HomeMy Public PortalAbout10721 MILOANN ST_Electrical__ - J
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COUNTY OF LOS ANGELES I APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY ������_� �.
WILLIAM J. FAX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
.ELECTRICIAN 1AhAA,. n ;
RECEIVED BY READY ,FOR DATE ISSUED
ADDRESS ` r. TE I Viae' FIRST INSPECTION
CITY •-s �fl�r e r NOa� �nn . -Z `0 r�
COUNTY LICENSE NO. EXPIRES IBUILDINO 'f f
PERMIT 'FEES ADDRESS 0 / / / /J ,61 1-Al_
NUMBER EACH FEE 11-13CALITY r
ice"
LIGHT OUTLETS NEAREST
:CROSS ST. -
RECEPTACLES �
WALL BWITCHEB 'OWNER
t
TOTAL OUTLETS 5c _ IMAIL r
ELECT. RANGES 25 ADDRESS
ELEC. HEATERS 25 �ICITY TEL NO.
-
FIXTURES S
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS & �. qND 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
F.NUM103ER HORSEPOWER FEEANGELES COUNTY LICENSE, GR•I AM THE LEGAL OWNED
Mw. HP OVER INC: EACH OF THE .RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2 s,LEES S .25 ,
SIGNATURE OF
Yz a .50 I PERMITTEE
a s 1.00 INSPECTION RECORD
S 1s 1.sD
15 50 2.50 1
50 200 5.00
200 Sao 10.00 I� J
500 1000 15.00 7Q
°Z,
OVER 1000 20.00 L7
M.G.,SET/FREQ. CHANGER-HP ..
WELDERSI.AC-KVA O
GENERATORS - KW.
TRANSFORMERS - KVA
TEMP. MOTORS (75% of CFi1G:) II
:I
MOVED MOTORS (75% aF CRIG.) I ..
MISC.
SIGNS I +'
NO. NO.TRANS. I APPROVALS
NO. NO.LAMPS
FOR. EACH. PERMIT: DATE INSPECTORPB NAME
WIRING !PUP13 s (gip — CONDUIT
FIXTURES 51.00 p Q fp 'WIRING
SUPPLEMENTARY .50 FIXTURES
(POWER
TOTAL. FEE S 0TILITY Co.NOTIFIED
FINAL.
16A668 DBS#6A 4-6E I P
2" WORKERS'COMPENSATION DECLARATION 76AO3 DPW 3/67 APPLICATION FOR ELECTRICAL PERMIT
`•'`Y��;bsreTy„affifm thal'!--have a certificate of consent to self �� O
in's4le, ora certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
orF certified copy thereof-(Sec. 3800, Lab. C.)
Policy�No. Company FOR APPLICANT TO FILL IN JOB //d9 n�
❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS-__ L /Y'
Certified co is filed with the count building LOCALITY �p
PY Y g inspec- 1 &2-Family, Sq. Ft. $ — $ /`�PL� t!17~Y
tion department. Multi-family Sq. Ft. — NEAREST
Date /2 !���4pplicant r CROSS T.
Residential Swimming Pools OWNERSOR�
//nn FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re light Sw.LfL MAIL
COMPENSATION INSURANCE o /�/ ADDRESS
(This section need not be completed if the work involved by //5 r First 20 ,CITY Tel. No.
the permit is for one hundred dollars($100)or less.) Total No. Additional 66 _161
PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS
so as to become subject to the Workers'Compensation Laws.
Additional �
Date Applicant Total No. CITY Tel. 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' Range— Heater—D.W. _ APPLICATION/Agan
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS er
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITY �AO Tel. No. 92v�
LICENSED CONTRACTORS DECLARATION LICEN
SE OR
Disp. — Room Air Cond. — REG. NUMBER .-� Class.
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the-Business Power Apparatus&Large Appliances DISTRICT NO. PRO ESSED BY >_
and Professions Code,and my license is in full force and effect. p O
Q Size&Tye HP, KW, KVA, or KVAR O
License Number��l 7Z� Lic.•Class _� Up to 1 Incl. 0 FINAL U
���� Date�,� `-� Over 1 to 10 Incl.
ContractorDATE % VALIDATION
❑ Over 10 to 50 Incl. FINAL r^, �
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C. for this reason Over 100 O_
Date: Services, Swbd., MCC&Panelboards / D
1 —0-200 Amp. Under 600 V Z
Signature 201 - 1000 Amp. Under 600 V
❑ i
Exemption for Reg. Maint. Elect. Over 1000 Amp, or Over 600 V
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit f 4tr; e v
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits lPSorl
Professions Code): i T i ^
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ ® TO-1 Ai 78 m 513
Business and Professions Code). �
CONSTRUCTION LENDING AGENCY 1.•HECUP" 7`'°•1-
_
I hereby affirm that there is a construction lending agency for ;::�)(llhi!�t .00
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE 00110-0-110111 12/13/90
Lender's Name i r
PERMIT ISSUING FEE O 43-175 1 AM +Y;y'?
Lender's Address 00 '
I certify that I have read this application and state that the TOTAL FEE
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby a4thorize representatives of this County to enter upon
the above Waproerty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Permitt Date ®'