HomeMy Public PortalAbout9903 NADINE ST_Electrical__ 76A663,DOSS^ 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR AP LI.CANT TO FILL IN DISTRICT NO. ORONO.
ZONE PERMIT O.
ELECTRICIAN ' 7 4 -1 � /o
RECEIVED BY READY FOR DATE ISSUED
ADDRESS O rr FIRST INSPECTION 3 _
CITY TEL NO.lYJ
COUNTY LICENSE NO. EXPIRES BUILDING
ADDRESS O ��
PERMIT FEES
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROBB ST.
C
WALL SWITCHES OWNER
TOTAL OUTLETS sc D MAIL
ELEC. RANGER 2s ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
FIXTURES B 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MIBc. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITI4 ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPE DESCRIBED ABOVE.
NEW Mw. HP ovEa iND. tACH �//R/T�
YA m UEBe # .25 SIGNATURE 0110
2 .50 PERMITTEE
2 B 1.00 INSPECTION RECORD
s 15 1.60
is 80 2.110
so 200 8.00
200 Soo 10.00 J
500 1000 15.00 Z
OVER 1000 20.00 O
M.G. SET/FREQ, CHANGER-HP lz
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% or DR1G.)
MOVED MOTORB (75% or Dials.)
MISC.
SIGNS
N0. NO.TRANB. T7*
APPROVALS _
NO. NO.LAMPS
DATE INSPEOTORPB NAME
FOR EACH PERMITS
WIRING 1111.00 ()d CONDUIT
FIXTURES $1.00 0 C7 WIRING /7
SUPPLEMENTARY .80 FIXTURES
POWER \
TOTAL FEE ® UTILITY CO.NOTIFIED
FINAL
.. a= RKER'�`COMPENSATION DECLARATION 200019 DPW 9/89 APPICA�'ION FOR ELECTRICAL PERMIT
78A683
'I he��by that t have a-certificate of consent to self Insure,
'or'g certiflcate of Workers Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPTT,OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JO RESS 0 3
Madine Sl-
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. = FEE ADD
LOCALITY �I
1:3 Certified copy Is filed with the county building inspection' 1&2-Family,Sq.Ft. $ — $
department. Multi-family Sq.Ft. C OSS ST. G,OI c"
Data Applicant Residential Swimming Pools ASSESSOR /� Q
.�,_.,—� �,; ' MAP BOOK V—�CJ V PAGE ` /V PARCEL 00/
CERTIFICATE OF EXEMPTION FROM WORKERS' � /%(J t OWNER OR
COMPENSATION INSURANCE Outlets:Rec. ght SW. �,70 J� FlRM NAME
First -7000MR
(This section need not be completed If the work Involved by the
permit Is for one hundred dollars($100)or lose.) Total No. Additional t`J 156 TA ADDRESS
I certify that in the performance of the work for which this permit CITY Tel.No.
Is issued, I shall not employ any person In any manner so as to
become subject to the Workers'Compensation Laws. Lighting Fixtures First 6 . O " APPLICANT
PLAN K
• Total No. Additional
Date Applicant ADDRESS
120V BRANCH CIRCUITS
NOTICE TO APPLICANT: If, after making this Certificate of 15 OR 20A, � - CITY Tel.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 APPLICANT J a 1,0 1 G
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH n
LICENSED CONTRACTORS DECLARATION ADDRESS Ct I'J3 Q %r, T 4.
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING•EACH O
(commencing with Section 7000)of Division 3 of the Business and CITY r� G f Tel.No. �s���pQ U
Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Clens. O
Power Apparatus&Large Appliances- _ REO.NUMBER
License Number Lic.Class Size&Type HP,KW,KVA,or KVAR _ DISTRICT NO. p' PROCESSED BY
Up to 3 Incl. W
Contractor Date Over 3 to 10 Incl DTE V)
Over 10 to 50 Incl.❑ I QQ Z I am exempt under Sec. Over 50 to 100 Incl. I` 4�7 - VALIDATION
Over 100 FINAL
B.&P.C.for this reason BY
Services,Sw,bWd.� CCjPe (boards .
Date: 0-20G A7Frp.U�der Z 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
HOME OWNER-BUILDER DECLARATION
ith Ci
B
with One Branch rcu
I hereby affirm that I am exempt from the Contractor's License Lew Sign w
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch.Circuits
Code): 1 T TENS
to - ---
I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors ��; -k:,i F=�� �'i
Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ,
..ir _ _ r
and Professions Code). :• sr%•`: (w7531�}
ifl�t•Ita
CONSTRUCTION LENDING AGENCY
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) 3
CIV.C.) - s C.
PLAN CHECKING FEE E:j-!=j "': E?:_1 .r :f 7
Lender's Name p•_ .11�
PERMIT ISSUING FEE
Lender's Address
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
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentloned
prope for inspectiyurpos�e SEE REVERSE FOR EXPLANATORY LANGUAGE
11_LL 5�^9Z
SIG IATURE 01 APPLICANT R AGENT DATE