HomeMy Public PortalAbout9918 NADINE ST_Electrical__ 76AG" OBS SA 3-50 APPLICATION FOR PERMIT
. , DEPARTMENT OF BUILDING AND SAFETY , ��������
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL INDISTRICT-00. GROUP ZONE PERMIT NO.
ELECTRICIAN
ED
ADDRESS U tv RECEIVED BY READY FOR FIRST INSPECTION ATE 1
CITY TEL No.t o g-ij a-
COUNTY LICENSE N0. O EXPIRES BUILDING //
P� FEES. ADORES. t- t
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST /
CROSS BT. L
RECEPTACLES
WALL SWITCHES OWNER 1 • C
TOTAL OUTLETS 344 SD III t Q MAIL
ELEC. RANGES 85 ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
FIXTURES s 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATS THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Or RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSBESS THE ABOVE VALID LOB
NUMBER HORSEPOWER rice ANGELES COUNTY LICENSES OR 1 AM THE LEGAL OWNER
New MvD. HP ovaR INC. EACH OF THE RESIDENTIAL PROPE D RIBED ABOVE.
A LZ9B 19 .25 SIGNATURE Or %,
va 2 .SD PERMITT�a
2 S. 1.00 INSPECTION RECORD
s is 1.50
--
is so 2.SO
so 200 5.00
2013 500 10.00 J
SCC 1000 18.00 Z
OVER 1000 20.00 O
M.O. BirT/FRM CHANGER-HP lz
WELDERBSAC-KVA
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% or ORia.)
MOVEMOTORS (76 or oars.)
MISC.
BIONS
N0. NO.TRANS.
NO. NO.LAMPS F7 APPROVALS
FOR EACH PERMITS DATE INSPECTOR'S NAME
WIRING 181.00 p'Q CONDUIT
rIXTUR¢S $1.00 06 WIRING
UPPLEMENTA .50 FIXTURES
POWER
TOTAL FEE 8 �s UTILITY CO.NOTIFIED
FINAL
WORKER S'COMPENSATION DECLARATION CE-806 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES -7— BUILDING AND SAFETY
insure,or a certificate of Workers'Compensation Insurance,or /
a.certified copy thereof(Sec.3800,Lab.C.)'
FOR APPLICANT TO FILL IN SOB
Policy No. CompanyEACH NO. FEE ADDRESS
New Residential Bldgs.&Pools
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY 1111
0 Certified co y g p Multi-family Sq. Ft. — OS �/�t
copy is filed with the count building inspection CROSS ST SAG(past 4CIA;;v
department. Residential Swimming Pools OWNER OR /►�j
FIRM NAME C��L E,V. 164 Oce-4—
Date Applicant Outlets: Rec.—Light ' Sw. MAIL f T
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. - >_COMPENSATION INSURANCE PLAN CHECK d
APPLICANT
(This section need not he completed if the work involvedU
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Additional
I certifythat in the Total No. O
performance of the work for,-which this Fixed Appliances Not Over 1 HP CITY Tel No. OF
permit is issued, I shall not employ y person in any manner PERMIT lL
so as to,become subject to the W ars'Compensatio Laws. Range_Heater D.W. _ APPLICANT a
E� S�
Oven _ Dryer_W.M._ ADDRESS z
Date���APplicantI JI Top _ FAU _W.H.,_
Hood _ Fan _Other_ CITY e
nl Tel No.
NOTICE TO APPLICANT: If, after ma g this Certificate of Disp. _.Room Air Condom LICENSE OR
Exemption, you should become su ject to the Workers' REG.NUMBER lass -4-0
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY
with comply with such provisions or this permit shall be
deemed revoked. . Size&Type HP,'KW,KVA,or KVA S
Up to 1 Incl.
FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE �� �Q� VALIDATION
Over 10 to 50 Incl. !JJ
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL ,
9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force and
effect. Services
License 3ME
r ��� Lic.Class C��� 0-200 Amp.Under 600 V
201-1000 Amp.Under 600 V
7 Tp �
Contracto_ ' '! oma Over 1000 Amp.'or Over 600 V
OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances r
I hereby affvSign with One Branch-Circuitm that I am exempt from the Contractor's �•
License Law for•the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors
13 I, as owner of the
property, will do the work and the Other(See Complete Fee Schedule)— '2.3010.5'.A
structure is not intended or offered'for sale (Section
7044, Business and Professions Code). # • •'• • • 2
CONSTRUCTION LENDING AGENCY, '
I hereby affirm that there is a construction lending agency 2'0'0 2 3 50
for the performance of the work for which this permit is pERMITIFEE (Sub Total) `
issued(Sec.3097,Civ.C.). •�•le'2 C5
3,5 0
-Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) I
Lender's Address 0 21 X91-812
PERMIT ISSUING FEE S
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 thJf County to enter upon
the aboverientioned property fr ins ction purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
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