $ r
T_ MAIL
ELEC. RANGEB 25 - ADDRESS a �.
ELEC. HEATERS 25 CITY TEL. N0.
FIXTURES - 5 - 1 HEREBY ACKNOWLED 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 I CERTIFY THAT 1 POBBEBS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELEB COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
FEE n
NEW .MVD. HP OVER .INC• EACH OF THE RESIDENTIALj�,ERTY D CRI BED AS E.
I/2 6 LESS $ .25 SIGNATURE OF
/2 2 .50 PERMITTEE
2 s l.00 INSPECTION RECORD
5 15 1.50
15 50 2.50
50 200 5.00 '
200 500 10.00 J
500 1000 15-00 Z
OVER 1000 20.00
M.G. SET/FREQ. CHANGER-HP
WELDERS:AC-KVA
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIO•)
MOVED MOTORS (75% OF DRIB.) '
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. - NO. LAMPS
- DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1..00 �Q CONDUIT � �//��/__/�/�A
FIXTURES $1.00 WIRING oL:..l�4T...® / ^.q+ �J�f�rl '.�
SUPPLEMENTARY .50 FIXTURES
Q POWER�t, Gil. O
TOTAL FEE $ UTILITY CO.NOTIFIEDt�1�f;ay .�f✓a
FINAL y{yy" .
76A663 DBS#5A 2-53 :�
WORKERS'COMPENSATION DECLARATION 5 4 70;4 3 loiet .<>:, APPLICATION FOR •ELECTRICAL PERMIT '."' �
L,he?b>+ affirm that I Have a certificate of consonP!'A e.`, CE-8 �G_•"t
P ��' COUNTY OF LOS ANGELES 7—e,
BUILDING AND SAFETY'
insult or a certificate of Workers' Com ensatior Insurance,
or a certified copy thereof (Sec. 3800, Lab:C.)
Policy No. Company FOR APPLICANT TO FILL IN, t JOB
Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
F] Certified
_ g LOCALITY
Certified'copy is filed with the county.buildinnsp
g iec- 1 & 2-Family, Sq. Ft.
NEAREST
tion department. .Multi-family Sq. Ft. — f
Residential Swimming Pools {ROSS
Date Applicant OWNER OR f
-FIRM NAME
CERTIFICATEOF EXEMPTION FROM WORKERS' ;MAIL _
Outlets: Rec Light Sw._
COMPENSATION'INSU RANCE. � , - ADDRESS
(This section need not-be completed if the First 20 work involved by .: CITY "�' el. No. 2
the permit is'for one hundred dollars ($100)or•less.) Total.No. Additional , / �
I certify that in t e` performance "of the work for which this _ PLAN CHECK =
Y .� P � ��� sti :` APPLICANT.
permit is issued, I shall not employ any person,in any manner _
so as to become'sub'ect.to the Workers'Compensation'Laws. Lighting Fixtures First 20' ADDRESS
Total No. Additional
CITY Tel. No.
nta(Zog"MA
NOT TO APPLICANApplicafter making t '"Certificate of Fixed Appliances Not Over 1 HP PERMIT
g
Exemption, you should become subject Range— Heater—D.W. _ APPLICANT To the Workers' 9
.Compensation provisions of the Labor Code, you must forth- Oven _ Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top _'FAU —W.H. —
deemed'revoked. Hood _ Fan Other_ CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Disp. Room Air Cond. 'LICENSE OR Class.
1 hereby affirm that I am licensed under provisions of Chapter 9 REG:NUMBER �.
(commencing with Section'7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PROCESS BY
and Professions Code,and my license is in full force and effect. r
Size &Type HP, KW, KVA, or KVAR O
License Number Lic. Class' Up to 1 Incl. • U
FINAL.
Over 1 to 10 Incl.
Contractor Date DATE VALIDATION 0
❑ Over 10 to 50 Incl. FINA . o
I-am exempt under Sec, Over 50 to 100 Inc. BY
Over 100
B.&P.C. for this reason
Services, Swbd;,'MCC & Panelboards Z
Date: 0 -200 Amp. Under 600 V .
Signature 201 -1000 Amp. Under 600 V
ElOver Amp. or Over 600 V
Exemption for Reg. Maint. Elect. L (!:', • �i;
SINGLE FAMILY Temp. Power Pole &Appurtenances a o C
HOME OWNER-BUILDER DECLARATION
Sign with.One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License
Law for the following ieasoni(Section 7031.5, Business and Additional Sign Branch Circuits c+
Professions Code): = 1 I
❑ 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)_ r' '• ,' [I-
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 whicK this permit is issued •PERMIT FEE (Sub-Total) :.
(Sec. 3097,.Civ. C.) t$ j
-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 S S
above`information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned p ope t for i spection purposes./ SEE REVERSE FOR EXPLANATORY LANGUAGE
�Signafure of rmittee Date ///