HomeMy Public PortalAbout9950 MILOANN ST_Electrical__ (2) FGA668C- C 80613 18/76 APPLICATION FOR ELECTRICAL: PERMIT
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BUILDING D SAFETY DIS ION
FOR APPLICANT TO FILL IN JOB'
ADDRESS
New Residential Bldgs.&Pools EACH NO. FEE Q
1 &2 Finally Sq. Ft. $ — $ LOCALITY Xa
Multi-family Sq. Ft. — NEAREST t�
Residential Swimming Pools CROSS ST.
OWNER OR
FIRM NAME a
Outlets: Light,Switch&ReceptacleMAI L
First 20 0
ADDRESS
Additibnal CITY ATel. N
PLAN:CHECK
Lighting Fixtures r APPLICANT
First 20 ® ADDRESS
Additional CITY Tel. No.
PERMIT �•
Fixed Appliances Not Over 1 HP APPLICANT
Range_ Heater_ D.W. _ ADDRESS
Oven _ Dryer _ W.M.
Top _ FAU _L W.H. _ CITYbf:f!1k_ Tel..No
Hood Fan LICENSE OR
Disp. A.C.
RE'G. NUMBER Class. C.2
�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Q
AND STATE THAT THE ABOVEIS CORRECT AND AGREE TO COMPLY
Power Apparatus&Large Appliances WITH ALL COUNTY' ORDINANCES AND STATE LAWS REGULATING V G1
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Size&Type HP,KW,.KVA,or KVAR ELECTRICAL WIRING.
U to 1 Incl.
P I HEREBY CERTIFY TNA I AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl. LICENSED AS REGUIR OS ANGELES COUNTY TAT OF
CALIFORNIA OR TN THE LE A WNE O VE
Over 10 to 50 Incl. DESCRIBED RESIDE ROPERTY
Over 50 to 100 Incl. PERMITEE
Over 100 SIGNATURE
Services DISTRICT NO. UMO
C3
SSEDI
0-200 Amp. Under 600 V v 02
201 -1000 Amp.Under 600 V APPROVALS DATE INSP O 'S
ATURE
Over 1000 Amp.or Over 600 V
TEMP,POWER POLE
Temp.Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit ROUGH CONDUIT
Additional Sig_n Branch Circuits
(Other). WIRING
F I'XTU RES
'POWER AUTHORIZED
PERMIT FEE (Sub-Total). UTILITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL
PERMIT•ISSUING FEE 'U
NOTES
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CAS PERMIT VALIDATION CK. M.O.. CASH
5 3 4 -,OCT. :7 2 D 1 1.7 U
- I Y7_52>
r rrr��,
• %,r Vy1ZtFKER ATION DECLARATION 76A663 10/81
I�hereby affirm that F a certificate of consent to self CE-806G APPLICATION FOR ELECTRICAL PERMIT
insure, or a certificate oNorkers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.) /�
Policy No. ' Company FOR APPLICANT TO FILL IN JOB
ADDRESS /-1/4
Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE
❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY Pu�
tion department. Multi-family Sq. Ft. — NEAREST
CROSS ST. �J
Date Applicant WOW
Residential Swimming Pools OWNER OR
�
` FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec `^' Light Sw.� 1V1�`tL
First 20 �+
COMPENSATION INSURANCE ADDRESS �%bIr � 1
(This section need not be completed if the work Involved by Total No. 13 Additional CITY 6WL,1r j� Tel. NojSO"1003
the permit is for one hundred dollars($100)or less.) PLAN CHEC
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not emplo y pe*theWorkers'
'
so as to become subject to the o ers'C . Lighting Fixtures First 20 W ADDRESS
Total No. Additional
Date A lic CITY � a' Tel. N -�(�Q
pp Fixed Appliances Not Over 1 HP PERMIT
NOTI E TO APPLICANT: If, after mak' g APPLICANT e�-�,
Exemption, you should become su jecRange_ Heater—D.W. _ t `��
Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M. ADDRESS ,& � lL0j.4-*&)
with comply with such provisions or this permit shall be Top _ FAU —W.H. — � ��
_
deemed revoked. Hood _ Fan _OtherCI 95eTel. IVa.
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. _ Room Air Cond. Class.
ir
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PRO S D BY W
and Professions Code,and my license is in full force and effect. /I Q
Size&Type HP, KW, KVA, or KVAR
License Number Lic. Class Up to 1 Incl. FINAL � , JIDATION
Over 1 to 10 Incl. DATE 4
Contractor Date❑ Over 10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY n
BAP.C. for this reason Over 100
Date: Services, Swbd., MCC 6 Panelboords ►
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 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit51 fi 8 A
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and # 0 0 0 0 0 2
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors o o 3 8,2 5
structure is not intended or offered for sale (Section Oi (See Co late Fee Schedule)_ ►
7044, Business and Professions Code). 2Q o 0 o 3 a2 5 5
CONSTRUCTION LENDING AGENCY U /.3 1 t 8 6
1 hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). 1
1� ■ �� PLAN CHECKING FEE
Lender's Name V IBJ ��
Lender's Address PERMIT ISSUING FEE
01
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
he authorize representatives of this County to enter upon
e a ave-me n p perty for inspection purposes.
1—11
` g! SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature Permittee Date �l