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Home My Public Portal About5745 PRIMROSE AVE_Electrical__ 76A663 CBS BA 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT ND. ELECTRICIAN ADDRESSRECEIVED. BY READY FOR DATE ISSUED �� f FIRST INSPECTION CITY TEL No. COUNTY LICENSE NO. EXPIRES BUILDING fCo/ V/LfylZLd-¢�. PERMIT FEES NUMBER EACH FEE LOCALITY LIGHT OUTLETS 2 NEAREST CROSS ST. RECEPTACLES WALL SWITCHES OWNER +A:�� TOTAL OUTLETS 5O IIS 3 MAIL / g ELEC. RANGES 85 ADDRESS (O J ale, / � ELEC. HEATERS 25 CITY TEL. NO.Gc�s��e,C' —a FIXTURES 5 O I HEREB ACKNOWLE GE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IB CORRECT NUMBER OF LIGHT CIRCUITS y Y' AND AGREE TO COMPLY WIT14 ALL COUNTY ORDINAN13ES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS Numsm HORSEPOWER FEE ANGELES COUNTY LI CEN E. OR 1 AM THE LEGA�OWNIERNEw MVO. HP OVER IND. EACH OF THE RESIDENTIAL P PERTY DESCRIBED AB %2 & LEBB !6 .25 SIGNATURE OF I/2 a .50 PERMITTEE a 5 1.00 INSPECTION 99CORD 5 is 1.50 is so 2.50 5o ZOO 5.00 ao0 Boo 10.00 J Soo 1000 15.CO Z OVER 1000 20.00 0 M.G. SET/FREC). CHANGER-HP Ix WELDERS:AC-KVA G GENERATORB - KW TRANSFORMERS - KVA TEMP. MOTORS (75% or ORIS.) MOVED MOTORS (75% Or ORIG.) MISC. SIGNS NO. NO.TRANS. APPROVALS NO. NO.LAMPS FOR EACH PERMITS DATE INBPEDTORPB NAME WIRING $1.00 CONDUIT FIXTURES 61.130 / WIRING !,!C=�� L� i/'� i SUPPL MENTARY .50 FIXTURES POWER TOTAL FEE ! 4 UTILITY CO.NOTIFIED, FINAL WORKER S'COIVIPENSATIONl,IECLARA I N !` ' .I 'OAB06G Ad) � APPLICATION FOR ELECTRICAL PERMIT rI Ihereby affirm that I have a certificate of consent to self , - COUNTY OF LOS ANGELES BUILD1.NG AND SAFETY�r e r insure,or a certificate of Workers'Compensation Insurance,.or a certified copy thereof(Sec.3800,.Lab.C.) Company FOR APPLICANT TO FILL IN JOB Policy No. J ��/i� e ti New Residential Bldgs.&Pools EACH NO. FEE ADDRESS (L„(� /� �7� SL Certified copy is hereby furnished. 1 &2-Family,Sq.Ft. $ — $ LOCALITY ElCertifiedSq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST departmbnt. Residential Swimming Pools :a .OWNER OR FIRM NAME d�/V Date Applicant Outlets: Rec.—Light Sw.• • ADDRESS First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional C.ItiTY Tel No. COMPENSATION INSURANCE PLAN CHECKtl (This section need not be completed if W work involved I APPLICANT by the permit is for one hundred dollars ($100) or less.) I Lighting Fixtures First 20 ADDRESS �. �� s Total No. Additional e. I certify that in. the performance of the work for which this CITY Q Tel No.�X�--� fe permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP,I PERMIT W so as to become-subject to the Workers'Compensation Laws. Range_Heater D.W._ APPLICANT a n _ Dryer_W.M._ ADDRESS / Z / _ FAU _W.H. ate Applicant CITY Tel No. Hood _ Fan _Other_ 'NOTICE TO APPLICANTi•If, after making this Certificate of I Disp. _Room Air Cond__ LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER Class 'Compensation .provisions of the Labor Code,you must forth• Power Apparatus&Large.App liances - DISTRICT NO. PROCESflED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR Up to 1 Incl. ' FINAL - LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE r � � VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINA BY 9 (commencing with Section 7000)of Division 3 of thb Busi- Over 1.00 ness and Professions..Code,and my license is in full force and i effect. i Services , License Number Lic.Class 0-200 Amp.Und'er 600 V 201-1000 Amp..Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I .am exempt from the Contractor's Sign with One Branch.Circuit 11 r , X License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits q IS�Q C ff- ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— 4 q, . structure is not intended or offered for sale (Section 7044,Business and Professions Cdde). CONSTRUCTION LENDING AGENCY I hereby affirm that there. is a construction lending agency for the. performance of the work for which this permit.is PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.). - Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE Q ,rd 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 ordinances and State' laws regulating Electrical wiring, and hereby authorize representatives of this County.to enter upon theabove-mentionedproperty for inspection purposes. I SEE'REVERSE FOR EXPLANATORY LANGUAGE SiWature of P— ermit a Date WORKERS'COMPENSQ7IQ�IyDECLARAiTION 7 8 3 1D,B;•• gPP'LICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificcfe aF consent tb self fir'_ insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or'a certified copy thereof.(Sec. 3900, Lab. C... Policy No. Company S7-4"r, !T(/IP.�v FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished.. EACH NO. FEE ADDRESS New Residential Bldgs. 8 Pools Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ _ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST /^� ^ a Residential Swimming Pools CROSS ST. Dat� -Applicant lY7/7�/9, /� OWNER NAOR ME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw.= MAIL COMPENSATION INSURANCE First 20 ADDRESS i. (This section need not be completed If the work Involved by Total No. Additional CITY �o� Tel. No. the permit is for one hundred dollars($100)or less.) I certifythat in the performance of the work for which this PLAN•CHECK p erAPPLICANT 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 • \Additional Total�No. CITY Tel. No. NOTICE Applicant. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT 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. deemed revoked. tl 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 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business '1 DISTRICT NO. PROCES D Y and Professions Code,and my license is in full force and effect. I Power Apparatus&Largo Appliances /� , Size&Type HP, KW, KVA, or KVAR' ✓(� License Number2(:�y 3:5 X9 Lic. Class - 2.0 Up to I. Incl. FINAL U t Over 1 to 10 Incl. DATE VAIIDATIO� 1119 Contractoro—A V� A��'�Bate •� Over 10 to 50 Incl. E] FINAL 4J I ani exempt under Sec. I Over 50 to 100 Inc. BYIYr � BAP.C. for this reason +t Over 100 Z 1 Services, Swbd.,MCC.&Parrelboards Date:. 0 -200 A -1011. mp, Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Elect. Over 1000 Amp. or Over 600 V @1 1 4, 1 A Maint. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION # 0 -0 0 0 0 2 Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o 0 1 7.50 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 o o o 1 7,505 structure is not intended or offered for'sale (Section Other(See Complete Fee Schedule)— , 7044; Business and Professions Code). 1 1.2 9—8 4 I ' CONSTRUCTION LENDING AGENCY ! 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE �Q Lender's Address " I certify that I have read this application and state that the TOTAL FEE 7 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hey—+y authorize representatives of this County to enter upon Above-mention d roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Pe ittee Date s