HomeMy Public PortalAbout5509 MCCULLOCH AVE_Electrical_2/10/1955_ i
OOUBTV OF Los AROELSO APFLMTM FOS PSHMT
III
DIV O'er SING ELECTRIC
WILLIAM L FOX. Owntr ftelo Ir '
FOR APPL3 AW TO FILYN Jam_ DISTRICT NO. RROUP I ZONE PERMIT NO.
ELECTRICIAN t� 9 " ,7��J�` �� O
ADDR RECEIVED ■Y FIRREADY BT IN■PIOOTION DAT! IGUED
CITY , ' TEV N ? P`
COU LIORN■! N0. =Place NUILDINN
PEBMU FM FR M ADDNZI 'rev�� —
NUMBER EACH LOCALITY
LIGHT OUTLLTN NEAN!■T
REOlPTAOLEM ROG ST.
0
WALL NWITOH!■ OWNER 216 I
TOTAL CUTLETS 50,41 MAIL r• f
CLEC. RANGER OR ADDR4 "1
VIP 2
ILEO. HEATERS G CITY • e TEL. Nd
FIXTUNCE N 1 HEREBY AOKNCWLIDR! THAT 1 HAVE READ THIN
MIND. APPLICATION AND STATE THAT THE ABOVE IN CORRECT
mumsen of LINHT OINOUITM AND ANREE TO OOMPLY WITH ALL COUNTY ORDINANUEN
NUMBER Or RloEPTAOL! OIROU17m AND STATE LAWM REMULATINN ELECTRICAL WINIMIL
MOTORS I CERTIFY THAT 1 POr THE ABOVE VALID LOB
NuI w HORSEPOWIN FEE ANMELE■ COUNTY LICEN■I. OR 1 AM THE LESAL HER
NEW MVO. HP Dues INC. CAM OF THE REMICENTIA�PROPERTY DEMO EDAE
• aso .NN ■IMMATURE
s
an PERN1
s s 1.00
Eff9pw77w nzcxm
N 1N 1.Bo
1B N0 s.sO
on Roo 5.00
s00 SCO 10.00 J
Soo 1000 1B.00 �
Z
OVER loon saoo p
MA. mcT/rnm OHANNEWHP
WELDERNI AO-KVA O
NENERATORS - ION
TRANBFORMERB - EVA
TEMP. MOTORS (T or OHIO.)
MOVED MOTORS Or OHIO.)
MIECL
EIONM
N0. NO.TRANS. APMOVMA
Mm N
FOR EACH PlRMITI INSPECTOR'S NAME
N pl,pp CONDUIT
WIRIN
F01TUR0 M1,pp WIRINN
I p FIXTURlN
rri
ER
TOTAL FEB D 1 ITY on.NDTIFI
I L
IlUall DBS*BA 443
7A663
DS-SA 12-84 APPLICATION FOR ELECTRIC PERMIT ••1
S.
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING rjD 47
gyl
WM.J. FOX, COUNTY ENGINEER ADDRESS �J
CASSATT D.GRIFFIN.SUPT OF BUILDING
FOR APPLICANT TO FILL IN LOCALITY
PERMIT FEES NEAREST
CROSS ST.
NUMBER EACH FEE
LIGHT OUTLETS OWNER .
RECEPTACLES MAILS D
WALL SWITCHES ADDRESSL ��(JJ _
TOTAL OUTLETS 5� S CITY —rt- TEL. NO.
ELEC. RANGES 25 ELECTRICIANo
ELEC.HEATERS 25• ADDREV D 7
KW A CITY TEL. NO. J
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS
DISTRICT NO. GROUP ZONE READY FOR INSPECTION
NUMBER OF RECEPTAC E CIRCUITS y I I
. �O D
MOTORS a
NUMBER HORSEPOWERFEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH
1/2&LESS S .25
1 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
misc.
NO.SIGNS NO.TRANS.
NO.SIGNS NO. LAMPS r
FOR EACH PERMIT'
WIRING 51.00 _L
FIXTURES 51.00
SUPPLEMENTARY .50 i
• APPROVALS
TOTAL FEE S / a! DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE.THAT I HAVE READ THIS APPLICATION CONDUIT t
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING /rr /.✓
ELECTRICAL WIRING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REOUIREO'BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROJIERTY. UTILITY CO.-NOTIFIED
SIGNATURE
OF PERMITTEE191u, FINAL1
�
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION'
'A00 4 12- 'f'EB 1 0 2 1.2 5
BY
DEPUTY •
WORKER'S COMPENSATION DECLARATION 200019 DPW 9/89 1 LJ
reby affirm that I have a certificate of consent to self insure,
83 APPLICATION FOR ELECTRICAL PERMIT
,certificate of Worker's Compensation Insurance, or a car.' COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
o ereof(Be . � .C.)
;y Company FOR APPLICANT TO FILf IN JOB
ADDRESS
Certified copy is hereby d. New Residential Bldgs.&Pools EACH NO. FEE
$ _ $ LOCALITY
1&2-Family,Sq.Ft.
Certified copy is filed with the my building Ins ti _ NEAREST
de artm ^ � Multi-family wiq.Ft. CROSS ASSES OR !s
B plicant�,L)� Residential Swimming Pools MAP ASSESSOR
IRc
PAGE PARCEL
CERT E OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw. OWNER OR e/
COMPENSATION INSURANCE g FIRM NAME
Is section need not be completed if the work involved by the First o MAIL
'mit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS
rrtify that in the performance of the wo. for which this rmit CITY / T.I.No Sf
ssued, I shall not employ any person any man s s to PLAN CHECK
:ome subject to t Workers.Compens Ion Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional ADDRESS
'e Applicant 15 OR 20A,120V BRANCH CIRCUITS
ITICE TO APPLICANT: If, aft r making this Certificate of CITY Tel.No.
3mption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
Mrr
ivisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH AP PLIC,ANIT QS14414 J0
ivisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH p Q a a
I LICENSED CONTRACTORS DECLARATION ADDRESS 0-
15 OR 20A,208V TO 277V LIGHTING EACHlereby affirm that I am licensed under provisions of Chapter 8 n o
Immencing with Section 7000)of Division 3 of the Business and CITY �✓j Tel. � U
ofessions Cade,and my license Is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE ORrL.may it
/ Power Apparatus&Large Appliances REG.NUMBER / Close.
tense Number — - Lic.Class L Size&Type HP,KW,KVA,or KVAR DISTRICT No. v PR seD BY O
Up to 3 Incl. �D o �"��� I (LU
L.
�I�� •/�J Over 3 to 10 Incl. FINAL CO
mtrector Date DAA
Over 10 to 50 Incl. Z
7 I am exempt under Sec. Over 50 to 100 Incl. FAL 2� VALIDATION
B.&P.C.for this reason
Over 100 BY
Services,Swbd.,MCC&Panelbo
Date: 0-200 Amp.Under 600 V W 0
Signature 201-1000 Amp.Under 600
Over 1000 Amp.or Over 600 V
Exemption for Reg.Maim.Elect. 2
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCTJ0
HOME OWNER-BUILDER DECLARATION I'
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 3307 42■95
for the following reason (Section 7031.5Business and Professions Additional Sign Branch Circuits
,
'Code): 1 ITEMS
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 62.95
Is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) ® CHECK
t�
and Professions Code). 5 17G R v ■
95
CONSTRUCTION LENDING AGENCY CHANGE ■00
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 QOD�-LD 1 9/ 1/92
Lender's Name 5294 1 AM $:47
PERMIT ISSUING FEE tat
Lender's Address J h,
I certify that have read this application and state that the above TOTAL FEE l/O`
informati0 1 correct. I agree to comply with all County ordinances
and Stet ws regulating Elect al wiring, and hereby authorize
repress Ives of th15JQjkunty enter upon the above-mentioned
prope for Inspectio pur s SEE REVERSE FOR EXPLANATORY LANGUAGE
ATURE OF APPLICANT OR4W9NT DATE