HomeMy Public PortalAbout6126 OAK AVE_Electrical__ DBS 5'A fi-46, - ANIMATION
FOR PEFMr
_
` DEPARTMENT OF BUILDING AND SAFEff i8r1CLa�LL�iJ
COUNTY-OF LOS ANGELES �LEV�'ItiC
1111M. J. FOX CHIEF-ENGINEER -
4 NAME ff DISTRICT,NO. GRO/UP Z
ONE.. PERMIT NO.
U ADDRESS /rl �21
ry RECEIVED BY READY FOR DATE ISSUED
W CITY {J!' TEL.NO. _ FIRST INSPECTION
COUNTY 0
a CERT.NO. EXPIRES G C��
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY - = ,
DESCR _TION OF WORD. - a
NUMBER.OF OUTLETS ON CIRCUITS :LOCALITY n' _/�
'LOCATION-BY ROOMS NEAREST V-
_ LIGHT OUTLETS SW. PLUGS Fi , •CROSS ST. //�//1 r�I
CIRCUIT A B C D- •E F G H 'N NAME A�_v /ia
3 MAIL
• - C: � - � � � ADDRESS � c• �r f2 (�l� -
' O `�j
CITY Q�ri SF¢..No,`
1 AM��THE LEGAL ppbSSE830R OF THE ABOVE LOS
ANGKLEZ COUNTY CEl3TIFICATIC OF QUALIFICATION:.
ELECTRICIAN.
i-AM THE r Ed L OWNER OF 71j6 PROP DE``SCRIBEfD
OWNER
CORRECTIONS
�' - - Z '.
TOTAL �7. c-/"° -- Cr
[PERMIT
o.-OF OUTLETS I'Cj 9 S' APPROVALS
O. OF FIXTURES C/ f DATE INSPECTOR'S NAME -
. _ 16
r•.. wi
O. OF MOTORS H.P. $ CONDUIT
O. OF SIGNS = TRANS.
- WIRING
O OF RANGES OR HEATERS S FIXTURES
ISCELLANEOUS S POWER 1 t'
1 � j.
FEE / � >8 i ,UTILITYCO:NOTIFIEDOTAL FEE ✓" FINAL'
7SA663-CEBOB 9.54 APPLICATION FOR ELECT SUILDI
CAL PERMIT
COUNTY OF LOS ANGELES
DEPUILDING AND SAFETY D IVISION R ADDRESS 6126 N. Qi�K
NG
B
JOHN A. LAMBIE, COUNTY ENGINEER /t
COLEMAN W. JENKINS, SUP'T. OF BUILDING LOCALITY TEMPLE CITY
EST
FOR APPLICANT TO FILL IN CRROSS ST. GARIBALDI
RECEPT. a TOTAL , NO. EACH FEE.
LIGHT - 'OUTLETSFIRST 20 $20 $ OWNER DU FEE
MAIL
R ADD'L ADDRESS
SWITCH. 1" OVER 20 10
TOTAL 'CITY TEL.NO.
LIGHTING I FIRST .20 Q ,
FIXTURES _ = ADD'L OV9R 20 .10 ELECTRICIAN CONLEE & SON ELECTRIC
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS 1030 N. GRANDVIEVI'AVE.
GARB.DISP. STA.COOK CITY S 0, SAN. GABRIEIEL.NOAT o 0—200
DISHWASH. AUTO.-WASH. STATE C
SPACE HTRS.1 STA.APP.(VA H.P.MAX.) 1 .50 O O LICENSE NO.toti 6 C—lO
MOTORS: OVER NOT OVER H.P. DIST ICTG UP F.r P SSED B
O 1 1.00 - ar
J
1 AIR C®NB:— s 1 1.50 1,50
_ _t INSPECTION RECORD �n
5 s 2.00 f/ /�/ °S (!. %r . O
8 is 2.50
15 50 5.00
OC
50 100 5.00 O
SIGNS: NO.TRANS-
NO.LAMPS - y
Z
SERVICE 0.600V-NOT OVER 200A 1 1.00 10 Q
SERVICE 0-SOOV-OVER 200•A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00 2.100
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ o
I S HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR' SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _
ELECTRICAL WIRING. WIRING Py , `9
1 HEREBY.CERTIFY THAT 1 AM PROPERLY REGISTERED AND%OR FIXTURES
LICENSED AS REOUIR Y L ANGELES COUNTY AND STATE OF
CALIFORNIA OR THA I A TH EGA WNER O AND INTEND TO
RESIDE IN.THE ABO DE RIB D RES DE TIAL P PERTY. POWER A A
SIGNATURE , UTILITY CO.NOTIFIED I
y
OF PERMITTEE FINAL - (S�a-
(DATION JOSEPH C. ROOHAN
CK , MO CASH SUPERVISING ELECTRICAL ENGINEER
%
o 1 '1 3Q MAY 2 8 2 D 9.4.0~ 1
WORKER'S COMPENSATION DECLARATION 200019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I herbby affirm that I have a certificate of consent to self insure, 76A863
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Policy No.y Company FOR APPLICANT TO FILL IN B
ADDRESS
Certified co Is hereby furnished. NO. EACH FEE
PY Y New Residential Bldgs.&Pools _ $ $
CALITY-
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. _ NEAREST //
01,
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR
�/ MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec/�Light T Sw.e— O]N OR,�
COMPENSATION INSURANCE /�0 Q FIRM NRAME
,,pp First 20 MAIL D
(This section need not be completed If the work Involved by the Total No.� Additional ADDRESS t.
permit Is for one hundred dollars(S100)or less.)
I certify that in the performance of the work for which this permit CITY C,d 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 20 PLAN CHECK/
�,L APPLICANT
Total No.— Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code,-you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR i /v ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. / o
(commencing with Section 7000) of Division 3 of the Business and CITY Tel.No.
Professions Code,and my license Is In full force and effect. Over 10 to 50 Incl.
LICENSE Claes.
Over 50 to 100 Incl. REG.NUMBB ER d
Over 100 DISTRICT NO. P ED BY O
License Number Lic.Class
Services,Swbd.,MCC&p�P$Jjnelboards
Contractor Date
0-399
Afflpe4l der 600 V 0 DATE
❑ I am exempt under Sec. 400-1000 Amp.Under 600 V
— VALIDATION
Over 1000 Amp.or Over 600 V FINAL LU
B.&P.C.for this reasonBRANCH CIRCUIT FEES BY
Date: ISA,or 20A,120V,Lighting or Recept. , �` - Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 1SA,20A,208V To 277V Lighting Br.Circuits
SINGLE FAMILY Temp.Power Pole&Appurtenances rf4''- °.X
HOME OWNER-BUILDER DECLARATION i
h Ci
Bra
with One Branch Circuit _' 1101.401
I hereby affirm that I am exempt from the Contractor's License Law Sign w 313 •
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): LTEN
I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL. 11L',�� a 40
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) I
and Professions Code). CHECK i�`r3°'-1
CONSTRUCTION LENDING AGENCY ("HANGS °(,ill
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)
Civ.C. i'�I11'► i. �� ";{ 16/9
PLAN CHECKING FEE
Lender's Name 35 s•= 1 AM. 7:ci
PERMIT ISSUING FEE
Lender's Address TOTAL FEE �� 9
I certify that I have read this application and under penalty of purjury state
that the 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 the above-mentioned property
for I action urposes, SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF ERMITTEE DATE