HomeMy Public PortalAbout5108 PERSIMMON AVE_Electrical__ .o
r COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Dof County Engineer �'ELEC�1tIC i
DIVISIONSION OF OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN t v 2:- A- / d ' 6 s
EIVED BY READY FOR DATE ISSUED
ADDRESS I,i 11+• A
FIRST INSPECTION
CITY TEL. NO. �Jo�iJ �NC�e�
COUNTY LICENSE NO. EXPIRES0,00 4 ■UIL•DIMGL�T7�
PERMIT FEES ADDREB 6 j
FEE "�I •+� 7�
NUMBER EACH hw LOCALITY
LIGHT OUTLETS . NEAREST
RECEPTACLES CROSS BT.
WALL SWITCHES `I OWNER
TOTAL OUTLETS VO SD $ A I" MAIL
ELEC. RANGES 85 ADDRESS
ELEC. 'HEATERS 25 tt' CITY TEL NO.
FIXTURES 5 1
• --� 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
M15C. APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS r LAND 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 INC. EACH OF THE RESIDENTIAL PROPERTY DESC 7BED ABOVE.
%s A LESS B .25 SIGNATURE OF
I�p 2 ,50 PERMITTE _
z 5 1.00 INSPECTION RECORD
5 15. 1.50
is 50 2.50
50 200 5.00
200 500 10.00 J
500 1000 15.00 Q
Z
OVER 1000 20.00 E
19
M.G. SET/FREI3. CHANGER-HP ly
WELDERS,AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIS.)
MOVED MOTORS (75% OF CRIG.)
MISC.
SIGNS
NO. NO.TRANS.
NO. NO.LAMPS APPRO ,AL3
FOR EACH PERMIT, D TE INSPECTORPS NAME
WIRING 01,00 CONDUIT pp
FIXTURES $1,00 WIRING 3
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE N Y UTILITY CO.NOTIFIED ,rY
r w
FINAL
TOA663 DBS#5A 4-52
WORORS'.COMPENSATION
certificate
DECLARATION 76AW3 10/81 APPLICATION FOR ELECTRICAL PERMIT
r�` irm }Fiat shave a certificate of consent to self i CE=BO6G
ruse, or a,sertificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
of a'ceriif ed'copy thereof(Sec. 3800, Lob. Cl) I
P_oh v No.411W _266 npony 614,4`1U�• FOR APPLICANT TO FILL IN JOB y( Certified copy is hereby furnished. EACH NO. FEE ADDRESS
New Residential Bldgs. &Pools
2-Family, LOCALITY
❑ Certified copy is filed with the county building inspec- , 1 y, Sq. Ft. $ — $ ddb!
�E�RTIFITE
Multi-family Sq. Ft. — NEAREST
CROSS ST.:
� a ; Residential Swimming Pools FNER OR
DateAPPlicant '— Sf� L—C C 'FlRMNAME Oh
EXEMPTION FROM WORKERS' I If Li � � I MAIL
COMPENSATION INSURANCE 1 Outlets: Rec ghtri Sw. ADDRESSr'S/�^✓+Os�
First 20 dw
(This section need not be completed if the work involved by. Total No./ Additional CITY�Q�' Tel. No.
the permit Is for one;hundred dollars($100)or less.) 02
I certify that in the performance of the work for which this I , PLAN CHECK
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 I ADDRESS
`
�� Additional
Total No. CITY Tel. No.
Date applicant Fixed Appliances Not Over 1 HIS PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' Range_.Heater_D.W. — APPLICANT y—
Compensation provisions of the Lobor Code, you must forth- Oven _Dryer —W.M.— ADDRESS 7`- ,
with comply with such provisions or this'permit shall be Top _ FAU —W.H:—
deemed revoked. Hood _ Fan _Other_ CITY t vee � Tel. IVo.�'
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. _ Room Air Cond. Class.
j hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER 7� � .S`
(commencing with Section 7000)of Division 3 of the Business ,power Apparatus&Large Appliances DISTRICT NO PROCESSE B W
and Professions Code,and my license is in full force and effect. Q
Size&Type HP, KW, KVA, or KVAR ✓ L ® 0
License Number /r1 773 S Lic. Closs _ U /T 0,
Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATEVALID N
Contractorl�'RR• 6045• Date - (y,
❑
Over 10 to 50 Incl. FINALr W'
I am exempt under Sec. Over 50 to 100 Inc. BY / N
B'.&P.C: for this reason Over 100 Z
Date: Services, Swbd.,MCC&Panelboards ►
ti 0 -200 Amp,Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over.600 V j
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 Addi,ti.onal Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code):
❑ 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)_• ,
7044, Business and Professions Code). zJ U �,5 A
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for # 0 0 0 0 0 2
the,performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). 1 - 4200
0 0 4 2 O 0
PLAN CHECKING FEE
Lender's Name. 0 0 0
It PERMIT ISSUING FEE 4 2 0 0
Lender's Address j I
I certify that I have read this application and state that the i TOTAL FEE ya ; 11,1 2-;78 5
above 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 e-mentioned property for'inspection p •poses. I
� SEE REVERSE FOR EXPLANATORY LANGUAGE '
tiS' nature of Permittee Dat9Fj ;