HomeMy Public PortalAbout4848 RYLAND AVE_Electrical__ 76A663 D99 9A,3-30 APPLICATION FOR PERMIT
DEPARTMENT OFAND SAFETY �� C
� ��
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT N.O.
WW
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDREBB el,"t,S'' s �-.�� w.�►tr-"+✓ y� FIRST INSPECTION � ss
CITY
COUNTY LICENSE NO. A� 0. EXPIRES BUILDING / d)
PERMIT FEES -ADDRESS �A
NUMBER EACH FEE LOCALITY
LIGHT OUTLETSq NEAREST /� /�/„S
CROSS ST. b7
RECEPTACLES 30
WALL SWITCHES OWNER/JI/R f i��s=✓� /1 r te” 'i 4�t
TOTAL OUTLETS Sc MAIL
ELEC. RANGES S5 ADDRESS
ELEC. HEATERS 25 CITY 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 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
Y9 6 LESS 111 .25
SIGNATURE OF �1 •• � �. •;`• ,�_�:--�
I/2 2 .50 PERMITTEE
2 s 1.00 INSPECTION RECORD
5 15 1.50
15 SO 2.50
50 1 200 5.00
ZOO 500 10.00 JJ
500 10013 15.00 Z
OVER 1000 20.00 Q
M.G. SET/FREq. CHANGER-HP
WELDERBIAC-KVA O
GENERATORS -_KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% or oRIG-)
MOVED MOTORS (75% of ORIO.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
DATE INSPECTORS NAME
FOR EACH PERMIT'
WIRING $1.00 0 CONDUIT i
FIXTURES 01.00 rn WIRING - -
SUPPLEMENTARY ,gp FIXTURES y^�y
POWER
TOTAL FEE 8 / L 6 UTILITY CO.NOTIFIED s'J�dA
FINAL 1.
WORKERS'COMPENSATION DECLARATION 20.0019 DPW 3/87 APPUCATPON FOR ELECTRICAL PERMIT O
I;hereby affirm that I have a certificate of consent to self CE-8006G
insure, or 0 certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or O certified copy thereof( 3800, Lab. C.)
Policy No.t� '�y C�any_f:±1M /ti A FOR APPLICANT TO FILL IN JOB (�
❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 4 � • & N 0
❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ -- $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
Date ApplT.
e Residential Swimming Pools I OWNERCROSS OR
_
FIRM NAME ✓(D S a n/
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec-4�—Light Sw.—LMAIL r
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work involved by Total No.�� Additional CITY Tel. No.
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
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
Date Applicant Total No. CITY Tel. No.
Fixed Appliances Not Over 1 HP PERMIT ��1
NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION" �� -"p�
Exemption, you should become subject to the Workers' Range— Heater—D.W. — q
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS ?(J
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITY ��f n Tel. No. Kq
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. _ Room Air Cond. — REG.NUMBER Class.
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. P ESSED BY >_
and Professions Code,and my license is in full force and effect. C p % d
Size&Type HP, KW, KVA, or KVAR ✓i t7p 0
License Number 4 - !21 Lic.Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DATE —�C/ 0
VALIDATION cc
Contractor �F Date—". �}}�}� Over 10 to 50 Incl. v
FI NA f—
I am exempt under Sec. Over 50 to 100 Inc. BY
U
W
B.&P.C. for this reason Over 100 (-
Services, Swbd., MCC&Panelboards COZ
Date: 0-200 Amp. Under 600 V —
Sig�a+�•a — 201 - 1000 Amp. Under 600 V
❑ 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
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code): c 0 4 7.4 A
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors # o o a o 0 2
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— 1002925
Business and Professions Code). o o'0 2 9 2 5
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for 0 a 1 8—8 8
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
hereby authorize representatives of this County to enter upon
th�mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permitt a Date U ®s