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HomeMy Public PortalAbout5839 OAK AVE_Electrical__ 129 s-A 7-40 28M APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC WM J FOX CHIEF ENGINEER _J NATURE OF INSTALLATION DISTRIC O GROUP I ZONE PERMIT No WIRING FIXTURES SERVICE RECEIVED BY READY FOR DATEISSUED RANGE HEATER POWER (D /f FIRST INSPECTION �'_/ SIGNS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY Z JOB NAME ADDRESS U � ADDRESS It-- LOCALITY �j NEAREST Id CITY EL NO CROSS ST COUNTY CERT NO EXPIRES // / K NAME DESCRIPTION O§ WORK Z MAIL NUMBER OF OUTLETS OM CIRCUITS O ADDRESS LOCATION BY ODMS CITY TEL NO LIGHT OUTLE SW PLUG I AM THE LEGAL POSSESSOR OF THE ABOVE LOS CIRCUIT B C D E F G ANGELES COUNTY CERTIF]IC/�T6 O UALIF� �N LIVING OOM , CTRICIAN DINING ROOM ` I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED __ ABOVE BRFST RM OWNER BATH — CORRECTIONS ENT HALL — HALL NO FRONT PORCH OUTSIDE KITCHEN " BERV PCH Q BDRM NO `—1 z CLOSET BDRM NO I O C SET T TOTAL No OF OUTLETS %f46rd APPROVALS r 4 NO OF FIXTURES S DATE INSPXL'MR 9 NAME NO OF MOTORS H P S CONDUIT (t/ NO OF SIGNS TRANS ffi WIRING NO OF RANGES OR HEATERS ffi FIXTURES MISCELLANEOUS ffi POWER !' PERMIT FEE ffi UTILITY CO NOTIFIED / T TOTAL FEE $ O FINAL WORKERS'COMPENSATION DECLARATION 766663 DPW 3187 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB }� Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS D Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY U tion department. Multi-family Sq. Ft, CROSS NEARESTT y ^• 'A" a Date A licant Residential Swimming Pools OWNER OR y 1 PP FIRM NAME ...s 1F��,' T✓`f J CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light ." Sw.= r-! ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY ',i r/./.- 4' r7' Tel. No/_ .t'`/z the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional f.= Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to the Workers' Range— Heater—D.W. — ` 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. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER d (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PROCESSED BY 0 and Professions Code,and my license is in full force and effect. l Size&Type HP, KW, KVA, or KVAR rs�f U License Number Lic. Class Up to 1 Incl. FINAL J Over 1 to 10 Incl. DATE VALIDATION LL Contractor Date Over 10 To 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY Q B.&P.C. for this reason Over 100 < Services, Swbd., MCC& Panelboards ► 0 Date: 0- 200 Amp. Under 600 V 2 Signature 201 - 1000 Amp. Under 600 V LU ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V 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 Sig Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits •, - 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 7044, Other (See Complete Fee Schedule)_ , VAL Business and Professions Code). CONSTRUCTION LENDING AGENCY `"« I hereby affirm that there is a construction lending agency for t2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE ,101D T Lender's Name " 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 ayih rite representatives of this County to enter upon the abo�re' entioned property for inspection urposes. t ) f SEE REVERSE FOR EXPLANATORY LANGUAGE Signature rmittee Date es f