HomeMy Public PortalAbout10159 LYNROSE ST_Electrical__ 1 76A663 DBS SA 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FORAP�PNT TO FIL�L`IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN i>—L�(�/LICA
ADDRESS �� RECEIVED BY READY FOR DAT ISSUED
FIRST INSPECTION
CITY / TEL 5' �9l-v
NO. �+
COUNTY LICENSE NO./fl(0 V EXPIRES BUILDING
PERMIT FEES ADDRESS ,
FEE
NUMBER EACH LOCALITYwo
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST.
WALL SWITCHES OWNER .
TOTAL OUTLETS 5C $ D 1 MAIL s V
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES B
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IB 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 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR IGAM THE LEGAL OWNER
NEw MVD. HP H
OVER IC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
-V I 6 LE99 � .25 SIGNATURE OF
1/2 2 .50 PERMITTEE
_ p/
2 s 1.00 WINSPECTION RECORD
8 15 1.50
15 SO 2.50
50 200 5.00
200 Soo 10.00 J
sD01000 15.00 Z
OVER 1000 20.00 a
M.O. SET/FREQ. CHANGER-HP Q'
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG•)
MOVED MOTORS (75% OF oRIG.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 ` CONDUIT
FIXTURES $1.00 / on WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $�.9 UTILITY CO.NOTIFIED
FINAL 14 ,
WORKERS'COMPENSATION DECLARATION CE-e06G 10/81 li�lll�FL��CG=�I��OII'CJ ITOR -ELSEC ll Il ALS [!"LSRIII' 5 l!
ul•herby'affirm thata have a certificate of consent to self)
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY,
or a ce�rttiified copy thereof (Sec 3800, Lab C )
Plicc. il _Comp �,�• FOR APPLICANT TO FILL IN JOB,
❑ Certified copy is hereby furnished New Residential Bldgs Pools ' ADDRESS
o & Pi EACH NO FEE
❑ Certified copy is filed with thb county building inspec- 1 &2-Family, Sq Ft $ _ $ LOCALITY (�
tion department I Multi-family Sq 'NEAREST
Ft CROSS ST L-
n ���"����.r.��,,�� Residential Swimming Pools OWNER OR `I'
Date /�� Appli �j➢�L�{riZ— FIRM NAME y� G (O
CERTIFICATE OF EXEMPTION FROM-WORKERS' MAIL l
Outlets Rec Light Sw_ ADDRESS �0�
COMPENSATION INSURANCE � � � L.
This section-need not be completed if the work Involved b First 20
( p Y Total No
the permit is For one hundred dollars ($100)or less.) Additional CITY Tel N .•.Z
that in the performance of The work for which this _ PLAN CHECK
I ceFtif
Y P � APPL'ICANT i
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20• ADDRESS
Total No Additional
J CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, after'making this Certificate 'of APPLICANT
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;7101) 5
with comply with such provisions or This permit shall be Top _ FAU J_W H
deemed revoked CITel No
Hood Fc*, _L Other_
LICENSED CONTRACTORS DECLARATION ., �4c, LICENS OR
Disp Room Air Cond Class
I hereby affirm that lam licensed-under,provisions of Chapter 9 REG NUMBER �2 ��
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCESSED' Y
and Professions Code,and my license is in full force and effect Power Apparatus 8 Large Appliances _ �t �®
�j Size &Type HP, KW, KVA, or KVAR- 0
License Number Lic Class Up to 1 Incl FINAL O
Co S� Over 1 to 10 Incl DATE VALI TION 0
Date
❑ Over 10 to 50 Incl FIN ~
I am exempt under Sec Over 50 to 100 Inc B LU
B&P C for this reason Over 100 t�/t
Date
Services, Swbd'; MCC & Panelboard D
0 -200 Amp Under 600 V t00 p
Signature 201 - 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maint Elect 2 2 5a 2 q -
r SINGLE FAMILY '
� _ Temp Power Pole &Appurtenances - _ #�o 0,0 0 0
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch,Circuits .'04 Q
Law for the following reason•(Sechon 7031 5, Business and
Professions Code) o c o (� Q v
❑ I, as owner of the property, will do the work and the Misc Cbnduits'& Conductors •
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D
7044, Business and Professions Code) 7.2 b,` $5
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 PERMIT FEE— (Sub-Total)
(Sec 3097, Civ C )
• l
PLAN CHECKING FEE.
Lender's Name
PERMIT ISSUING-FEE
' Lender's Address ,n A - -
I certify that I have read this application and state that the TOTAL FEE ,00
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-m ent ioneld property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE. .
'-;;.Signature of Permittee Date