HomeMy Public PortalAbout6132 OAK AVE_Electrical__ 76AG63C- CE8068 12/75 APPLICATION FOR ELECTRICAL PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN _ JOB
New Residential Bldgs.&Pools
EACH NO. FEE ADDRESS aG
1 &2 Finaily Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. — NEAREST.
Q r /3 dL �•/
Residential Swimming Pools CROSS ST
OWNER RM NAME Z o / e a4/ G k I�
Outlets: Light,Switch&Receptacle ADORE MAIL
s (m/3a !1/. O a kFirst 20 �/�/V�7•�
Additional CITY if of Of2 Jr— (44/ Tel. No.
PLAN CHECIC
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional
CITY Tel'... o.
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT
Range_ Heater_ D.W. ADDRESS
Oven _ Dryer _ W.M. VW
Top — FAU _ W.H. CITY Tei.No.
Hood — Fan LICENSE OR o
Disp. A.C.
REG. NUMBER. Class. v
�
• 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I--'
Power Apparatus&Large Appliances WITH ALL COUNTY. ORDINANCES AND STATE LAWS 'REGULATING C.D.
Size&Type HP, KW;KVA,or KVAR BLE CTRICAL WIRING. H
Up to 1 Incl. Z
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 50 Incl. DESCRIBED RESIDENTI PROPERTY'.
Over 60 t0 100 InCI. PERMITEE
Over 100 SIGNATURE
DISTRICT NO. P SEP qnr
Services
0-200 Amp. Under 600 V it 0"9
201 -1000 Amp. Under 600 V APPROVALS INSPECTOR'S
Over 1.000 Amp.or Over 600 V
SIGNATURE
J.RGUGH
.POW E.R.POLE
Temp. Power Pole&Appurtenances ERSLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits CONDUIT
(Other) NG
URES
ER.A.UTHORIZED
PERMIT FEE (Sub-Total) CeLTILITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL1� �
PERMIT ISSUING FEE
TOTAL FEE Imo, NOTES
PLAN CHECK VALIDATION CK. M.O. CASH*V PERMIT VALIDATION M.O. CASH
CK.
3 0 3 r-,N9V 16 .2 D . 9.0 0 efts
,y WGQZI{ERS'COMPENSATIONDECLARATION 7BAS63
CE$.06G.(2-80) APPLICATION FOR ELECTRICAL PERMIT
�
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES 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 JOB
Policy Nb. Company New Residential Bldgs:&Pools. EACH NO. FEE ;New
Certified copy is hereby furnished. 1 &2-Family,Sq.Ft. $ — LOCALITY 7F&gX1& C -
Multi-family Sq.Ft. NEAREST
Certified copy is filed with the county building inspection CROSS ST `1 POf 6V/ C
department. Residential Swimming Pools OWNER OR
FIRM NAME ®✓ �3`/
Date Applicant: Outlets: Rec Cig S ADDRESS
First 20
CERTIFICATE OF EXEMPT..ION FROM WORKERS' Total No, AdditionalCITY SeaegR Tel No.. e NZ
COMPENSATION INSURANCE ' ,
PLAN CHECK CL
(This section,need not be completed if the work involved APPLICANT 0
20 First Fixtures xtures rst
by the permit is for one hundred dollars ($100) or less.) LigADDRESS
' Total No.
�— Additional ' �•
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No.
permit is issued, I shall'not employ any person in any manner PERMIT W
so as to become subject to the Workers'Compensation Laws. Range_.Heater_D.W._ APPLICANT UJ
Oven — Dryer_W.M._ ADDRESSto
Date Applicant, Top _FAU _W:H.._
Z
Hood _ Fan _Other_ CITY Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond.— LICENSE OR
Exemption, you should become subject to the Workers' 7 REG..NUMBER Class
Compensation provisions of the Labor Code,you must forth- Power Apparatus&Large Appliances DISTRICT NO. P OCE ED BY
with comply with such provisions or this permit shall be Type Size Te HP, ,o
KW,KVAr KVAR
deemed revoked.• +( .
Up to 1 Incl. -
Over 1 to 10 Incl. FINALDATE VALIDATION
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl.
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 1'00 Inc. FINAL.
9 (commencing with Section 7006)of Division 3 of the Busi- Over 100 BY
ness and Professions.Cbde, and my license is in full force and r
effect. Services
License NumlierZ7 ✓� Lic.Class C 3 0-200 Amp.Under 600 V
�( 201-1000 Amp.Under 600 V
�!�
ContractorLaY✓m���/`ia! - Date - 7-/37-C!?0 Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances ,
I hereby affirm that 'I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi-' Additional Sign,Branch Circuits
ness and Professions Code):IL '
Misc.Conduits&Conductors ++
14 I, as owner of the property, will do the work and the Other.(See Complete Fee,Schedule)—
structure is not intended or offered for sale (Section c 1 3 Z 5 A
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency # a o :0 0 0 2
for the performance of the work for which this permit is PERMIT-FEE (Sub-Total) 2 o o 3 1.Q o.
issue4(Sec.3097,Civ.Q. /
Lender's Name O>/ S /001 PLAN CHECKING FEE (One-Fourth Permit.Fee) 0 0 0 3 0 C
Lender's Address TQ O. OSB?yrBL� PERMIT ISSUING F'EE
07, 17-80
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 author�fio �rrt
es of this County to enter upon
thabove- nor inspection purposes. SEVREVERSE FOR'EXPLANATORY LANGUAGE
a e orPermittee Date