HomeMy Public PortalAbout6115 PRIMROSE AVE_Electrical__ 76A663 DBB 5A 3-513 ' APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY .,
COUNTY OF LOS ANGELES � � �� 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NG-
ELECTRICIAN RI�-�o '�8d�111Oft 1-Ve. READY FOR 12� 3�
ADDRESS 5134 o Acacia St. RECEIVED BY FIRST INSPECTION DATE ISSUED
CITY San Gabo TEL NO.AT 68583 —�w/-15
COUNTY LICENSE NO. 1104 EXPIRES BUILDIADDRENG
6115 Primrose Avec
PERMIT FEES FEE Temple City
NUMBER EACH LOCALITY
LIGHT OUTLETS 13 NEAREST
RECEPTACLES 22 CROSS ST.
WALL SWITCHES 18 OWNER Meeker
TOTAL OUTLETS 53 5C 8 fL5 MAIL
ELEC...RANGES 2s ADDRESS
ELEC.-HEATERS I 25 CITY TEL. NO.
FIXTURES 13 5 65 I HEREBY 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 1 POSSESS THE ABOVE.VALID LOB
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEw MVD. HP OVER INC. EACH OF THE RESIDENTIAL PRUP_EMTY DESCRIBED ABOVE.
1 3Z4 v, m LESS 8 .25 25 SIGNATURE OF
2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD-
S 16 1.60
15 50 2.50
50 21313 5.00
200 son 10.013 A-k' Rx -v A
500 1 1000 15.00 Z
OVER 1000 20.00
M.G. SET/FRE13. CHANGER-HP
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% CR DRIo.)
MOVED MOTORS (75% ac CRIB.)
SIGNS
NO. NO.TRANS.
NO: NO.LAMPS APPROVALS
FOR EACH PERMIT: DATE /INBPECTORIB NAME
WIRING !81.00 1 00 CONDUIT 0' /Ci Zb✓
FIXTURES 81.00 1 00 WIRING ''lr.l (��+'dtw.
SUPPLEMENTARY .50 FIXTURES YiiIAAI�
5 80 POWER /I
TOTAL FEE 8 UTILITY CO.NOTIFIED
FINAL v��
WORKERS'COMPENSATION DECLARATION 76-883 10/87 APPLICATION FOR ELECTRICAL PERMIT
hereby affirgk that.I-have a certificate of consent to self insure, CE-806G
or a certificate of Workers' Compensation Insurance,or a certified COUNTY OF LOS ANGELES ; BUILDING AND SAFETY
copy thereof'(Sea 3800,Lab.C.)
Policy N0. Company FOR APPLICANT TO FILL IN IJOB I �-
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESSi
❑ $ _ $ I LOCALITY
Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft.
department. Multi-family Sq.Ft. NEAREST '�,�fi�d�'�
Residential Swimming Pools .CROSS ST ,T4
Date.— Applicant "OWNER OR
,FIRM NAME ,(+.S i
CERTIFICATE OF EXEMPTION FROM WORKERS' I Outlets:Rec—Light_Sw._ yMAIL
COMPENSATION INSURANCE (ADDRESS X410-9.4�
(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 Tel.No.
I certify that in the performance of the work.for which this permit 'PLAN CHECK
is issued, I shall-not employ a erson in 'APPLICANT
' p y ny p any manner so as to I
become subject to the Workers'•Compensation Laws..,' Lighting Fixtures First.20 ADDRESS
Total No. Additional CITY Tel.No., '
Daf #40 Applican Fixed Appliances Not Over 1:HP PERMIT
NOTICE TO APPLICANT. If. after making.,this Cartifi to of , ,
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. APPLICAN
provisions.of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRES 0/.gp"� . �V
provisions or this permit shall be..deemed revoked. Top _ -FAU •_ W.H.
LICENSED CONTRACTORS DECLARATIONCITY Tel.Nq ,
Hood — Fan _ Other_
I hereby affirm that I am'licensed under provisions of Chapter 9 LICENSE OR /n / J
i Disp. — Room Air Cond. ` REG.NUMBER , Class D
(commencing with'Sectlon 7000)of Division 3.of the Business and
Professions Code,and my license Is in full force and effect. IDISTRICT'NO. PROCESSED BY
i Power Apparatus&Large Appliances r ,
/¢���s Size&Type HP,KW;KVA,or KVAR ; �V Q
License Number 41 /."ZI Lic.Class 14 Up to 1 Incl. FINAL GG77
Over 1 to 10 Incl. DATE
?Contrac d Avow Over 10.to 50 Inc). VALIDATION.
1 FIN- W
lr
lam exempt under Sec. Over 50 to 100 Inc. By .
B.&P.C.for this reasonOver 100. � , Z
1 Services,Swbd.,MCC&Panelboard ,..�
Date: I, 0-200 Amp.Under 600.V �/
Signature 201 - 1000 Amp.Under 6.00 V
❑ ` Over 1000.Amp.or Over 600'V 0 8 al A
`Exemption for Reg.Maint.Elect. # 0 0 0 0 0 2
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit: ° ° 2 5,5 0
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5.,Business and Professions Additional Sign Branch Circuits o 0 0 255 0 5
Code):
❑ Misc.Conduits&Conductors { al 0 8 8
I,as owner,of the property,will do the work and the structure
is not intended or offered for sale.(Section 7044, Business Other(See Complete-Fee Schedule) _
And.Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that thbre is a construction lending agency for the
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.),
PLAN CHECKING FEE
Lender's Name '
PERMIT ISSUING FEE C.
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE S
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 above-mentioned
Property.for insp�Iorpcaes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of rDate i