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Home My Public Portal About4938 PERSIMMON AVE_Electrical__ 7s td/8 5A 7-51 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. ELECTRICIAN Walton Eleatria COl (�3 6 �5``( RECEIVED BY READY FOR DATE 18HUED ADDRESS }� PA54 No Rosemead Blvd a• I') FIRST INSPECTION ) CITY E Monte TEL.NO. ►' 16, " &' ��V-'1 f 91 COUNTY LICENSE NO. 1104 EXPIRES BUILDING ��3� d4—ers+ejVg07 PERMIT FEES ADDRESS NUMBER EACH FEE LOCALITY Tamle City. LIGHT OUTLETS 7 NEAREST CROSS ST. RECEPTACLES 11.9 WALL SWITCHES 7 OWNER Celeste Const• Coo TOTAL OUTLETS7 5C � MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 ITY TEL. NO. ry FIXTURES r 5 I HEREBY ACKNOWLEDGE, THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE 19 CORRECT NUMBER OF LIGHT CIRCUITS x-70 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEw MvD. HP OVER INC. EACH OF THE RESIDENTIAL PR DESCRIBED ABOVE. %2 A LESS $ .25 SIGNATURE O I/2 2 .50 PERMITTER 2 5 1.00 INSPECTION RECORD 5 15 1.50 15 50 2.50 50 200 5.00 200 500 10.00 J 500 1000 15.130 Z OVER 1000 20.00 M.G. SET/FREQ. CHANGER-HP WELDERS•AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF CRIB.) MIBC. SIGNS NO. NO.TRANS. APPROVALS NO. NO.LAMPS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1.00 1 QD CONDUIT FIXTURES $1.00 11 OO WIRING SUPPLEMENTARY .50 FIXTURES POWER. TOTAL FEE $ 70 UTILITY CM,NOTIFIED FINAL • --- WORKERS'COMPENSATIOM DECPRA. Oi�Yi r. '76Z 10/BL .,'1 CE B06G . . : �4PPLICATI.ON FOR ELECTRICAL PERMIT !,,07hsirebydel affirm that I�.have a certifictite.�lof'conse)t to self i� u t r � I + insure, or a certificate of Wqrkers'Competnsat?yh-gurgrice, I 1 COUNTY OF,LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec:�3800; Lab..C.) Policy No. Company FOR APPLICANT TO FILL IN JOB F1 Certified copy is hereby furnished. New Residential.Bldgs. &Pools EACH NO. FEE ADDRESS ❑ $ LOCALITY Certified copy is filed with the county building inspec- I 1 &2-Family, Sq. Ft. $ = tion department. Multi-family Sq. Ft. 'NEAREST Date Applicant � Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM.WORKERS' I Outlets: Rec Light Sw._ 'MAIL r COMPENSATION INSURANCE i First 20 ADDRESS (This section need not be completed if the work involved bar Total No. Additional CITY Tel. No. the permit is for one hundred dollars( 5100)or less.) PIAN CHECK I certify that in the performance of the work'for which this 1 'APPLICANT permit 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 Date Applicant CITY Tel. No. Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of I PERMIT Exemption, you should become subject to the Workers' I Range_ Heater_D.W. _ APPLICANT + Compensation provisions of the Labor Code, you must forth- Oven _Dryer —W.M.— ADDRESS. with comply with such provisions or this 'permit shall be o- Top _ FAU —W.H. — deemed revoked. I CITY Tel. No. + LICENSED CONTRACTORS DECLARATION Hood _Fan _Other— _ Disp _ Room Air Cond. LICENSE Class. I hereby affirm that I am licensed under provisions of Chapter 9 . Room.Air NUMBER (commencing with Section 7000)of Division 3 of the Business I DISTRICT NO. P ESSED y BY and Professions Code,and m license is in full force and-effect. Power Apparatus 8 Large Appliances �►� _. t Size&Type HP, KW, KVA,.or KVAR- s' License Number Lic. Class. . Up to 1 Incl. FINAL W I Over 1 to 10 Incl. DATE _ VALIDA ION 99 Contractor Date Over 10 to 50 Incl. 1 am exempt under Seal Over 50 to 1.00 Inc. BIN E] B.&P..C. for this reason Over 100 Date:. Services, Swbd.,MCC&Ponelboards 0.-200 Amp. Under 600 V Signature, 201 - 1000 Amp..Under 600 V ' ExemptionOver 1000 Amp. or Over 600 V ' for Reg. Maint. Elec �15 4.9•R' + SINGLE FAMILY Temp. Power Pole&Appurtenances # o o 0 0 0 2 HOME OWNER-BUILDER DEC" RATION I Sign with One Branch Circuit I hereby affirm that I am exempt.from thlContractor's License � ( o o 2 5 5 0 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Prof Bions Code): I •o 0 0 2 5 5 Q U I, as owner of the property, will do the work and the ' Misc. Conduits&Conductors structure is not intended or offered for sale (Section .Other(See Complete Fee Schedule)_ , o 220-85 7044, Business and Professions Code). + CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for i the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ.. C.). If PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 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 with all County y ordinances and State laws regulating Electrical wiring,. and hereby authorize representatives of this County to enter upon the Bove=mentio d pro rty for inspection p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE +gnature of Permittee Date 4 , WORKERS'COMPENSATION DECLARATIOP� 76-►� "t4/BI ' APPWCA.TION FOR ELECTRICAL PERMIT I, hgr ,*affirm that I 'have a„certificate of cons6nt oto selfi CE-�6G t hsure;or ck certificate of Workers'Compensation Insurgnce, COUNTY OF LOS ANGELES �,�` • BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) P�olicy No. Company FOR APPLICANT TO FIL IN JOB EA H NO. FEE ADDRESS14q5 im(►O I O. Certified copy is hereby furnished. New Residential Bldgs. &Pools Certified copy is filed with the county building inspec- y, q. $ — S LOCALITY p►1 1 1 &2-Family, S Ft. �e C� tion,department. Multi-family Sq. Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR p CERTIFICATE OF EXEMPTION FROM WORKERS' FIRMN AME �}e Rep�S l� �,N1� COMPENSATION INSURANCE Outlets: Rec Light I .Sw.._3 t ADDRESS `I d O SI Q x) First 20. (This section need not be completed if the work involved by Total No. Additional �O CITY Te f 11 Tel, No.C/C•( .. 5y/ the permit Is for one hundred dollars($100)or less.) performance of the work for which this PLAN CHECK I certifyy that in the P APPLICANT permit is issued, I shall not employ any.person in any manner PJ so as to become subject to the Workers'Compe sation Laws. Lighting Fixtures First 20 Z A 7 ADDRESS Additional .• Total No.._-�_ CITY Tel. No. Date -/ A(pplicant. vFixed Appliances Not Over 1 HP PERMITp NOTICE TO P ICANT: If, after making this Certificate of APPLICANT YO-L Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ - Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top _ FAU —W.H. — CITY Tel. 1`46.deemed revoked. Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION j LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 i Disp. _ Room Air Cond.. REG. NUMBER . Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE D BY. and Professions Code,and my license is in full force and effect. (Power Apparatus&Large Appliances i Size&Type HP,,KW,, KVA, or KVAR' O V License Number Lic. Class •Up to 1 Incl.. FINAL � Contractor Date Over 1 to 10 Incl. DATE Ui' VALIDATION V Over 10 to 50 Incl. ❑ 1 am exempt under Sec: Over 50 to 100 Inc. IL B.&P.C. for this reason Over 100 Z Date: Services,Swbd.,.MCC&Panelboards , I LO -200 Amo Under 600 V. Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V V<1 5 Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances %o r. r.. HOME OWNER:BUILDER DECLARATION - ry 5 t; r "Sign with•One Branch Circuit _ a I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits r''06—8 h Law for the following reason (Section 7031.5, Business and Protf ' ns Code): L'tJ I, as.owner of the property, will do the work and the I lie Conduits 11 Conductors ' structure is not intended or offered for sale (Section i they(See Complete Fee Schedule.)_ , 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for A the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). I PLAN CHECKING FEE Lender's Name _ PERMIT ISSUING FEE IJSd Lender's Address .. ` I I certify that I have read this application and state that the TOTAL.FEE 5 5. i above information.is correct. I agree to comply with all County j ordinances and State laws regulating E.I. trical wiring, and hereby author' a repr entative o t s unty to enter upon the abo e- rationed p pert i sp tion purposes. ' �, / SEE REVERSE FOR'EXPLANATORY LANGUAGE Sig Lure of Pe . ittee _ Date i ti