HomeMy Public PortalAbout5543 RYLAND AVE_Electrical__ 76ASS3 DBB.5A 3-50 APPLICATION FOR PERMIT '
DEPARTCOUNTY OF LOS ANGELES AFEMENT OF BDING AND 17CTY
WILLIAM J. FOX, CHIEF-ENGINEER
FOR APPLIJ; NT TO""F��IvvL""L''IN : DISTRICT,NOv GROUP ZONE PERMIT ND.
ELECTRICIAN .iVbl-� .ciL,r
�( � ,//,���� _ f RECEIVED BY READY FOR of TE IMUED
ADDRESS��jj�� (`� Ad—t3 _yy�. �. FIR T INSPECTION
CITY .,/<Al.rt.�Fia '] TEL NO. r
COUNTY LICENSE NOZn EXPIRES �iBUILDING
PERMIT FEES =ADDRESS
NUMBER EACH FEE LOCALITY 5;203f!Tejgk
LIGHT OUTLETS NEAREST
CROMB ST. &—A-- ) r
RECEPTACLES
WALL SWITCHES .OWNER
TOTAL OUTLETS MAIL v f/
ELEC. RANGES 85 ADDRESS V
ELEC. HEATERS 25 �" - CITY TEL NO.
FIXTURES
MISC. 677Y4tl 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
�r s APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
NUMBER pI LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY OROJ'NANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOB
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE n
NEW MVD. HP own INC. EACH OF THE RESIDENTIAL PROPERTY D SCRIBED ABOVE.-
Y2.& UESB S .25 SIGNATURE OF '
I/z 2 .50 PERMITTE/_ 6
2' S 1.00 (j;"NSPECTION RECOAD:•
5 15 1.50
15 50 2.50
50 200 5.00
200 BOo 10.00 J
500 1000 15.00 Z
OVER 1000 20.00 0
tM.G. /FREQ. CHANGER-HP Ir
WL13 p
O
BENERATORB - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% of CRIB.)
MOVED MOTORS (75% of CRIB.)
Misc.
BIONS
NO. NO.TRANS.
• APPROVALS
NO. NO.LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING .61.00 CONDUIT �
FIXTURES 61.00 /� /��ry WIRING //. ^ate' //�`u
r
SUPPLEMENTARY .50 FIXTURES
POWER
TDTAL FEE 6 ,/ UTILITY Co.NOTIFIED
FINAL
WORKERS'COMPENSATIONDECLARATION CE-806G (2=80)
CAPPLICATION FOR ELECTRICAL PERMIT
• E$06
I hereby affirm that I have a certificate of consent to self COUNTY OF'LOS ANGELESBUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or �7
a certified copy thereof(Sec 3800,Lab.C.) f7
Ti ��+^ FO•R APPLICANT TO FILL IN JOB 1
Policy No ompany , Cr i EACH NO. FEE ADDRESS r
New Residential Bldgs..&Pools �Q'
Certified copy is hereby furnished. 1/�/� fes"f 1 &2-Family,Sq. Ft. $ — $ LOCALITY d.
Multi-family Sq. Ft. NEAREST ,*p�
Certified copy is filed with the county building inspection CROSS ST �6/+
department. Residential Swimming Pools OWNER OR e)
Date A licant Y NW �1' FIRM NAME ,��✓V
PP ' Outlet;: Rec.,___Light Sw. MAIL..
First 20 1 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No
COMPENSATION INSURANCE
PLAN.CHECK a
(This section need not be completed if the work involved APPLICANT U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Total No. Additional
I certify that in the performance of the work for which thisCITY Tel No.:
Fixed Appliances Not Over 1 HP
.permit is issued, I ahall not employ any person in any manner PERMIT W
so as to become subject to the Workers'Compensation Laws. Range_Heater D.W._ APPLICANT �ADMON /���! a
Oven — Dryer_W.M._ ADORES
S y
Date Applicant Top _ FAU _W.H.,_ �0A. ��a
7Hood _ Fan , _Other_ CITY •®�} TNOTICE TO APPLICANT: If, after making.this Certificate of ,Disp. _Room Air Cond— LICEN ORExemption, you should become subject to the Workers' REG.NUMBER CCompensation .provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO.
with comply with such provisions or. this permit shall -be 11
Size&Type HP,KW,KVA,.or KVAR
deemed revoked. /10
I Up to 1 Incl.
Over 1 to 10 Incl. ,d Q FINAL
LICENSED CONTRACTORS DECLARATION I DATE VALIDATION
Over 10 to 50 Incl. r
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
BY
9 (commencing with.Section 7000)of Division 3 of the Busi- Over 100
ness and Professions.Code,and my license is in full force and
effect. Services
License Number_$6120 ,2 Lic.Class. —,Z ZQ 0-200 Amp.Under 600 V
G _ 201-1000 Amp.Under 600 V
Contractor �ng� Date a —I?.) ' Over 1000 Amp.or Over 600 V "3 9 21 R
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances, o o .0 0 0 2
I
hereby affirm that I. am exempt from the Contractor's Sign with One Branch Circuit 'o•o
,icense Law for the following reason '(Section 7031.5, Busi- Additional Sign,Branch Circuits 2 1 A Jr 0
less and Professions Code):
Misc.Conduits&Conductors ° ° ° 1 5 vz
I, as owner of the property, will do the work.and the Other(See Complete Fee Schedule)— -82
8 2
structure is not intended or offered for sale (Section j
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency
or the performance of the work for which this permit is PERMIT FEE (Sub-Total)
ssued(Sec.3097,Civ.C.). ;
.ender%Name PLAIN CHECKING FEE (One-Fourth Permit Fee)
.ender's Address PERMIT ISSUING FEE
certify that I have .read this application and state that the TOTAL FEE
bove.information is correct.I.agree to comply with all County i
rdinances and State laws regulating Electrical wiring, and
ereby authorize representatives of this County to enter upon
he above-mentioned poperty for inspection purposes.
SEE'REVERSE FOR EXPLANATORY LANGUAGE
Date
Signature of Permittee '