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Home My Public Portal About5028 MCCLINTOCK AVE_Electrical__ 76ASM oBBSA 11-49 APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY ELECTRIC COUNTY OFF LOS LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FIL I - ` DISTRICT NO. GROUP ZONE PERMIT'NO. �• RECEIVED BY. READY FOR DAT ISBU�D ADDRESS `�!y✓J �. FIRST INSPECTION " ^ TEL. Z7/ - •' s�T .6/ l CITY :z �ry� / _ COUNTY LICENSE NO. ./6411 f✓ 2 EXPfRES I BUILDING `� PERMIT FEES G� ADDRESS /e• .r ;�, „ NUMBER OUTLETS EACH FEE LOCALITY 11 4 LIGHT 5O III NEAREST V i� CROSS ST. f RECEPTACLES 5 d 6j FIXTURES s OWNER r�P•��'=�,��r! WALL SWITCHES 5 MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY -TEL. NO. MISC. I HEREBY ACKNOWLEDGE THAT 1 NAVE READ THIS NUMBER OF CIRCUITS INSTALLED, TOTAL APPLICATION AND STATE THAT THE ABOVE IB CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWER FEE I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB ` NEW Mw. NP OVER Ino. EACH ANGELES COUNTY"LICENSE, OR 1 AM THE LEGAL OWNER 1 OF THE RESIDENT PEW ESCRISFD ABOVE. ♦ /2 a LESS $ .25 %2 2 .5O SIGNATURE 2 5 1.00 PERMITTE s is 1.50 INSPECTION CORD 2.50 SO ZOO 5.00 200 600 10.00 ^� :/�f .t/+' �'f► .i=�l BOG 1131313 15.00 .^�c .s Q OVER 1000 20.00 I �6 M.G. BET/FRER. CHANGER-HP [7 WELDERS,AC-KVA , GENERATORS - KW O TRANSFORMERS - KVA \v TEMP. MOTORS (75% of onlo.) MOVED MOTORS (75% of OHIO.) MISC. SIGNS TYPE, NO.TRANS. TYPE, NO. LAMPS APPROVALS FOR EACH PERMIT, DATE INSPECTORPS NAME WIRING 81.00 CONDUIT FIXTURES $1.00 WIRING SUPPLEMENTARY .50 FIXTURES POWER TOTAL FEE !S l® UTILITY CO.NOTIFIED Q FINAL r 7dASS3 0088^ 11-49 ` APPLICATION FOR PERMIT DEPARTMENT'OF BUILDING AND SAFETY ) COUNTY OF LOS ANGELES ELECTRIC WILLIAM J. FOX, CHIEF ENGINEER FOR A PLICANT TO FILL IN,,! * Ai DISTRI 7 NO. GROUP ZONE PERMIT NO. ELECTRICIAN ray / ,�-' ��i_-� /� f ® f r - RECEIVED BY READY FOR DATE 198UED ADDRESS � -r' rEl :A'�/r�d:,Q+�-11��♦ �� FIRST INSPECTION ELlNO. P/ COU TY LICENSE NO. - - PIREB 9 ® BUILDING ` L3 PERMIT FEES` FEE r ADDRESS. a Jl /1C! z NUMBER OUTLETS EACH LOCALITY LIGHT So 5 0 NEAREST CROBS ST. RECEPTACLES 5 .® FIXTURES 5 , G1 OWNER &�—�4 WALL SWITCHES 5 Q MAIL ELEC. RANGES.. 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. MISC. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS NUMBER OF CIRCUITS INSTALLED: TOTA, APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWER FEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEw MvD. HP avER INc. FAUN ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER OF THE RESIDENTIA ROE'ERTY RISED ABOVE. Y2 & LESS $ .25 / Q 1/22 .513 SIGNATURE OF 2 6 1.00 PERMITTE d ff .0v 5 is 1.6o INSPECTION CORD is 60 2.50 50 200 8.00 2130 6013 10.00 _ s00 loco 15.00 JQ OVER 1000 1 20.00 Z M.G. BET/FREQ. CHANGER-HP (9 WELDERS:AC-KVA IY GENERATORS - KW O TRANSFORMERS - KVA TEMP. MOTORS (75% DF GRID.) MOVED MOTORS (75% of GRID.) MISC. SIGNS TYPE: NO.TRANS. TYPE* NO. LAMPS APPROVALS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $7.130 CONDUIT FIXTURES 57.00 B®' WIRING ter. i /, P SUPPLEMENTARY .50 FIXTURES �f POWER ,c TOTAL FEE 5 �i A' UTILITY CO.NOTIFIED Al FINAL —Ab WORKERS'COMPENSATION DECLARATION 76663 CE-806G '0'87 APPLICATION FOR ELECTRICAL PERMIT `-yereby affirm that I have a certificate of consent to self insure, I or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ EACHNO. FEE ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools ❑ Certified copy is filed with the county building Inspection 1 &2-Family,Sq.Ft. $ _ $ LOCALITY . department. Multi-family Sq.Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME GG CERTIFICATE OF EXEMPTION FROM WORKERS' 'MAIL Outlets:Rec—Light_Sw.— COMPENSATION INSURANCE First 20 ADDRESS s (This section need not be completed if the work involved by the CITY Tel.No. permit is for one hundred dollars($100)or less.) Total No. Additional CHECKPLAN I certify that in the performance of the work for which this permit APPLICANT 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 Additional Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT p G provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ ADDRESS - C 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 Chapter 9 Disp. — Room Air Cond. LICENSE OR /��s� Class. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER /C. �.. DISTRICT NO. PROCESSED Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances Size&Type HP,KW,KVA,or KVAR a License Number Lic.Class Up to 1 Incl. FINAL /� Over 1 to 10 Incl. DATE V ATION Contractor Date I Over 10 to 50 Incl. FINA v ❑ I am exempt under Sec. I Over 50 to 100 Inc. BY BAP.C.for this reason ; Over 100 r 9 5 5,2 A oWl. Services,Swbd.,MCC&Panelboards # 0 0 0 0 2 , Date: 0-200 Amp.Under 600 V 0 Signature 201 - 1000 Amp.Under 600 V Io - 21.00 ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. 0 0 021.0 0 c=i SINGLE FAMILY Temp.Power Pole&Appurtenances 0 509-88 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): Misc.Conduits&Conductors I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) is not intended or offered for sale (Section 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 which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct.I agree to comply with all County ordinances ASIgnat s regulating Electrical wiring, and hereby authorize s of t ' Countyenter upon the above-mentioned c o purpose SEE REVERSE.FOR EXPLANATORY LANGUAGE s- --erm�e Date