HomeMy Public PortalAbout10258 NADINE ST_Electrical__ 78A863�EB06t 9,57 APPLICATIO F�t ELECTAL PERMIT
•- COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING OS
BUILDING AND SAFETY DIVISION ADDRESS Iw/
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALI
yr
NEARS
FOR APPLICANT TO FILL IN CROSS T
N A F
RECEP $ S OWNS
MAIL
LIGHT T T�1L FIRST 20 � 20 ADDRES
SWITCH �XJ OVER 20 10 CITY TEL NO$/'*#-!-qf
Z
LIGHTING �.TOTAL, FIRST 20 20 CONTRACTOR
FIXTURES OVER 20 1 10 ADDRESS 4a
RANGETDRYERI—WTR HTR _ CITY A "7 EL NO
STA COOK_DISP _F A U _
LICENSE NO
SPACE HTR /—AIR COND 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
CLOTHES WASH I—DISHWASH_ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
FAN—OTHER 1 00 Ob 1 HEREBY CERTIFY THAT 1 M PROPERLY REGISTERED AND/OR
JDISTRI
CENSED AS REQUIRED BY ANGELES COUNTY AND STATE OF
MOTORS TRANSFORMERS RATING LIFORNIA OR THAT 1 AM LEGAL OWNER OF AND INTEND TO
IND HEATERS ETC HP KW KVA SIDE IN THE ABO E 0 SCRIBED RESIDE TIAL PROPERTY
SIZE & TYPE OVER TO GNATURE �,/0 - 1 i 00 PERMITTEE 'v,de
1 - to 3 0o CT GRO Z E P ES ED BY10 - 50 500 � of
50 - 100 1000 OTES
100 - 500 15 00 D.
h
SIGN GAS S
TUBE OR IGN AND ONE CIRCUIT 3 001 z
MARQUEE ADDITIONAL CIRCUITS 1 00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00
SERVICE OVER 600 VOLTS OR 200 AMP 500
TEMP SERVICE POLE &APPURTENANCES 3 00
APPROVALS DATE INSPECTOR 8 SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
LPERFE,
E 2 00 DO WIRING dry
FIXTURES
NTARY ISSUING FEE 1 00 POWER AUTHORIZED A
E UTILITY CO NOTIFIEDK FEE (507 PERMIT FEE) FINALdE 6 JOSE H C ROOHAN
SUPERVISING ELT AL :WINEER
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION ELT
M o*ff%ASH
(ACo 3 d 5 0:8 FEB 2 3 - Q D 2.6 0 cu
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
30 7awe62 Dae eA 11 49 av APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY ELECTRIC
COIINTY OFF LOS LOS ANGELES
WILLIAM J FOX, CHIer ENGINEER
FOR AP LICANT TO FILL IN DISTRICT GROUP I ZONE PERMIT NO
ELECTRICIAN V e �"`C
ir
RECEIVED �EADY FOR DATE ISSUED
ADDRESS �v✓✓'I'�7 rIRST INSPECTION
CITY TEL.NO / q
COUNTY LICENSE No EXPIRES BUILDIN
PERMIT r
NUMBER OUTLETS EACH reE LOCALITY .. L
LIGHTSC • NEAREST CROSS ST
RECEPTACLES 6
rixTumee s OWNER /��/R�S
WALL SWITCHES 6 MAIL
ELCO RANGES 25 ADDRESS
ELEC HEATERS 25 CITY TEL. NO
Ine 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER or CIRCUITS INSTALLED
TOTAL APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LIGHTS RECEPTAJOLEIt AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING
NUMBER HORSEPOWER rEe I CERTIFY THAT I POSSESS THE ABOVE VALID LOB
New MVD HP oven INC EACH ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER
ya i LEea • 26 or THE REBIDENTIAL ROPERTY DESCRIBED ABOVE
2 s0 SIGNATURE OR
2 S Ica PERMITTE
s is ISO INSPECTION RECORD
is SO 250
80 2930 Sao
200 soo 10 00
----Sao loco 15013
OVER 1000 2000 Z
mo SET/FREQ CHANGER HP a
WELDERS AC KVA rx
GENERATORS • KW O
TRANSFORMERS - KVA +
TEMP MOTORS (75 OF CRIB)
MOVED MoTORs (7s DF DRIB)
MISC
SIGNS
TYPE NO TRANS
PE NO LAMPS APPROVALS
r93R EACH PERMIT DATE INSPECTOR B NAME
WIRING 11111313 CONDUIT
rIXTURE6 111111313 WIRING
SUPPLEMENTARY so FI REB
6R
TOTAL FEE • UTILITY Co NoTIr1ED i
rINAL
WORKERS COMPENSATION DECLARATION,,.– a W6 lO/At_ APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self e06G
insure or a certificate of Workers 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 Q fL
Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE
❑
Certified copy is filed with the county building mspec 1 8 2 Family Sq Ft $ — S LOCALITY w eI
tion department Multi family Sq Ft — NEAREST �T
R r
Residential Swimming Pools CROSS ST Ar4eIqL
OWNER OR
Date Applicant FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS JO kw rys-hp
Outlets Rec�Light Sw_ MAIL
COMPENSATION INSURANCE First 20 ADDRESS O B P
(This section need not be completed If the work Involved by Total No Additional CITY 'p Tel No
the permit Is for one hundred dollars(:100)or less) PLAN CHEC
I certify that in the performance of the work for which this If
APPLICANT
permit 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 ADDRESS
Total No Additional
CITY Tel No
Date- Applicant Fixed Appliances Not Over 1 HP PERMIT i
NOTICE TO APPLICANT If after making this Certificate of
Exemption you should become subject to the Workers Range_ Heater_D W AL-01,
// APPLICANT _
Compensation provisions of the labor Code you must forth Oven _Dryer _W M — ADDRESS
with comply with such provisions or this permit shall be Top _ FAU —W H
deemed revoked CITY Tel No
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other
Disp _ Room Air Cond LICENSE Class
MM BER
(commencing with Section 7000)of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO PROCESSED BY �,
and Professions Code and my license is in full force and effect f �p d
Size&Type HP KW KVA or KVAR (� 1 `-'�J
License Number Lic Class Up to 1 Incl FINAL u
r Date Over 1 to 10 Incl DATE VALIDATION 0
Contracto
❑ Over 10 to 50 Incl FINAL V
I am exempt under Sec Over 50 to 100 Inc BY j W
B 8P C for this reason Over 100 a
Date Services Swbd MCC&Ponelboords ►
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600 V
❑
Exemption for Reg MaOver 1000 Amp or Over 600 V
mt Elect
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
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
Professions Code)
❑ I as owner of the property will do the work and the Misc Conduits&Conductors
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 000 ;9481 1 A
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY + # • •,• • • 2
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) 2 •�• 1 4.75
(Sec 3097 Civ C )
PLAN CHECKING FEE _ • •,• 1 4.7 5 F�-
Lender s Name 0*8 2 6—8 3
PERMIT ISSUING FEE
Lender s Address
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 authorize representatives of this County to enter upon
e above entwhed pr perty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
f- ` -
igna ure of Permittee Date