HomeMy Public PortalAbout5014 RYLAND AVE_Electrical__ 76A668 DBS 6A 11-50 • APPLICATION FOR PERMIT
DEPARTMENT GAF`BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN 4r;-,
✓ RECEIVED BY READY FOR DATE ISSUED
ADDRESS
FIRST INSPECTION
CITY EL. NO. la
COUNTY CENSE NO. EXPIRES BUILDING
a
PERMIT S ADDRESS M
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST. A+y{Jl,(lJsnL/1rC/J�L
RECEPTACLES ®
J.
WALL SWITCHES �
OWNER ui�
TOTAL OUTLETS Se $ I MAIL V �/
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES 5 rr' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
�� CC 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 I INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
1/2&LESS $ .2S SIGNATURE OF
1/2 2 .50 PERMITTE �vJ.�ry
z s 1.00 INSPECTION I$ECORD
s 1s 1.50
Is so 2.50
so 200 5.00
200 500 10.00 J
Boo 1000 15.00 Z
OVER 1000 20.00 3
M. G. SET/FREQ. CHANGER-HP lx
WELDERS:AC-KVA 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%OF ORIG.)
MOVED MOTORS (75%OFOR1G.)
MISC.
SIGNS
NO. NO. TRANS. I I APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT:
DATE INSPECTOR'S NAME
WIRING $1.00 IB 0 CONDUIT �
FIXTURES WIRING
$1.00 r
SUPPLEMENTARY •S0 FIXTURES
POWER
TOTAL FEE $ �
UTILITY CO. NOTIFIED
t' �
OTI
0 FINAL
7A663
D:S-SA 9•SS APPLICATION FOR ELECTRIC PERMIT �.
S.
DIVISION OF BUMDING AND SAFETY
Deportment of County Engineer
County of LOS Angeles BUILDING �f4
WM.J. FOX,COUNTY ENGINEER ADDRESS G/
CASSATT D.GRIFFIN.SUPT OF BUILDING J
x+� +•r- LOCALITY
or F
FOR APPLICANT TO FILL IN x NEARESTcl
r PERMIT FEES CROSS ST. 2rd !I
NUMBER EACH FEE
OWNER
` LIGHT OUTLETS
V C7
RECEPTACLES MAIL
.ADDRESS
° WALL SWITCHES
TOTAL OUTLETS g¢ $ CITY EL.NO
ELEC.RANGES 25 ELECTRICIAN
_ELEC. HEATERS 25 ADDRESS t
KW EA CITY TEL.N04072-V16
r FIXTURES 5
LICENSE NO.
r NUMBER OF LIGHT CIRCUITS
DISTRICT NO. GROUP I ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS INSPECTION RECORD
NUMBER HORSEPOWER FEE
NEW MVD. HP OVER INC. EACH
.l
B LESS S .25
1h 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS
°
FOR EACH PERMIT:
WIRING $1.00
�- FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
c
TOTAL FEE g DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION „ CONDUIT
AND STATE THAT THE 'ABOVE IS CORRECT AND AGREE TO COMPLY / r
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING f/ ~I -
ELECTRICAL WIRING.
•' I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL O NER OF THE ABOVE POWER
DESCRIBED RESIDENTIA P PERTY.
'c UTILITY CO.NOTIFIED
SIGNATURE �/
OF PERMITTEE �L� 0r� FINAL +s
r9'.•
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR
2 0 9 7;n PFOB 7 2
125
-WORKER'S COMPENSATION DECLARATION 77SAG669 DPW(12.91) APPLICATION ®p� ELECTRICAL PERMIT LJ
I hereby affirm That I hgve a gertiJicate of consent to self insure,
or a certlfica4e of Worker's Compensation Insurance,or a certified> COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN ADDRES3SIO/ R �&N® �t�, 7_ e .
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. $ EACH $ FEE LOCALITY
❑ Certified copy is filed with the county building Inspection 1 &2-Family,Sq.Ft. _ NEAREST 1
department. Multi-family Sq.Ft. CROSS ST. joi/7 J f-9 OS 4
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS'
OWNER A y /�i 4 4
COMPENSATION INSURANCE Outlets:Re ...Light Sw. t0 FIRM NAME �/rTS/�V �Vv/v„��SN��r/�®'d
�/� First 20 D' MAIL �/ '1
(This section need not be completed if the work Involved by the ! Total No. I/ / Additional ADDRESS 5 4t M/J DAVC-
permit
Is for one hundred dollars($100)or less.) p
I'certify that in the pdrformance of the work for which this permit I CIN EM c- elT
is issued, I shall not dmploy any person in any:manner so as to i PLAN CHECK'
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No.:Z.1- Additional'
• ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO-APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code;you must forthwith comply with such PERMIT �vA]L„ /�t�+�/ /L��
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT /_0J T>r
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAFy ADDRESS/ JEY(�tl� ��� .
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 1ntl'� ��
(commencing with Section 7000)of Division 3 of the Business and. CITY fiV� Lc-C f7 Tel. ��
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl.
LICENSE r
Over 50 to 100 Incl. REG.NUMBER
Class >_Q„ER O
Over 100 DISTRICT NO. P SSED BY U
License Number Lic.Class
Services,Swbd.,MCC&Panelboards (/ O
Contractor Date 0-399 Amp.Under 600 V DATE I--
❑ 400-1000 Amp.Under 600 V �y V
I am exempt under Sec. G'�i�" VALIDATION LU
Over 1000 Amp.or Over 600 V FINAL 0.
B.&P.C.for this reasonBRANCH CIRCUIT FEES BY Z
Date: 1.5A,or 20A,120V,Lighting or Recept. —
1 To 10 Branch Circuits
Signature 11-To 40 Branch Circuits
Al Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits ry
SINGLE FAMILY Temp.Power Pole&Appurtenances �GT o v
HOME OWNER-BUILDER DECLARATION J
I hereby affirm that I am exempt from the Contractor's License LSign with One Branch Circuit
Law n e t
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 3-,630 J� 17Crev0
ITEMS
I,as owner of the property,will do the work and the structure Miso.Conduits&Conductors TOTAL a �
Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code). GASH 178.60
CONSTRUCTION LENDING AGENCY CHANGE .00
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) O
Civ.C.)
PLAN CHECKING FEE 10-1.1 0000-0001 12/ 1/95
Lender's Name n 35354 1 AM 110 42
PERMIT ISSUING FEE �7 0
Lender's Address /
I certify that I have read this application and under penalty of purjury state T TAL FEE
that the 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 above-mentioned property
for Ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
I
el URE OF PERmrmE DATE ,