Loading...
HomeMy Public PortalAbout6263 PRIMROSE AVE_Electrical__ 76ASSS Deg EA 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC 1 i WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT No. GROUP I ZONE PERMIT NO. ELECTRICIAN R F.Walton S-16 I' RECEIVED BY READY FOR DATE ISSUED ADDRESS 5134 N. Acacia St• FIRST INSPECTION CITY San Gab, TEL. No.AT 65583 COUNTY LICENSE NO. 1104 EXPIRESBUILDING 6263 Pr]mrose PERMIT FEES ADDRESS NUMBER EACH FEE LOCALITY Temple City LIGHT OUTLETS 13 NEAREST RECEPTACLES •�/b• CROSS ST. WALL SWITCHES OWNER Meeker TOTAL OUTLETS 53 Sc ffi2 65 MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 2+ CITY TEL. NO. FIXTURES IS 5 1 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 I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWERANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER FEE NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPE DESCRIBED ABOVE. 1/2 a LESS S .25 25 SIGNATURE OF 1/2 2 .50 PERMITTEE z 5 1.00 INSPECTION RECORD 5 Is 1.50 15 50 2.SO 50 200 5-00 200 Boo 10.00 . 500 1000 I5.do Z OVER 1000 20.00 5 M. G. SET/FREQ. CHANGER-HP (g WELDERS:AC-KVA 0 GENERATORS-KW TRANSFORMERS-KVA TEMP. MOTORS (7S%oFoe1G.) MOVED MOTORS (75%oFOR1G.) MISC. SIGNS NO. NO.TRANS. I APPROVALS NO. NO. LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT: 1)` WIRING ffi1.00 QQ CONDUIT FIXTURES $1.00 ], 00 WIRING SUPPLEMENTARY .50 FIXTURES �� U 5 80 POWER TOTAL FEE S UTILITY CO. NOTIFIED �,�••� :sI' IH�r!��a ® I I FINAL G�V�• �`��� WORKER'S COMPENSATION DECLARATION 766AA663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affITl that I have a certificate of consent to self Insure, or•SlcertificiiV 0 Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy th NfSec.3 00 b.C.) Policy N ' /Company FOR APPLICANT TO FILL IN JOB. ADDRESS Certified copy is•hereby furnishe New Residential Bldgs.&Pools NO: EACH FEE LOCALITY Certified co y is filed with the unty g inspection 1&2-Family,Sq.Ft. _ $ $ NEAREST dep Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK12 p E PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' of. ?� OWNER u4ty-W ax COMPENSATION INSURANCE Outlets:Rec. Light Sw. / FIRM NAME �` s First 20 (ThMAIL Total section need not be completed If the work Involved by the Total No. Additional ADDRESS permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers%Compensation Laws. Lighting Fixtures First 20 APPLICANT_ Total No. Additional ADDRESS Date Applicant RESIDENT L LIANCES OT OVER 3 HP. NOTICE,TO APPLICANT: If, after making this Certificate of CITYTel.No. Exemption,you should become subject to,the Workers'Compensation OTHER HP.. pEaMlr provisions of the Labor Code,you must forthwith comply with such power App tue&Large Appliances. PERMIT AN ' provisions or this pdrmit shall be deemed revoked. LICENSED'CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR p DDRES I hereby affirm that I am licensed.under provisions of Chapter 9 _ Over 3 fo 10 Incl. 1 / (commencing with Section 7000)of Division 3 of the Business and CITY Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Incl. REGNNUMBER CI a License Number r� Lic.Class �"`' Over 100 DISTRICT NO. ESSED BV C 2 Services;Swbd.,MCC&Panelboards . s�Acirr 0 399 Amp.Under 600 V FINAL C ' Contractor Date DATE, ' 0 I am exempt under Sec. 400:1000 Amp.Under 60Q V — = VALIDATION W Over 1000 Amp.or Over 600 V FINAL S. a i B.&P.C.for this reason BRANCH:CIRCUIT FEES BY Cr Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits r� Signature 11 To 40 Branch Circuits '' a 41 Or More Branch Circuits fiC a Exemption for Reg.Maint.Elect. 1.5A,206 206V To 277V Lighting Br.Circuits 3303 __; r SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION l_I'Z ' I hereby affirm that I am exempt from the Contractor's License'Law SignTwith•One Branch Circuit S PM for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits„ Code): . IrL, m, I i I,as owner of the property,will do the work and the.structure Misc.Conduits&Conductors CHE K% { Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , CP.AIN,G and Professions Code). CONSTRUCTION LENDING AGENCY 2 s ++ - I hereby affirm that there is a construction lending agency for the (3)`7{Irl3001 2� ?`I Performance of the work for which'this permit is issued Sec. $097, P p (. PERMIT FEE (Sub-Total) �� 964b Civ.C.) PLAN CHECKING FEE f Lender's Name PERMIT ISSUING FEE 7-6 00 Lender's Address Qo I certify that I have his application and under penalty of purjury state TOTAL FEE .O that:the above I. rmati is correct. I agree to comply with all County ordinances dto aws eguiating Electrical wirin ,and hereby authorize representati s f thi. o ty enter upon the ab ve-mentioned property for inspection SEE REVERSE FOR EXPLANATORY LANGUAGE it t W! �� • SIGNATURE OF PERMITTEE O TE WORKER'S COMPENSATION DECLARATION 9 DPW(,z-e,). 7M663 APPLICATION FOR ELECTRICAL PERMIT 76A68 ,� I hereby affirm that I have a certificate of consent to self insure, r or srcertitie�. of WorXgr's Compensation insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) -� Poll Cy No. Company FOR APPLICANT TO FILL IN 'JOB ADDRESS 2 ,- x/m,�(J�� Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH. FEE _ LOCALITY ❑ Certified co y g p 1&2-Family,Sq.Ft. copy is filed with the building Inspection _ NEAREST � department. Multi-family Sq.Ft. CROSS ST. g Date Applicant Residential Swimming Pools ASSESSOR .� MAP BOOK ,� PAGEF)i O 1 PARCEL 022P CERTIFICATE OF EXEMPTION FROM WORKERS, OWNER.OR •—� COMPENSATION INSURANCE Outlets:Rec. Light W. FIRM NAME A'c. . First 20 MAIL (This section need not be completed if the work Involved by the Total'No Additional ADDRESS permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY E/H Z4F jr Tei.No. ?� Is Issued, I shall not employ any person in any man. s s o PIAN CHECK become subject to the Workers'Compens 'ion. 01hting:FixtuFirst 20 APPLICANT Date �Appl.icant IAL A T OVER 3 HP ADDRESS' Total No. Additional ESS' NOTICE O APPLICANT: If, after making s if ate o RESIDENT APPLIANCES NO CITY Tel.No. Exemption,.you should become subject to the kers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you must forth ith comply with such APPLICANT �.lJjZPi� provisions or this permit shell be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS .I'hereby affirm that I am licenseO under provisions of Chapter 9 Over 3 to.10 Incl. (commencing:with Sectioh 7060) of Division 3-of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR } Over 50 to 100 Incl. REG.NUMBER Class' a Over 100 DISTRICT NO. PROCED By.. V License Number Lic.Class ©� F Services,Swbd.,MCC&Panelboards: v Contractor Date 0.-399 Amp,Under 600 V DATE O ❑ I am exempt under Sec. 400-1.000 Amp..Und'er 600-V 2 W Over 1000 Am or Over 600 V ; VALIDATION V B.&P.C.for this reason p BY AL BRANCH CIRCUIT FEES i� Date: 15A,or 20A,120V,Lighting or Recept. -5:5O �� 3 60.45 z_ 2— 000 1 To 10 Branch Circuits Jc/ Signatureo - 11 To 40 Branch Circuits : �- `++ �� 4.1 Or More Branch Circuits. t I } a @ ,i 5 0 Exemption for Reg.Mafnt.Elect. 15A,20A,208V To 277V Lighting Br.Circuits !OTAw SINGLE FAMILY Temp.Power Pole&Appurtenances (NECK 6t)='i=i HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit c l ( i I hereby affirm that 1.am exempt from the Contractor's License Law CHANIGE =L for the following reason(Section 7031.5, Business and Professions. Additional Sign Branch Circuits Code): �I,as owner of the property,will do the work and the structure -Misc.Conduits&Conductorst' Ci Is not intended or offered'for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). 90 i 1 i '414 9.00-' 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C:) PLAN CHECKING FEE Lender's Name 2—k ' PERMIT ISSUING FEE g Lender's Address FEELLZT I certify that I have read this application and under penalty of purjury state TOTAL (p Q. that the above information Is-correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize f representatives of. Co ty toe r 'the ab entionedproperty forI�arJection p se s SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF P DAT '