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Home My Public Portal About9470 OLIVE ST_Electrical__ 6S9 DBS-SA 8•S9APPLICATION FOR ELECTRIC LECTRIC ®E MIT 1 1 DMSION OF BUILDING AND SAFETY ! Deportment of County Engineer County of Los Angeles BUILDING �� WM.J. FOX,COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. LIGHT OUTLETS NUMBER EACH FEE ' OWNER ) ` RECEPTACLES MAILADDRESS F, WALL SWITCHES TOTAL OUTLETS 5¢ S CITY TE!NO.ELEC.RANGES 25 ELECTRICIAELEC. HEATERS 25 ADDRESS KW EA CITY FIXTURES 5 LICENSE NO. NUMBER OF LIGHT CIRCUITS - DISTRICT O. GROUP Iff I READY FOR INSPECTION 5 NUMBER OF RECEPTACLE CIRCUITS I 1 IL MOTORS — WWW NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH i` ]F2 8 LESS S .25 1/2 2 .50 2 5 1.00 5 15 1.50 15 ";0 2.50 50 200 5.00 ` M C SIGNS NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERM IT* WIRING $1.00 FIXTURES 51..00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE g DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS A15PLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING _ ELECTRICAL WIRING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT THE LEGAL WNER OF THE ABOVE POWER DESCRIBED RESIDE PROPS UTILITY CO.NOTIFIED SIGNATURE OF PERM I FINAL �s WILLIAM J.FOY4 COUNTY ENGINE VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR i 2 13 01"no JAN?3 2 1.1 0 DBS-5A APPLICATION ION FOR ELECTP�C PERMIT 1 DBS-SA 9.53 DIVISION OF BUILDING AND SAFETY �D Department of County Engineer County of Los Angeles BUILDING r, WM.J. FOX,COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING ` PAMWI +'s LOCALITY " FOR APPLICANT TO FILL IN NEAREST PEBb= FEES CROSS ST. NUMBER EACH FEE �+ OWNER � LIGHT OUTLETS RECEPTACLES MAIL ADDRESS WALL SWITCHES .� TOTAL OUTLETS S¢ $ D CITY TEL.NO. ELEC.RANGES rZ 25 ELECTRICIAN ELEC. HEATERS 25 ADDRESS KW EACITY TEL.NO. '. FIXTURES 5 LICENSE NO. NUMBER OF LIGHT CIRCUITS - DISTRICT O. I GR� P I IO� READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS 0 MOTORS a NUMBER HORSEPOWER FEE INSPECTION RECORD 't[ NEW MVD. HP OVER INC. EACH 1/2&LESS 1 2 .50 2 5 1.00 5 15 1.50 d 15 50 2.50 6 50 1 200 5.00 a. MISC. w i NO.SIGNS NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERMIT- 1 WIRING $1.00 FIXTURES 51.00 i. SUPPLEMENTARY .50 APPROVALS TOTAL FEE S .i DATE IN PECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING �i I�} lr..• ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER I I { DESCRIBED RES IDENTIg].,PROPERTY '1 SIGNATURE pUTILITY CO.NOTIFIED :.' I < �Ja•��-� OF PERMITTEE FINAL WILLIAM J.FOX.COUNTY ENGIN ER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR i_ a O ftp 16 ti.� W�RKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT 1 ,I hr_ ffrm that I have a certificate of consent to self , CE-806G "ins e,'or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES i BUILDING AND SAFETY qr,a certified copy thereof(Sec. 3800; Lab. C.) 1361icyT-997042ompany INA Ins. FOR APPLICANT TO FILL IN JOB ❑ Certified co is hereby fur0hbld EACH NO. FEE ADDRESS PY Y New Residential Bldgs. &Pools 1 &2-Family,S 'Ft. $ — $ LOCALITY TeM— ];e City Certified copy is filed with ng inspec-j Y. q• tion department. I Multi=family Sq. Ft. — {.'NEAREST f Residential Swimming Pools CROSS OWNER TOR .Date a /� �Q O Applicant FIRM N RpillyCERTIFICATE OF EXEMPTIOORKERS' MAfL • COMPENSATION INSURANCE Outlets: Rec Light Sw._ ADDRESS same First 20 ` (This section need not be-completed'if the work involved by Total No. Additional CITY Tel. No. 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 I so as to become subject to the Workers'.Compensation Laws.. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of TKay nne A/C Exemption, you should become subject to the Workers] Range_ Heater.—D.W. APPCICAN Compensation. provisions of the Labor Code, you must forth- Oven —.Dryer _W.M.— r .ADDRESS14.41 S. Anahwim Blvd with comply with such provisions or this permit shall be Top _ FAU —W.H. — CITY Tel. No. revoked. Hood _Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE O . I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Roo.rn Air Cond. REG. NUMBER Cla (commencing with Section.7000)of Division 3 of the Business DISTRICT NO. PROCE ED BY and Professions Code,and my license is in full force.and effect. Power Apparatus&Large Appliances � I- Size&Type HP, KWj KVA;or KVAR'' ✓( �0 License Number 41 9758 Lic. Class x'20 FINAL ,r cc Up to 1 Incl. Ki V C Date 9 30 85 Over 1 to 10 Incl. DATE �' � V IDATION 0 Contractor Ylne�� f Over 10 to 50 Incl. FINAL V ❑ I am exempt under Sec. Ovet 50 to 100 Inc. BY Ul B.&P.C. for this reason Over'100 Date: Services,Swbd.,MCC&Panelboards ® e 0 -200 Amp. Under 600 V Signature 201 -1000 Amp. Under 600 V 3 0 9.4 A Over 1000 Amp. or Over 600 V ❑ Exemption for Reg. Maint. Elect. # o o o 0 0 2 SINGLE FAMILY I Temp. Power Pole&Appurtenances 1 0,0-17.50 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit Ihereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o 0 0 1 7.5.0 C5 Law for the following reason (Section 7031.5; Business and Professions Code): 1 (108-685 ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is .not intended or offered for sale (Section O er ee Complete Fee Sche e)_ , 7044, Business and'Professions Code). CONSTRUCTION LENDING AGENCY , I hereby affirm that there is a construction lending agency for the.performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE 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 ordUbe d State laws regulating.Electrical wiring,.-and heri re resentatives of this County to enter upon t eon d property Jor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 943U85 Sign ure of rmittee Date