HomeMy Public PortalAbout4819 RYLAND AVE_Electrical__ 76AS58 DBS SA 11-00`-" - APPLICATION FOR PERM
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMITp NO.
ELECTRICIA
RECEIVED BY READY FOR DATE ISSUED
ADDRESS 1J __. --- a/� FIRST INSPECTION
Cr_C
CITY a TEL. NO.
COUNTY fCENS NO. EXPIRES ' BUILDING
PER ADDRESS F�
FEE v V
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAR
ST
p t CROSS ST.
RECEPTACLES I/! est+ / 2�,Rai t
9 o JA
WALL SWITCHES OWNER .d. lk"-Vwv
TOTAL OUTLETS Sc $ MAIL li 1e
ELEC. RANGES 2S ADDRESS
ELEC. HEATERS 25 Cyry TEL. NO.
FIXTURES 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 I CERTIFY THAT 1 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 PROPERTY DESCRIBED ABOVE.
1/2 a 1Es6 $ 25 SIGNATURE OF �/ !
Z/ 1/2 2 .50 05 PERMITTE A
2 s 1.00 INSPECTION BkCORD
5 is I.So
1 S 5o 2.50
50 200 5.00
200 Boo- 10.00 J
500 1000 15.00 Z
OVER 1000 20.00
M. G. SET/FREQ. CHANGER-HP Q'
WELDERS:AC-KVA O
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%OF ORIG.)
MOVED MOTORS (75%OFCRIS.)
MISC. T
SIGNS
NO. NO.TRANS. I I APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT:
DATE INSPECTOR'S NAME WIRING $1.00 /
( CONDUIT .
0 ����
WIRING /,,YG„'_'
FIXTURES $1.00 V
SUPPLEMENTARY .50
FIXTURES
POWER
TOTAL FEE $ UTILITYCO. NOTIFIED
® FINAL Q4
to Gr
, e'�iVORKERS'COMPENSATION DECLARATION 20.0019 DPW 3/87
If d. affirm that I have a certificate of consent to self I76A66G APPUCAV�Gm FOR ELECTRICAL PERMIT
��insure, 8r a certificate of Workers'Compensation Insurance, I COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
'or•a certified copy thereof(Sec. 3800, Lob. C.) 1 !
Policy No. Company FOR APPLICANT TO FILL IN JOB: / •
Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ _ $ LOCALITY
tion department. Multi-family Sq. Ft. NEAREST
CROSS ST.
Date Applicant
Residential Swimming Pools OWNER OR Lj
FIRM NAME
L'.Q f
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec LightrFirSt2l�
w_ ADDRESS 7(1 Q
COMPENSATION INSURANCE �Lr
(This section need not be completed If the work involved by Total No. Additional CITYJAI" Tel. No. -
the permit is for one hundred dollars($100)or loss.) PLAN CHECK
I certify that in the performance of the work for which this APPLICANTdr
permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS
so as to become subject to the Work s'Compens tion Laws.
(� Total No. Additional CITY Tel. No.
Date ��- O 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' I Range— Heater—D.W. — APPLICATION
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be I Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp' — Room Air Cond. — REG. NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. ROCESSE BY d
and Professions Code,and my license is in full force and effect. . Size&Type HP, KW, KVA, or KVAR S U
License Number Lic. Class Up to 1 Incl. FINAL _
Over 1 to 10 Incl. DATE VALIDATION Er
Contractor Date i Over 10 to 50 Incl. ��// F-
❑F-1
FINAL
I am exempt under Sec. I Over 50 to 100 Inc. BY W
B.&P.C. for this reason Over 100 a
Z
Services, Swbd., MCC&Ponelboards
te: 1 0-200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
14 Over 1000 Amp. or Over 600 V &A 0 b 6 A
Exemption for Reg. Mainf. Elect.
SINGLE FAMILY Temp. Power Pole&Appurtenances # o o o 0 0 2
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ' 0 0 1 2 C 0
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits o - . 12000,
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 11.04-88
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)—
Business and Professions Code).
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
Lender's Address
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 RR
\ hereby a horize representatives of this County to enter upon
the b e- ntioned pr er y for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date ®�