HomeMy Public PortalAbout6396 OAK AVE_Electrical__ IGA663C- CE8068 12/76 APPLICATION FOR ELECTRICAL PERMIT
BUILDING AND SAFETY DIVISION '4�WIK ILL.JJJ
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Pools
EACH NO. FEE ADDRESS N.
1 &2 Finaily.Sq. Ft. 10 $ — $ LOCALITY
Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS..ST.
OWNER OR
FIRM NAME
Outlets: Light,Switch&Receptacle MAIL �aa
.
First 20 � �® ADDRESS /V
Additional CITY 0AII., Tel.No. b�
PLAN.CHECK
Lighting Fixtures APPLICANT'
First 20 AQ A® ® ADDRESS
Additional
CITY Tel. No.
PERMIT
(Fixed Appliances Not Over 1 HP APPLICANT
Range Heater_ D.W. ADDRESS kbtkoWLtts
Oven _ Dryer _ W.M.
Top FAU W.H. _ CITY Tel.No. 104-4414S7 �-
Hood Fan
— ENUMBER
Disp. JA.C. 17 ! d �4 Class.
ar
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 0
AND TATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY
SV
Power Apparatus&Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 8
LLI
Size&Type HP, KW,KVA,.or KVAR ELECTRICAL WIRING'. ti
Up to 1 Incl. 1. D Z
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTEREAND/OR
Over 1 to 10 Incl LICENSE. AS REgU1RED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 50 Incl. DESCRIBE.RESIDENTIAL PROPERTY.
Over 50 to 100 Incl. _ PERMITEE "
Over 100 SIGNATURE
DISTRICT NQ. PROCESSED BY
Services 's—,
a
0-200 Amp. Under 600 V ,
201 -1000 Amp. Under 600 V APPROVALS DATE INSPECTOR'S
Over 1000 Amp.or Over 600 V '
SIGNATURE
TEMP.POWER POLE
Temp.Power Pole&Appurtenances UN,DERSLAB WOR. ° , d
Sign with One Branch Circuit.
Additional Sign Branch Circuits ROUGH CONDUIT
(Other) WIRING
FIXTURES
s1AS
POWER AUTHORIZED
PERMIT FEE (Sub-Total) vUTILITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) a�
FINAL
PERMIT ISSUING FEE
TOTAL FEE NOTES
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDAT NCK. M:O. CASH
e 7 5:09SEP 12 2 0 3 `13 5
WOAK
TON
TION
I hereby Affirm that I'h veMa cert�ifi Tate.of conse t to self insure, 0019 DPW(12-91)78A863 APPLICATION FOR ELECTRICAL PERMIT
or ii 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 N0. Company FOR APPLICANT TO FILL IN JOB /
ADDRESS IN li^ F6 F�yA U E
b /7
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE ---+
_ $ $ LOCALITY J,& e
Certified copy is filed with the county building Inspection 1 &2-Family,Sq.Ft.
SSTC033department. Multi-family Sq.Ft.
Q
it D
Date Applicant' Residential Swimming Pools ASSESSOR
MAPBOOK 3 PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS'. 31OWNE
RR O .
Outlets: BC, Light�_SW. FIRM NAM ,��} �5
COMPENSATION INSURANCE
(This section need not be completed If the work Involved by the First 20 MAIL
permit is for one hundred dollars($700)or less.)
Total No. Additional ADDRESS �t�r/�
I certify that in the performance of the work for which this permit CITY C 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:
9 g APPLICANT
Total No. Additional
ADDRESS
Date ApplicantRESIDENTIAL 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 ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(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 OR Class.
Over 50 to 100 Incl. REO.NUMBER D.
License Number
Over 100 DISTRICT NO. PROCESS 0
Lic.C_lass
Services,Swbd.,MCC&Panelboards• 4Q
Contractor Date
0-399 Amp.Under 600'V FINAL O
`
DATE
I am exempt under Sec. 400-1000 Amp.Under 600 V 1 LJJ
Over 1000 Amp.or Over 600 V FINAL
t/ VALIDATION V'
B.&P.C..for this reason BRANCH CIRCUIT FEES BY
Date: 15A,or20A,120V,Lighting or Recept. Z_
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
41 Or More Branch Circuits
Exemption for.Reg:Malnt.Elect. 15A,20A,208V To 277V Lighting Br.Circuits
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION ACCTog'
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the following reason(Section 703.1,5, Business and Professions Additional Sign Branch CircuitsW-51VILP, Ir 3307 55.58
Code): 1. ITEMS
I,as owner of the property,will do the work and the structure
Misc.Conduits&Conductors
•is not intended or offered for sale(Section 7044, Business Other(See.Complete Fee Schedule) , TOTAL 55.58
and Professions Code).
CHECK55.58
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending-agency for the CHANGE .00
performance of the work for Which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) .7
Civ.C.)
PLAN CHECKING FEEIjl�i�—i [��� /19I$3
Lender's Name
PERMIT ISSUING FEE 7687 1 Aft 'I#n36
Lender's Address
I certify that I have readthis application'and under penalty of purjury state TOTAL.FEE �
that the above information Is correct. I agree to comply with all County
ordinances and State laws regulating Electrical Wiring,and hereby authorize y
representatives of this County to enter upon above-mentioned property
for Ins p to urposescSEE REVERSE FOR EXPLANATORY LANGUAGE
SIO E OF PERMITTEE DATE ,