HomeMy Public PortalAbout5114 PERSIMMON AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of BUILDING
Engineer ��������
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Enginoor
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN S. W. HERRIN ! 3 A- I ��573
ADDRESS 0937 BUFFINGTON ROAD RECEIVED BY READY FOR DATE ISSUED
L FIRST INSPECTION (�
CITY 4T OI TEL O. AD _/� _
COUNTY LICENSE NO. 4626 EXPIRES LS ADDRE eS/'�//-
PERMIT FEES
FEE
NUMBF.R EACH LOCALITY
LIGHT OUTLETS NEARER
C
RECEPTACLES
WALL SWITCHES OWNER
TOTAL OUTLETS 5C $ MAIL
ELEC. RANGES 85 ADDRESS
ELEC. HEATERS 25 +� CITY TEL NO.
FIXTURES 5
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MIBC. 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
NUMBER HORSEPOWER FEE ANGELEB COUNTY LICENSE. OR I AM THE LEGAL OWNER
NEw MVO. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY D RIBED ABOVE.
%z A LESS N .25 SIGNATURE OF r
I/22 .513 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 is ls0
is 50 2.50
50 200 5.00
200 500 10.00 J
5013 1000 15.00 Q
Z
OVER 1000 20.00 M
M.G. SET/FREQ. CHANGER-HP R
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIB-)
{
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
ND. NO.TRANS.
APPROlVALS
NO. NO.LAMPS
FOR EACH PERMIT: D TE INSPECTOR'S NAME
WIRING $1.00 9# CONDUIT
FIXTURES 431.00
WIRING
SUPPLEMENTARY .50 —FIXTURES
POWER
TOTAL FEE B T� UTILITY CO.NOTIFIED
1 FINAL `7�
TOA668 DBS*5A 4-58
WORKERS'COMPENSATION DECLARATION6A610/61 APPLICATION FOR ELECTRICAL PERMIT
hereb�6.affirm that I have a certificate of consent to self insure, E-a06o6G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy f�e 38 O,Lab.C.) <�
POIIC O. Ompa FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. EACHFFEEADDRESS
New Residential Bldgs.&Poolsfiled with t cc y building inspection 1 & 2-Family,Sq.Ft. $ LOCALITY
Multi-family Sq.Ft. NEAREST
Z II Residential Swimming Pools CROSS ST.
Date Applican OWNER OR _ n
1 FIRM NAME �J(
CERTIFICATE OF EXEMPTION FROM WORKE I Outlets:Rec_L___Light—Sw. MAIL
COMPENSATION INSURANCE ��j ADDRESS
(This section need not be completed If the work involved by the First 20 ._
permit is for one hundred dollars($100)or less.)
Total No. Additional CITY T
7 9
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 tot
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 PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer W.M._ ' OO ADDR
.provisions or this permit shall be deemed revoked. Top — FAU W.H. _ _
LICENSED CONTRACTORS DECLARATIONCIT
Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Cl
(commencing with Section 7000)of Division'3 of the Business and REG.NUMBER
Professions Code,and my license is in full force and effect. DISTRICT NO. PR•CE D BY
Power Apparatus&Large Appliances >
I/a r-t Size&Type HP,KW,KVA,or KVAR - � � Q
License Number Lic.Clas Up to 1 Incl. FINAL V
Over 1 to 10 Incl. DATE VALIDATION Q
Contractor Date Over 10 to 50 Incl. V
ElFINAL
I am exempt under Sec. Over 50 to 100 Inc. BY d
BAP.C:for this reason Over 100 IL
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 Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions
Code): _`••� %.� e
Misc.Conduits&Conductors _
❑ I,as owner of the property,will do the work and the structure a- _
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _
a-{
and Professions Code). iH� _ 70
I
CONSTRUCTION LENDING AGENCY k iii t_K -•
I hereby affirm that there is a construction lending agency for the NG
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) '-- jy1=�
Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address I /? i
I certify that I have read this application and state that the above TOTAL FEE . 7�
information i ct.1 agree to comply with all County ordinances
and State aws r gulating Electrical wiring, and hereby authorize
repress five his County to enter upon the above-mentioned
propel for i p on purposes.
1 SEE REVERSE FOR EXPLANATORY LANGUAGE
P9 /91--
Signature of Permittee Da e