HomeMy Public PortalAbout10715 MILOANN ST_Electrical__ COUNTY OF LOS ANGELES I APPLICATION FOR PERMIT
Department of County EngineerELECT1tELECTRIC;DIVISIOISIO OF
N OF BUILDING 8z SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT1'O FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
6 sr
ELECTRICIAN �.7�yy� �1r41��..°:� ".1) 07 ✓
RECEIVED BY READY FOR DATE ISSUED
ADDRESS ?y r1d`-'S�: �' Arooq
I' / FIRST INSPECTION
CITY r`B - TEL.NO.4 r fw6 �l i:• c 3` �r
COUNTY LICENSE NO. 10973 EXPIRES / ,�2 BUILDING
PERMIT FEES �- ADDREBB��,�i
FEE v
NUMBER EACH LOCALITY F
LIGHT OUTLETS NEAREST
CROSB ST.
RECEPTACLES
WALL SWITCHES ` _ , OWNER - r f� i= �i 1tV
TOTAL OUTLETS 5e MAIL
ELEC. RANGES 25 60DREBB
ELEC. HEATERS 25 / `CITY TEL NO.
5 p�
FIXTURES r , 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. - -" N 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 I CERTIFY- THAT I POSSESS THE ABOVE VALID LOS
NumSER HORSEPOWER FEE AFIGELEB COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVG. HP OVER INC. EACH, OF THE RESIDENTIAL PROPERTY ESCRIBED ABOVE.
I/2 i LESS 18 .25 ®IGNATURE OF
I/2 2 .50 PERMITTE. *`� 1 �•'�tl
2 5 1.OD INSPECTION RECORD
5 15 1.50
15 50 2.50
50 200 5.00
200 BOO 10.00 J
500 1000 15.00 Z
OVER 1000 20.00
M.G. SET/FREQ. CHANGER-HP
WELDERS.AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% of DRIG•)
I
MOVED MOTORS (75% OF GRIG.)
M ISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO.LAMPS
FOR EACH PERMIT. DATE INSPECTORFB NAME
WIRING $1.00 d dF G CONDUIT +� Al
G°/�1 WIRING y d.�i /Fr+a�rCt•yy sI R.
FIXTURES $1.00 �—
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE !floe 1i UTILITY CO.NOTIFIED r r� 11
FINAL � �1 i'/� /I P
T6A668 DBS#5A 4-52 d
I
WORKERS'COMPENSATION DECLARATION 78,883 tD,a,
CE,8080 fl
APPLICATION FOR ELECTRICAL PERMIT
I hereby affirM that I have a•certificate of consent to self insure,
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
c th f O,Lab.C.)
lCy No. Company a An FOR APPLICANT TO FILL IN JOB
❑ EACH NO. FEE ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools LOCALITY
Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ _ $
departm nt. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTI ICATE OF EXEMPTION FROM WORKERS' MAIL
Outlets:Reo Light_�Sw. ADDRESS
COMPENSATION INSURANCE I
(This section need not be completed if the work involved by the I First 20S715- 3o c3
permit Is for one hundred dollars($100)or less.) Total No. Additional CITY Tel.No
I certify that in the performance of the work for which this permit PLAN CHECK
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 41, ADDRESS
Date Applicant �Total No. Additional
CITY Tei.No.
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS C;
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _
CITYTel.No.
' LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ C Ce
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class.
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT Q �,.` PRO ED BY
Size&Type HP,KW,KVA,or KVAR � of Q1
License Number Lic.C s 8
Up to 1 Incl. FINAL
S Over 1 to 10 Incl. DATE VALIDATION IX
Contra Over 10 to 50 Incl.
FINAL
❑ I am exempt under Sec. Over 50 to 100 litc. BY W
i
B.&P.C.for this reason I Over 100 N
Services,Swbd.,MCC&Panelboards , Z
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ - Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License.Law ACL•I a s
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits j[
Code): 1 3407 •M a 40
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors , 1 ITEMS
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ,
40
and Professions Code). T1�TA1- 'm
CONSTRUCTION LENDING AGENCY CHECK 36.413
1 hereby affirm that there is a construction lending agency for the CHANGE OLD
Performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name 0000-13001 6/ 6/913
PERMIT ISSUING FEE 1124 1 AN 8027
Lender's Address '
1 certify that I have read this application and state that the.above TOTAL FEE 3
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
erty r inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE
Ma
Ignatureo rmitte r Dat