HomeMy Public PortalAbout5337 PAL MAL AVE_Electrical__ �eAeaace eoe le/�eI APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO PILL IN ADDRESS — PO4 L AL
New Residential Bldgs 8 Pools EACH NO FEE DD b J
37
1 8 2 Family Sq Ft E 025 — $ LOCALITY C'
Multi family Sq Ft 02 — NEA ESST v
Residential Swimming Pools 25 00
FIRM NAME
Outlets Rec—Light_Sw _ 50 ADDRESS G f>I"
First 20
Total No Additional 30 CIT Tel No 9'
PLAN CHKK
APPLICANT
Lighting Fixtures First 20 50 ADDRESS
Additional 30
Tocol Na CITY Tel No
Fixed Appliances Not Over l HP PERMIT
Range_Heater_D W APPLICANT
ADDRESS
Oven_Dryer_W M
Top _FAU _ WH _ CITY _ Tel No
Hood—Fan _Other_ LICENSEOR Ij
Dnp _Room Air Cond 250 REG NUMBER Class
I HEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICA
Power Apparatus B Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size BT HP KW KVA or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS y
Type Up to 1 Incl 2 50 REGULATING ELECTRICAL WIRING " ' so
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl Soo LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Over 10 to 50 Ind 1250 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 50 to 100 Inc
2500 DESCRIBED RESIDENTIAL PROPERTY
rsn
PERMITEE
Over 100 40 00 ✓' V
SIGNATURE �r
Services DISTRI P D BY z
0 200 Amp Under 600 V 12 50 Z
201 1000 Amp Under 600 V 25 DO
Over 1000 Amp or Over 600 V 5000 Z
O
Temp Power Pole 8 Appurtenances 1000
Sign with One Branch Circuit 1000 0O=
Additional Sign Branch Circuits 200 INSPECTION ;
Misc Conduits 8 Conductors 1000 INFORMATION syyc A 0 5 5 0 A
Other(See Complete Fee Schedule)_ ON REVERSE SIDE V # e,e 0 2
2 • • 1950
• • • 19505
PERMIT FEE (Sub Total)
# 11:
PLAN CHECKING FEE (One Fourth Permit Feel O 0 2 7 8
F
PERMIT ISSUING FEE S7 00A?,so
=Qo
TOTAL FEE >
INSPECTION FINALED
dote 1,01J-12?
O/J /2? By es
WORKERS COMPENSATION DECLARATION 766W10,81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent toa4W6f self �'�'
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES �` BUILDING AND SAFETY
or a certified copy thereof (Sec 3800 Lab C ) / / /
Policy No Company FOR APPLICANT TO FRL IN 108 7 T L
Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH na FEE ADDRESS JJ
❑ 1 8 2-Family Ft s — 3 LOCALITY [� /
Certified copy m filed with the county building inspe< Y SQ
non department Multi-family Sq Ft — ='QST
CROSS S<
OR
Date Applicant
Residential Swimming Pools�/,n FIRRMM ENAME
vJ
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets"RxLightSw c MAIL 3 P
First 20 L
COMPENSATION INSURANCE ADDRESS
(This sectlon need not be completed R work ork Involved by I el No
the permit is for one hundred dollar($100)or less) Total No�.�. Additional
1 certify that in the performance of the work for which this 4 APPLICANT
permit is issued I shall not employ any person in any manner
so as to become subject to the Workers CompensaI, Law Lighting Fixtures First 20 ADDRESS
�j Additional p-��rs,'/�� Total No CITY No
y Date l-�.PS.LA� pplicant Fixed Appliances Not Over 1 HP PERMIT
/\ NOTICE TO APPLICANT If, aft making this Certificate of APPLICANT 1
Exemption, you should bec a subject to the Workers Range— Heater D W
Compensation provisions of Ore Labor Code, you must forth Oven _ DryerW Mx ADDRESS
with comply with such provisions or this permit shall be Top _ FAU W H —
deemed revoked Hood — Fan _Other_ CITY Tel No
LICENSED CONTRACTORS DECLARATION V S TUI
NSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Dup _ Room Air Cond REG NUMBER Class
(commencing with Section 7000) of Division 3 of the Buvness Power Apparatus 8 Large Appliances DISTRICT NO �� PROCE BY d
and Professions Code and m license is in full force and effect
Size 8 Type HP KW KVA or KVAR O
License Number Lic Clost Up to 1 Incl FINAL V
DATE
Over I to 10 Incl VALIDATION C
Contractor Date Over 10 to 50 Incl
❑ FINAL
I am exempt under Sec Over 50 to 100 Inc BY �
B 8P C for this reason Over 100 =
Dote Services Swbd MCC 8 Ponelboords ► i —
0 -200 Amo, Under 600 V
Signature 201 - 1000 Amp Under 600 V
ElExemption
1000 Amp or Over 60D V
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits
Law for the following reason (Section 7031 5 Business and
Professions Cade) .28683A
❑ I as owner of the property will do the work and the Misc Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► # 2
7044 Business and Professions Code)
2,• • 6075
CONSTRUCTION LENDING AGENCY • • • G Q,�5 s
5
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) 1230-82
(Sec 3097 Gv C )
PLAN CHECKING FEE
Lenders Name
PERMIT ISSUING FEE D
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 wish all County
ordinances and State laws regulating Electrical wiring and
hereby authorize representatives of this County to enter upon
t above mentioned property r spection purposes
r SEE REVERSE FOR EXPLANATORY LANGUAGE
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ignature of Permittee Date