HomeMy Public PortalAbout5034 RIO HONDO AVE_Electrical__ 76A668 DBS SA 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC 1
s COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN F. Walton
RECEIVED BY READY FOR DATE ISSUED
ADDRESS 5134 N Acacia St FIRST INSPECTION r/ _�/
CITY San Gabo TEL. No. AT 68553 /
COUNTY LICENSE NO. 1104 EXPIRES BUILDING
PERMIT FEES ADDRESS 5034 Rio Hondo A4ea
FEE Temple City
NUMBER EACH LOCALITY
LIGHT OUTLETS 9 NEAREST
RECEPTACLES 16 CROSS ST.
WALL SWITCHES 16 OWNER Turner Homes
TOTAL OUTLETS 41 Sc $ ?. 05 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY• TEL. NO.
FIXTURES 9 S 45
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSPOWER EANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE I OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
NEW MVD. HP OVER INC. EACH
4 1/2 a LESS $ .25 1 25 SIGNATURE 7 F
1/2 2 .50 PERI
2 5 1.00 INSPECTION RECORD
S is 1.50
15 SO 2.50
50 200 5.00 •
Poo Boo 10.00 J
Soo 1000 15.00 a
Z
OVER 1000 20.00
M. G. SET/FREQ. CHANGER-HP
WELDERS:AC-KVA 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%OF ORIG.)
MOVED MOTORS (75%OFORIG.)
MISC.
SIGNS
NO. NO.TRANS. I I APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.00 TCONDUIT
FIXTURES $1.00 1 nn
WIRING / cl/�•�
SUPPLEMENTARY .50 FIXTURES
4 75 POWER
TOTAL FEE $ UTILITY CO. NOTIFIED
® I FINAL - 3
I
., ® r7p� PERMIT T
DBS.SA3.55 APPLICATION FOR ELECTRIC ■ ERMI ■
DMSION OF BUILDING AND SAFETY
lt6poriment of County Engineer
County of LOS AIIgeleBBUILDING
WWI.J. FOX.COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN.SUPT OF BUILDING r/ y
•• LOCALITY /1/f IL If r
FOR APPLICANT TO FILL IN r NEARESTD `�
PERMIT FEES CROSS ST. L.jq O
I FEE
NUMBER EACH OWNER
LIGHT OUTLETSMAIL
may` j� /,
RECEPTACLES ADDRESS D�7 ief ///G D
L WALL SWITCHES / /�
TOTAL OUTLETS 5¢ 5 CITY TEL.NO&140.1/
ELEC.RANGES 25 ELECTRICIAN
ELEC.HEATERS -28 ADDRESS
KW EA CITY TEL.NO.
r FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS - DISTRICT NO. GROUPI WNE/ READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS I T
"`CCC /
MOTORS o6
NUMBER HORSEPOWER FEE INSnCTION RECORD
NEW MVD. HP OVER INC. EACH l ® `3 ��. ft�� .. D. -L
I/2 @ LESS $ .25rL
C,' �•
Ifz 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 'S.00
M ISC.
NO.SIGNS NO.TRANS.
y NO.SIGNS NO.LAMPS
FOR EACH PERMIT'
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 ,' APPROVALS
TOTAL FEE SAW DATE INSPECTOR'S SIGNATURE
! HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT A
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING s WIRING
ELECTRICAL WIRING. -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIA ROyjERTY. UTILITY CO.NOTIFIED
SIGNATURE �(///y mp
OF PERM ITT FINAL /� / r'
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR
0 3 0 0SEP 1g 2 2.40
^WORKERS'COMPENSATION DECLARATION 7&AA gDPW 3%� APPLICATION FOR ELECTRICAL PERMIT O
t; ,l helreby affirm that I have a,certificate of consent to self
'insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereo�(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO.FILL IN JOB
❑Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS R
Certified co is filed with the-count building inspec- 1 &2-Family,S Ft. $ — $ LOCALITY
PY • Y 9 P Y. q•
tion department. Multi-family Sq. Ft. -- NEARESTCROSS ST. I
Residential Swimming Pools OWNER ORCOw�r $
Date Applicant L
2"1FIRM NAME � yr e
CERTIFICATE OF EXEMPTION FROM WORKERS', Outlets: Re. Light Sw._L MAIL
COMPENSATION INSURANCE ADDRESS fjQ'k Z4 IV NaAnj 12A yo-
First 20
(This section need not be completed if-the work in*olved by Total No. -- Additiortdl r CIT I
,e JJf1 . Nogg Z%&09�
the permit is for one hundred dollars($100)or less.) ' , PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS
so as to become subject to the Workers'Compensation Laws-. g g
Additional
I��yt� l B h�rL Total No.�_ CITY Tel. No.
Date Applicant Fixed-Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of _ APPLICATION ,
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 WM. —
deemed revoked. Hood — Fan — Other— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. — Room Air Cond. — 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 Power Apparatus&Large Appliances DISTRICT NO. PR ESSED BY ?•
and Professions Code,and-my license is in full force and effect: IL
Size&,Type HP, KW, KVA, or KVAR O
License Number Lic. Class, Up to 1 Incl: � FINAL U
Over 1 to 10 lficl. DATE _ VALIDATION cc
Contractor Date Over 10 to 50 Incl. U
QFINAL
I am exempt under Sec. Over 50 to 100 Inc: BY W
B.&P.C. for this reason Over 100 a
Services, Swbd.;MCC&Pan0tl ;jjd�. U)Date: Z
Ow-200 Amp. Under 60Signature 201 - 1000'Amp. Under 60
❑ 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 ;t r .a
I hereby affirm that I am exempt from the Contractor's License n�:i•1:•c
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits _} _ _
Professions Code): 5r
• s h v:s E Y •..ri n6 Lf
ewI, as.owner of the property, will do the work and the Misc. Conduits&Conductors ' 1Irl:
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ ® - 52
. 60
U AL
Business and Professions Code).
CONSTRUCTION LENDING AGENCY CA-SH } ^v l
I hereby affirm that there is a construction lending agency forjt CHANGE
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). OF
' PLAN CHECKING FEE
Lender's Name C1011115-000 1 `1217 91
PERMIT ISSUING FEE Z-100
• i Y ilolEl^
Lender's Address '=' tir fel' u 9
1 certify that I have read this application and state that the 1.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
the abo -mention d roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE !
6-9
Signa ure ofPerFn7tee Date ®s