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Home My Public Portal About5103 PAL MAL AVE_Electrical__ 76A663 D88 SA 11-60 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE/ PERMIT N.D. ELECTRICIAN-ChOPV PV RECEIVED BY READY FOR DATE ISSUED ADDRESS FIRST INSPECTION P CITY py COUNTY LICENSE NO. EXPIRES a 30-0 BUILDING PERMIT / 9 /� ��/qua PERMIT FES ADDRE98 4! ,,,} /N! {�n1 FEE LOCALITY7-e221 I NUMBER EACH LIGHT OUTLETS NEAREST yyrr'' RECEPTACLES L CROSS ST. WALL SWITCHES OWNER ��N C md TOTAL OUTLETS 5c MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY 9 TEL NO. FIXTURES 5 g 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NumsERHORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEw MvD. HP OVER INC- EACH DF THE RESIDENTIAL PR ERTY DESCRIBED ABOVE. r 4 II2 & LESS 9 .25 SIGNATURE OFj0f �2 2 .5m PERMITTE % �"/'01 �' "�•" 2 s 1.130 INSPECTION RECORD 5 15 1.50 13 50 2.5o Bo 2130 5.130 21313 BOO 10.00 J Boo loom 15.CC g OVER IOOO 213.00 M.G. SET/FREQ. CHANGER-HP WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% or DRIB-) MOVED MOTORS (75% of DRIB.) MIBC. SIGNS No. No.TRANS. I APPROVALS NO. NO.LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT: I WIRING lS1.013 CONDUIT FIXTURES l,pp ®� WIRING i SUPPLEMENTARY .513 FIXTURES POWER r TOTAL FEE $62 r UTILITY CO.NOTIFIED LFINAL 1� 76.0669-CE806 11-71 APPLICATION FOR ELECTRICAL PERMIT L.1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNEAREST ,� BUILDING AND SAFETY DIVISION D A a 019 Ile, �h? / FOR APPLICANT TO FILL IN OUTLETS NO. EACH FEE 1 OWNER RECEPT._ $ $ MAIL LIGHT TOTAL FIRST. 20 25 ADDRESS a, 1) i4fileL CITY TEL. NO. SWITCH OVER 20 .10 PLAN CHECK LIGHTING TOTAL FIRST 20 .25 APPLICANT OVER 20 ADDRESS FIXTURES - .f0 RESIDENTIAL APPLIANCES CITY TEL. NO. APPLICANT RANGE DRYER� AP _WTR. HTR. PLICANT e d I LO A q. STA. COOK DISP. F.A.U. ADDRESS, SPACE HTR. AIR COND. I CITY TEL. NO. CLOTHES.WASH. DISHWASH. LICENSE NO. CLASS. FAN OTHER 1.00 o I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER . TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF d CALIFORNIA OR THAT I THE LEGAL OWNER OF, AND.INTEND TO 1 - 110 9.00 RESIDE IN, THE A DESCRIBED ESIDENTIA PROPERTY. O SIGNATURE CK 10 - 50 5.00 OF PERMITTEE 50 100 10.00 �j DISTRICTNO. CLASS ONE PROCESSED BY Lu100 - 500 15.00 -T"4 -/ ° a .® � z SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: TUBE, OR MARQUEE ADDITIONAL CIRCUITS, 1.00 SERVICE NOTOVER600VOLTS OR200AMP 3.00 Q APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CEOVER 600 VOLTS OR 200AMP 10.00 TEMP.POWER POLE TEM P SERVI CE,POL E,&APPU RTENAN CES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT WIRING FIXTURES /{� PERMIT FEE (SUB TOTAL) POWER AUTHORIZED UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALI TION CK. M.O. CASH DCT 2 8.�0 v SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 06 5-A 18-4T 45M APPLICATION FOR PEMW ` DEPAItENT OF BUILDING .AND SAFETY_ ,OUNTY OF LOS ANGELES ELECTRIC WM. J. FOX .CHIEF ENGINEER NA vd��/ . DISTRICT NO. GROUP ZONJE PERMIT NO. ADDRESS AA ��c CITY .�VPLG�b TEL.NO. I n�7.h r RECEIVED sly READY FOR DATE ISSUED .1 FIRST INSPECTION W CERT.NO. .. `z EXPIRES •/r �/ � 7i ^E( APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLYJO G �4 DESCRIPTION OF WORK, ADDRESS NUMBER OF OUTLETS ON CIRCUITS r LOCALITY LOCATION 13Y ROOMS NEAREST.. LIGHT OUTLETS SW. :. PLUGS FI7[i CROSS or. AV E' a:gown CIRCUIT A B C D E F G H A: NAME kr I Z MAIL r, P4QC. 3 ADDRESS 0124 r O CITY• TEL.NO. 1 AM -THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIF CATS OF QUALIFICATION.. :I" n e crwaAN. •G• A1. VBTHX LEGAL OWNER OF THE PROPEATY DF�SCRIBID S 0, �► OWNER. 14 ' CORRECTIONS ��. 1?41 TOTAL NO. OF OUTLETS G s 1 3 O APPROVALS.. NO. OR FIXTURES ffi 9 a DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT n // LPEIRM OF SIGNS TRANS. S WIRING OF RANGES OR HEATERS S FIXTURES 1 - ELLANEOUS S POWER IT FEE S UTILITYCO.NOTIFlED ,L FEE JS, FINAL WORKERS'COMPENSATION DECLARATION 76-863 10/81 APPLICATION FOR ELECTRICAL PERMIT - CE-808G, I hereby affirm that I have a certificate of consent to self insure, or0a certificall of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY ,copy thereof(Sec.3800,Lab.C.) Policy Mb. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS -15-10:5 d New Residential Bldgs.&Pools I ❑ 1 &2-Family,Sq.Ft. $ — $ LOCALITY / Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. — NEAREST CROSS ST. AA $ Date Applicant Residential Swimming Pools OWNER OR NAME /r I f, D r F _e 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 CIT Tel.No I certify that in the performance of the work for which this permit PIAN CHECK APPLICANT 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 ADDRESS Total No.. Additional CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT i NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT (/ r �[�} Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS a J provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _ CITY Tel.Noil il LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ y I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. LICEN MB Class. (commencing with Section 7000).of Division 3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. DISTRICT NQ—. PROCE ev, „ Power Apparatus&Large Appliances Size&Type HP,KW,KVA,or KVAR O License Number Lic.Class Up to 1 Incl. FINAL Over 1 to'10 Incl. DATE 2 -7 VALIDATION O Contractor Date Over 10 to 50 Incl. FINAL V ❑ I am exempt under Sec. Over 50 to 100 Inc. BY OW.. B.&P.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards , Z 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. SINGLE FAMILY Temp.Power Pole&Appurtenances 3307 25050 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 ITEMS I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits T�yp� ��® � Code): I�+.��44►TA,� I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors �d1s771 25.511 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® ME .00 and Professions Code). CONSTRUCTION LENDING AGENCY nye!ere� f 1 n �O I hereby affirm that there is a construction lending agency for the MD—Mol 10/31 I� performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). 6485 1 AH110-13 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE ' Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct.I agree to comply with all County ordinances and State laws regulating Electri I wiring, and hereby authorize representatives of this Co y enter upon the above-me tioned prop or i pecti se SEE REVERSE FOR EXPLANATORY LANGUAGE /4 I Sig ure of tee at rr