HomeMy Public PortalAbout10726 MILOANN ST_Electrical__ 76AR53-OEg6s-10/72 APPLICATION� � K LC � MIT �
COUNTY OF LOS ANGELES
��'!• Di EARTMENT OF COUNTY ENGINEER 7ADDRESSUILDING AND SAFETY DIVISIONFOR APPLICANT TO FILL IN NEAREST
OUTLETS N0. EACN FEE ,d (/ /��ypp' , v
RECEPT. 0 $ $ ADDRESS �a- MAIL L
FIRST 20 25 � ''/
TOTAL p _
LIGHT CITY / le E TEL. NO.
SWITCHL OVER 20 •10
PLAN CHECK
T�TAL
LIGHTING FIRST 20 .25 APPLICANT
OVER ADDRESS
RESIDENTIAL
FIXTURES •ip
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP., F.A.U.... ADDRESS
SPACE HTR. AIR COND. ` CITY 'to dig
TEL. NO.
CLOTHES WASH..1/// DISHWASH. LICENSE OR REG. NUMBER CLASS.
FAN/O7MT d1.00 �y I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
V AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS. RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 110p LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALI FOR N IA OR THAT I AM THE LEGAL OWNER OF THE ABOVE at
1 - 1O 9.00 OE.SCRIRED RESIDEN AL PROPERTY.
PERMITEECj
10 - 50 5.00 SIGNATURE CD
O
H
50 - 100 10A0 DISTRICT NO. PROCESSED BY a
100 - S00 15.00 7 9 R N
/
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS top TEMP. POWER POLE
SERVICENOTOVER 600 VOLTS OR 200AMP /' 3.00 3 Oa UNDERSLAB WORK
SERVICEOVER600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT
TEMP SERVICE,POLE,&APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES 4 fl
POWER AUTHORIZED c
UTILITY CO. NOTIFIED
FINAL e�E(
LPERMIT
(SUB TOTAL) NOTES:
FEE
ING FEE 3.00
E '7T
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VAL D TION CK. M.0. CASH
i fir„ 2 1 9 7-3 JUL 13 D 1 1 .7 5 A
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
• , COUNTY OF Los A■lELEM APPLmTLON FOR PSS�QT
n 09 ELECTRIC i
DNISICN OF SIIII.DII�iG & SAFSTY
WILLIAM L FOX. County EWmr
FOR APPLICANT TO FILL IN OIYTRICT NO- GROUP ZONE PKRmrr NO.
A.
ADDRo■ • - wsosrvsD sY READYIma FDR DATE 1■■um
ICIA 12 �,-�1 r _ FIRST INSPECTION w tea,I43
OITv
.g2UwxAmMw NC6-, ��!l CKPIRKO
ADDRESS � f 01a,
-
PERMT FM r
NUMMER EAOH FEE LOOALnv
LIMHT OIITLLTM NEARER
RECEPTACLE■ jummin ST.
WALL dWITOHEw OWNER Z-Y net
TOTAL OuTLLTM no a MAIL
CLEM RANMEM !d ADDREr
FLED. HEATERS OR CITY TEL. NO.
FIXTURES f 1 NEREt1Y AOENOWLEDSE THAT 1 HAVE READ THIS
NIOL CATION AND RATE THAT THE A■OVE IS OORREOT
NUMSEw OF LIMHT CIRCUITS - Xs AND AMORE TO COMPLY WITH ALL COUNTY ORDINANCES
MUMMER OF REOC"ADLE CIRCUIT■ AND STATE LAWN REMULATINE ELECTRICAL WIRINl.
MOTORS 1 OCMTIFY THAT 1 PO THE ANDVE VALID LOS
Nuwoell HORSEPOWER FEE AMEELE■ COUNTY LICENM& OR 1 AN THE LEMAL OWNER
New Mw. HP oven 1106 WON dr THE RESIDENTIAL PROPERTY wtMEO AMOVE.
vm SU i Lem .!01 W PERM CF � M�l• r� I
■ f
1.0131 IS Ec77ON BWOW
d 1 f 1.dC
7d MO l.010
an S00 01.00
■m ROD 10.00
0100 1DOO Imam
Z
OVER IOm MO.DO p
M.O. mirr/rNML CHANMER-HP O:
WELDE11011 AO-EVA O
■ENERATORM - XW
TRAM■FORMER■ - EVA
TEMP. MOTORS 10e oms
MOVED MOTORS 1 of o101MJ
BION!
NO. NO.TRANS. VMA
FOII EACH PERMITI DATE IN■PEOTOR'S NAME-
WIMIND 1,DC edl IOONDUIT _
FI1LTuJ 1.m e p WIRINS 3 i s � /�•
LWrARVM FIXTURES
POWER
TOTAL FR! * 1 f - UTILITY OC.NOTIFIED
FINAL
IUMB Mo U 440
WORKER'S COMPENSATION DECLARATION 7IM6 3 DPW 9,89 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self Insure,
or a certificate of Worker's Compensation Insurance,or a certified , COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 00 Lab.C.)
Policy No.�Company FOR APPLICANT TO FILL IN JOB
ADDRESS v Of(
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE
r� $ _ $ LOCALITYertifie copy is filed with the coun wilding inspection 1 &2-Family,Sq.Ft. NEAREST
e a nt. Multi-family Sq.Ft. CROSS ST.
Date 1:— Applicant Residential Swimming Pools ASSESSOR �7
// MAP BOOK PAGE Da PARCEi�Z
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.�_Light:3L_Sw.- G FIRM NAME
COMPENSATION INSURANCE First 20 �D d
(This section need not be completed if the work involved by the ` MAIL
permit Is for one hundred dollars($100)or less.) Total No. 6 Additional ADDRESS
I certify that in the performance of the work for which this permit CITY Tet.No
is Issued, I shall not employ any person in any manner so as to 3 PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures 3 First 20 • APPLICANT
Total No. Additional
ADDRESS
Date Applicant 15 OR 20A,120V BRANCH CIRCUITS
NOTICE TO APPLICANT: If, after making this Certificate of CITY TBI.No.
Exemption,,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code,you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERAPPLIT
ICANT
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION ADDRESS O •�
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,206V TO 277V LIGHTING EACH
(commencing with Section 7000)of Division 3 of the Business and CITY ' Tel.No! V
Professions Code,and my license is in full force and effect. ° RESIDENTIAL APPLIANCES UP TO SHP LICENS94R
Power Apparatus&Large Appliances REG.N BER Class. Q
License Number Lic.Class. Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PR D BY
Up to 3 Incl. UJ
Over 3 to 10 Incl. FINAL a
Contractor ate I DATE
❑ Over 10 to 50 Incl.
I am exempt under Sec. Over 50 to 100 Incl. VALIDATION
Over 100 FINAL
B.&P.C.for this reason BY
Services,Swbd.,MCC&Paneiboards
Date: 1 0-200 Amp.Under 600 V
Signature 201-1000 Amp.Under 600 V
❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V 2A44TaS
SINGLE FAMILY Temp.Power Pole&Appurtenances L
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ? 40 o V4
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits ITEMS
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 44S. 84
Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , CHECK 46.84and Professions Code). i
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.) 0000-0001 8/14/K
I
PLAN CHECKING FEE
Lender's Name I 5026 1 ACI 8"46
PERMIT ISSUING FEE
Lender's Address D
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
andS e laws regulating Electrical wiring, and hereby authorize
repr ant Ives of this County to enter upon the above-me tioned
X810NATE
inspection r I SEE REVERSE FOR EXPLANATORY LANGUAGE
F APPLICANT OR AGENT ATE '