HomeMy Public PortalAbout5203 PAL MAL AVE_Electrical__ 78"868 DBS SA 11-90 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR PPLICANT TO FILL IN DISTRICT NO. GROUP I 7 E PERMIT NO.
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDRESS S`I U 52r— �� FIRST INSPECTION
CITY TEL. NO.
L Nh/
COUNTY LICENSE NO. ® EXPIRESBUILDING
PERMIT FEES ADDRESS �a 3 V AdU
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
ST.
RECEPTACLES CROSS
WALL SWITCHES OWNER �11F`3'vyD I
TOTAL OUTLETS Sc S MAIL
ELEC. RANGES 85 'ADDRESS
ELEC. HEATERS 29 CITY TEL. NO.
FIXTURES S
1 HEREBY ACKNOWLEDGE THAT I 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 I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIA PROPER LM [BED ABOVE.
•
1/2 @ LESS $ .23 SIGNATURE OF
1/2 E .90
PERMITTE
2 5 1.00 INSPECTION RECORD
5 1s 1.50
1s so 2.50 CES
50 200 5.00L���'C3 �J�Z'{y%J 1 r{
200 500 10.00 1 % ®� J
Soo 1000 15.00 Z
OVER 1000 20.00 Ro
M. G. SET/FREQ. CHANGER-HP [Y
WELDERS:AC-KVA 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%ofORIG.)
MOVED MOTORS (75%oFOR16.)
MISC.
SIGNS
NO. NO.TRANS. I APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.001 1 IOU CONDUIT
FIXTURES
$1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $ l A%�� .UTILITY CO. NOTIFIED
® FINAL
WORKERS'COMPENSATION DECLARATION 7•'.6-80B 10/81 APPLICATION FOR ELECTRICAL PERMIT
CE-80f3G Il
I hereby affirm that I have a certificate of consent to self insure, .
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IIV JOB
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS fi?�✓. i
New Residential Bldgs.&Pools
❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools NER OR
6/ FIRMNAME i—WCILLD OL, 09LtC VAW
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light—Sw.— MAIL
COMPENSATION INSURANCE First 20 ADDRESSPO?" 64
(This section need not be completed if the work Involved by the CITY Tel.No.
t�L j
permit is for one hundred dollars($100)or less.) Total No. Additional `K G ��
7 /�
I certify that in the performance of the work for which this permit PLAN 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
NOTICE TO APPLICANT: If, after making this Certificate of y'PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT L L C-UJ n C � �(.1�k•2�Z
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS5Wg
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY—�M Tel.No.q LJ
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ OLS
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR 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. Power Apparatus&Large Appliances DISTRICT NV PROCESS Y
Size&Type HP,KW,KVA,or KVAR p
License Number Lic.Class Up to 1 Inc]. FINAL 8
Over 1 to 10 Incl. DATE Z ^ VALIDATION 0
Contractor Date Over 10 to 50 Incl. /
FINAL
❑ I am exempt under Sec. r)--';n to 100 Inc. BY W
B.&P.C.for this reason r iQ0 N'
Swbd.,MCC&Panelboards i1 C� ® Z
Date: 0-200 Amp.Under 600 V L
Signature 1 - 1000 Amp.Under 600 V
❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
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
Code):
I,as owner of the property,will do the work and the structure Mise.Conduits•&ConductorsACCTa
a
ACCT.
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ , 3
and Professions Code). 03 f ITEMS 65.20
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the TOTAL 65.20
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.). CHECK 65.20
PLAN CHECKING FEE �h11 yc1^f1�
Lender's Name C' 11
PERMIT ISSUING FEE
Lender's Address r
I certify that I have read this application and state that the above TOTAL FEE :cam Z1
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned
Property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
V n reof rmi a-e Date