HomeMy Public PortalAbout10703 MILOANN ST_Electrical__ 70Aeea-CKSOS 5-04 AkICATION FOR ELCTRICAL RMIT
COUNTY OF LAS ANGELES 1111011
DEPARTMENT OF COUNTY ENGINEER MU1LDIN01 f +
BUILDING AND SAFETY DIVISION ADDRtOq own ON,
JOHN A.LAMBIE. COUNTY ENa1NKKR
COLEMAN W.JENKINS.SUPT.OF 9OILDINO LOCALITY
NEAREST
CRAM aT.
RECEPT. TOTAL 7FIRST wo. r
iOWNERLIGHTOUTLETISWITCH. ADDS
LIGHTING TOTAL I [FOYER
1NST 20 .10 WTV To-No. +2
FIXTURES r} / ADD% ELECTRICUW
20
1NINaES &DEVICES WTI,NTES. 1.00 ADIM a Q 3w r
UNM o1RP. STII.OooE •
clrr Td Na 916d �
1101111 1. AUTO.-WASH.
SPACE NTEE. Iffm AFP.(%N.P.MAN.) .50 LICENSE N0.
Moro l Ovo1 MOT ova N.P. DISTf CT ZOE P CE ED BY
.0
0 1 10 O O. G U
I A'01
1 a 1.50 INSPECTION RECORD
a a s.o0 p
a 1s 5.50 8
is so a.00 O1
0o too 5.00
a10)Nal No.TIMNS• y
No.LAIaS Z
MIMICK 0-600V-NOT ova SODA VAM '
SE ICE 0-600Y-0101012A0 A. 5.00
somics OVER aoov 5.00
MIaC.
PERMIT IMUINO!KE SAO 2 Qd
11111UPPLa1KNTA"PERMIT IMUMI01 MIX 1.00
TOTAL FEE
1 MOT ACIMML1 K THAT 1 HAVE READ TNIE APPLICATION �� 1
ANa M XTE THAT THE ASDIPE 10 COME=AND MRO TO COMPLY CONDUIT •--
WRN ALL COUNTY ORDINANCES AND STATE LAWS NOULATINO
� � wwiNa WIRING /'(' K ^•
1 NKNERY.CERTIFY THAT 1 AN PROPERLY RE STEREO ANq/O� FDLTURM
LICENSED AS RIMMME0 BY LOS ANOELEO N AND ST4ATE O
RESIDE CALIFOIINN1.THE AROYE O E S OAL SNTI AND INT TO POWER
al01NATURK UTIL 1 '
OF PERM FINAL r
LIDATION i3uPe11RNvuiNa Oe acrmiCAL ENommIsm
C8 MO amm
Lko eosaro APR 2 D 3.60- 4
• r `1`. OOuxw OF LOS ANOWLCcAPPLWJLTAM FOR PST ,
WILLIAM L FOX. Omw& EMf1eNr
ELECTRIC I
FCI#APPLICANT TC FILL INDIiTRIp. OR UP ZONE PERMIT"13.
LECTRICIAN . Juiz. -
,ADDKEMi dEOc1VJW .� IR■r VON DATE IMweM ,
olTr L.NC
00 loc c Na. IREM - u1LDtwo �r
PST DRQ L f
FEE
NUMiER H
Coe
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kewi.
`
REVIC16TAOL101 ' ,
WALL ITONCR 1 WNER
Tc rAL CuTLz= id ,
eLICCL N■cM `• -li Rl<MM .
ELZIL NEA 1•� TiG NO.
Tf71TURiM' 1 i Y "ERcw AOKm&AunbE THAT 1 NAVE ]RAD ,TNI ,
MINIL �MATION• ,AND MTATc TNM" TNO A1■bVX IM ooRRcdT
NtJMitiR'OP LIORT OIOOYITi 1 P • IS AMIICE ''td OOMPL4'Wn-k ALL OOVK+V ORDINANOEM ,
NYMiCR OR micawrAOLC'OIROYTPM •' ' MTATE LAWM REMIILATINM ELEOrNIUAL WIp1RM.
MOT R9 1 OcRTIFV TRAT 1 POS Tlfc 'AiD1R BVAUD I=
NORi�OWr11 X*� MOLEN ocumm v1scRtM4 OM 1 AM ,TNc LEGAL oWNlR
NTMI Jitls. NP CveN IMO• e11aI - •a F THE RlEt•11PENTIIA�L9PRQ{JPER'1'Y•PEMO�IlIRRb Ambvw '.
a 6eN .ii IMNATYR irOr
14
RRMI ,,
�b 1111
SIX
iDD i.00 ! k, ,f.
• 4
- 1 1iou iou IM.� _ j
I A aao �aoC �s.DD Z
CVeR I� 2300
Wim. gg 15HARMER-HP'
WELO R uo-IIVA Q'
seNeRATdiw - KW F
THOMFORMERN EVA ,
TCUP.JdaTUINI (2&6r 0111+
MOVED Kgromm ( of Usua l
BION® '
NO. No.TRAM
lift NCL LA04PIN noun
FOR EACH PEDATIC INMPCOTCH"NAMERMITI. ;
MIIRINM MdNDWIT
FIXTURE■ 1.00 P •WIRINM .r
OO FI REM
floWEle
.=Tj%L r9C., O u'r1uTr oo.wrIFIcD
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HIAA a-,R*rLFir
WORISER'S COMPENSATION DECIARATlO&i J, 20.0019 DPW 9189 LI
1-hereby afiffm.that I have a certificate of consent to self insure, , 7M63 APPLICATION FOR ELECTRICAL. PERMIT
ora certificate.of Worker's Compensation°Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy.thereof(Sec.3800 Lab.C.) T
Policy No. Company FOR APPLICANT TO FILL IN ADDRESS loZ a3 M L 1 OU.t&yx
❑ Certified copy is herbby furnished. New Residential Bldgs.&Pools EACH NO. FEE
❑ $ — $ LOCALITY ,
Certified copy is.filed.with the county building Inspection:. 1-- 1&:9-Family,Sq.Ft. — NEAREST
department. Multi-family Sq.Ft. Y CROSS ST. &4'tr, $T '.
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK, PAGE PARCEL '
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR i
COMPENSATION INSURANCE FIRM NAME +Z{,(q ,' El G�
This secflon need not be completed If the work Involved b the First 20 MAIL'
( P Y ADDRESS
Total No.• Additional �
permit is for one hundred`dollare($100)'or less.) ' ' �
I certify that in the performance df the work for.which this permit CITY t� 'If `f L TeI..No.
is issued; I shall.not,emplby any person in any manner so as to.
become subject to"the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT K
Total No. Additional
5Ig 9�. lu ADDRESS
Data Applicant II-1.✓c- W►rt I OG'�<< -15 OR 20A,120V BRANCH CIRCUITS
NOTICE TO APPLICANT-.--If, after making this`•Certiflcate of CITY Tel:No.
Exemption,You should,become subject to the Workers'Compensation 1 TO 10INCLUSNE,EACH
provisions of the Labor Code;.you.must forthwith•.com.l with such - 11 TO -40EACH PERMIT'
P Y 'APPLICANT k.t,✓'c �� F_LCCi C'<< C,'
provisions or this permit shall be deemed revoked. ,41 OR MORE BRANCH CIRCUITS EACH /� }•
LICENSED CONTRACTORSbta iATION ADDRESS 64JS Grro�jt r�la�,t- d
' 15 OR 20A,268V TO 277V LIGHTING EACH `
I hereby affirm that I ani licensed under provisions of Chapter 9 O
(commencing with.Section 70.00)of Divisioh 3.Of.the Business and _ CITY . VV`btt,e `► C� Tel.No.�����) V
Professions Code,and my license is In full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE oR
Power Apparatus&Large Appliances REG.NUMBER Class' `+ O
$"jZ R$O —Ib .
License Number.. 193 Lic.Class �`L� Size&Type HP,KW,KVA,or.KVAR DISTRICT NO. PROCESSED BY V
..
"!r LU to 3-Incl. LU
Contractor Ltvc. .w Cre V—(cc.Ti.�� S IT-194 Over 3 to 10 Incl: DATE (A
" CL
O 93 Over 10'tb 50Incl.
❑ I am exempt.under Bec. Over 50 to 100 Incl. VALIDATION
S.&P.C.for this reason BY
Over 100 F AL
S P Services,SwbdJ.,IVI &Panelboards ,rte
Date: /tmp0. de r Q
Signature 201-1000 Amp.Under 800 V
Over 1000 Amp.o'r Over 800 V
❑ Exemption for Reg.Malnt.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances' M
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuli
for the following reason(Section 7031.5,,Business and Professions Additional Sign'Branch Circuits hi1T 'niy�
Code):
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors J. '.i r '-
is not Intended or offered for Bale(Section,7044, Business Other(See Complete Fee Schedule) 'r •'e5
and Professions Code). HEIC
, }:i � ;
CONSTRUCTION LENDING AGENCY _
Thereby affirm that there is a construction lending agency for the '.�� a,;
S•t,:�t+t,..
performance of the work for which this permit is Issued(Sec.3097, PERMIT FEE• (Sub-Total)
Civ.C.)
PLAN CHECKING FEE s�ll_ti l ;G(2C i. -5/. 8152
Lender's Namen c;
PERMIT ISSUING FEE p � �Y�.;� A-k f}_:'':!
Lender's Address. TOTAL'FEE Y y -
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 authorise
representatives of this County to:enter upon the above-menti'oneil
property for inspection purposes. 5 SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATU OF . PLICAW OR AGENT' - DATE -