HomeMy Public PortalAbout5019 PAL MAL AVE_Electrical__ 7GA03 SA 25M SETS 7.45 �711�*CATION LIAR S1Lb1R'!f0
DEPARTMEW OFF LOSING ANO sAFETY ��E�LvEIEilVCl� 1TRI�Ci��i
COUNTY OF LOS ANGELES
M J. HI FE
a NAME q DISTRICT NO. GROUP ZONE PERMIT NO.
ADDRESS � . / �� . A-1 . 16 16
CITY TEL.NO. �Y READY FOR DATE ISSUED
.1 COUNTY FIRST INSPECTION q o
WW G 17
o
LICENSE NO. EXPIRES
APPLICANT FE.L IN E MMY OUTLINM PORTION ONLY
DESCRIPTION OF WORE UA SP S E L —v
NUMBER OF OUTLETS ON CIRCUITS
LOCATION BY ROOMS
LIGHT OUTLETS 8W. PLUGS NE
NEARE
CIRCUIT A B C D E FJr. H CA 1.1.! //Ti .0
c� ,p� i�
�21 t^�R�� ESS ay® �++ q� C Q..sMPAj% &B 4Y'TEL.NO.r� ��l4 Z, r
L �P� 1 AM THE LEGAL POSSESS OF THE ABOVE LOS a
ANGff"W COUNTY CERTIFICATE OF QUALIFICATION..
K&Z=RIeIAN.
I AM THE BR THEP PFRTY=Esc
ABOVE e-
bv YA
OWN
IdHi MONS
4 J
Q
Z
m
O
TOTAL
NO. OF OUTLETS MIS$
_ APPROVALS
NO. OF FIXTURES r DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. CONDUIT
NO. OF SIGNS TRANS. 'WIRING
NO. OF RANGES OR HEATERS FIXTURES
MISCELLANEOUS POWER
PERMIT FEE UTILITY CO.NOTIFIED.
TOT FEE FINAL
76AWS SA 46M BETS 7-48 •7111?*CATION FORPERM
COUNTY Y F LOSING AND gAFEI'Y 1�rE'L�lEiiVl� i' V IC
COUNTY OF LOS ANGELES
. J. O HI F E G
ADDRESSe EE: DIST N0. GR�O
UP �N� I���.
1 RWMVEQ READY FOR DATE ISSUED
CITY TEL.NO. FIRST INSPECTION
COUNTY a e-- a 1 0
LICENSE NO. EXPIRES 7
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
DESCRIPTION OF WORK ADDRESS .!P .5 b ' v
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAR
LIGHT OUTLETS SW. PLUGS Fl ir CROSSST.
Ica,
RCUIT A B D C E F G H m NAME d r 0.�' t1 It b�AD
Id
AIL
�j/.�' _ z� ADDRESS s7 a ��
CITY ,15,
I AAp��Np�THE LEGAL POSSES OF THE ABOVE LOS
ANGELES COUNTY CERTIFICAT$ OF QUALIFICATION..
E18CTRICIAN.
1 AM THE M. 'F THE P OPFJiTY DEs ED 1
ABOVE
OWN .
M . 70NS
a j
Q
Z
L7
[C
O
TOTAL
NO. OF OUTLETS 65, (-" $ APPROVALS
' NO. OF FIXTURES -:3 � DATE INSPECTOR'S NAME
NO. OF MOTORS N.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS ffi FIXTURES
t
ELLANEOUS $ POWER
OIT FEE $ UTILITYCO.NOTIFIED
FEE �' FINAL
WORKERS'COMPENSATION DECLARATION OE 8oeG tG/at APPLICATION FOR ELECTRICAL PERN4IT
I hereby affirm that I have a certificate of consent to self insure,
or a ceriffcate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES I BUILDING AND SAFETY
copy.•.hereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB /
.❑ Certified copy is herebyfurnished. EACH fJO. FEE dDDRESS
New Residential Bldgs.&Pools❑ �OCALITY
y g inspection Certified copy is filed with the count building 1 &2-Family,Sq.Ft. $ _ $
department. Multi-family Sq.Ft. NEAREST
GROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
F)RM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light_Sw.— MAIL
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars($100)or less.)
Total No. Additional CITY Tel.No.
I certify that in the performance of the Work for which this permit P�AN CHECK
is issued, I shall not employ any person in any manner so as to APPLICANT
become subject to the Workers'Tn
tion Laws. Lighting Fixtures First 20 ADDRESS
Additional
Total No. CITY Tel.No.
Date. ApplicaFixed Appliances Not Over 1 HPNOTICE APPLICANT: If, ng this Cerificate of PERMIT
Exempti n,you should become su Workers'Compensation
Range_ Heater_ D.W. _ APPLICANT �-�
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _ ��
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY No. k"Z
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE B Class.
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER �} (M
Professions Code,and my license is in full force and effect. DISTRICT Nq�� �/ PROC ED BY
Power Apparatus&Large Appliances .{J-. (XJ p
n Size&Type HP,KW,KVA,or KVAR U
License Numb e / Lic.Class C`f� Up to 1 Incl. FINAL Q� Ile
Over 1 to 10 Incl: DATE ✓// VALIDATION cO
Contractor Date Over 10 to 50 Incl. V
FINAL
❑ I am xempt under Sec. Over 50 to 100 Inc. BY 0.
100
B.&P.C.for this reason Over I Z
Services,Swbd.,MCC&Panelboards
Date: 0-200 Amp.Under•600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect. ,a
a
SINGLE FAMILY Temp.Power Pole&Appurtenances �•
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT Ar
I hereby affirm that I am exempt from the Contractor's License Lawr
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits 3307 25,511
Code):
1 ITEM
ElI,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 25.50
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code).
CHECK 25M
CONSTRUCTION LENDING AGENCY I C�yA�irfrL ,�I
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) o
Civ.C.). /15
PLAN CHECKING FEE GMD—M 8/24/89
Lender's Name r� 5282 1 AN 90-17
PERMIT ISSUING FEE
Lender's Address G
I certify that I have read this application and state that the above TOTAL FEE 5�J
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representati Of this County to enter upon the above-mentioned
proper r i pection p'ur ose SEE REVERSE FOR EXPLANATORY LANGUAGE
Signa of Permittee ate 4