HomeMy Public PortalAbout9578 PENTLAND ST_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department F of CountBUILDING
EngineerFELECTRIC 1
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN 'Wal:ka 1: E@�� '�B r�vinpcc RECEIVED BY READY FOR DATE ISSUED
ADDRESS /�_ FIRST INSPECTION
CITY TEL NO. A,
COUNTY LICENSE NO. EXPIRES BUILDING
PERMIT FEES ADDRESS 9578 I.—Fen ,id-
NUMBER EACH FEE LOCALITY Temple Clty,
LIGHT OUTLETS NEAREST
CROBB ST.
RECEPTACLES
WALL SWITCHES OWNER 1
TOTAL OUTLETS 9 5C $ MAIL
ELEC. RANGER 25 ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
FIXTURES 5
1HEREBY 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 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NuMeER HORSEPOWER FEE ANGELES. COUNTY LICENSE. OR I AM THE LEGAL OWNER
NEW MVD. HP OVER IND. EACH OF TH/E,/("/�tES�IDENTIAL PROPERTY DESCRIBED ABOVE.
1/s 6 LESS $ .25
], BIGN�K'f'UM OFA
1/ 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 15 1.50
15 50 2.50
BO 200 5.00
200 500 10.00 J
500 1000 15.00 Q
Z
OVER 1000 20.00 E9
M.G. BET/FREQ. CHANGER-HP lz
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS t75% OF OR10.1
MOVED MC.TORS (75% OF DRIDJ
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING P $1.00 11nnCONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY ,gp FIXTURES /�^^
POWER
TOTAL FEE $ 1 10 UTILITY CO.NOTIFIED
FINAL
76^663 DBS#5A 2-53 / ,
WORKERS'&O1111PENSA'1ION DECLARATION, 200019 DPW 3/87
I hereby affirm that I have a certificate of consent to self CAPPLICATION FOR ELECTRICAL PERMITE-606G O
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy NcS&MA Company s. ars 66 FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
Certified co is filed with the count buildinginspec- 1 &2-Family, S Ft. $ — $ LOCALITY
copy y P y q NEAREST
tion department. r--� Multi-family Sq. Ft.
����}.�ggp �t1Cl. Residential Swimming Pools --OWNERCROSS OT.
RDate����a ` Applicant ott.
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLightSw.J MA
COMPENSATION INSURANCE ADDILRESS
tThis section need not be completed if the work Involved b First 20
he permit is for one hundred dollars($100)or less.) y Totdl No. Additional PLAN CH Tel. N g�_6
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 Lighting Fixtures' First 20 ADDRESS
so as to become subject to the Workers'Compensation Laws.
Additional
Date Applicant Total No. CITY Tel. No.
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Ove 1 HP PERMIT
Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION Q(a
Compensation provisions of the Labor Code, you must forth- Oven — Dryer W.M.— ADDRESS S
with comply with such provisions or this permit shall beTop — FAU Z W.H. —
deemed revoked. CITY'` Tel. Nog
LICENSED CONTRACTORS DECLARATION Hood — Fan —Other—
Dis — Room Air Cond. — LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 p REG. NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRI h)O. PR SED B >_
and Professions Code,and my license is in full force and effect. O D-
`` Size&Type HP, KW, KVA, or KVAR ���.../// O
n���1
License Number : Lic. Class Up to 1 Incl. FINAL U
\�� Over 1 to 10 Incl. DATE A 1A VALIDATION 0
Contractor,
� vDate���'m � a� _��
IDOver 10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. gY U
Over 100 LU
B.&P.C, for this reason D_
CD
Date: Services, Swbd., MCC&Panelboards Z
' 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
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit a
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits �1�+rr�.v
Professions Code): -s0-} 30
.225
❑ 1, as owner of the property, will do the work and the Misc. Conduits&Conductors 1 ITEMS
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule
Business and Professions Code). , TOTAL 30 o 25
CONSTRUCTION LENDING AGENCY
��
til
I hereby affirm that there is a construction lending agency for
30.
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) CHANGE .00
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name PERMIT ISSUING FEE 0000-0001 11129/89
Lender's Address 7117 1 AM 9:5
1 certify that I have read this application and state that the TOTAL FEE
above information is correct. I agree to comply with all County
ordinancesand regulating Electrical wiring, and
here b nze represen Ives of this County to enter upon
ove a fione rty for inspection p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
t
Signature of Per ittee Me es