HomeMy Public PortalAbout5831 SULTANA AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERM
DEPARTMENT OF COUNTY ENGINEER
DMSION OF BUILDING & SAFETY ELECTRIC , 1
WI zlM r. FOX COUNTY ENGINEER
FOR APPLICANT FILL IN DISTRICT-NO. GRO�UP ZONE PERMIT NO.
ELECTRICIAN -�-- /� j �q
ADDRESS y�j� RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION _
CITY /l TEL. NO f- '
COUNTY LICENSE NO. EXPIRES
BUILDING /, � / A
PERM FEES ADDRESS .J
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST. i •d--��r/��
WALL SWITCHES OWNER /! •[= . "
TOTAL OUTLETS Sc S MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
CITY TEL. NO.
FIXTURES B
MISC. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
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 Mvo. HP OVER. I INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBE ABOVE.
_ V2 a LEBS 5 .25 SIGNATURE OF ' GG:�[.L'
V2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 15 1.50
1S SO 2.50
SO 200 5.00
200 500 10.00 J
SOO 1000 15.00 Q
OVER 1000 20.00 Zz
M.G. SET/FREQ. CHANGER-HP
WELDERS- AC-KVA O
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF OR16.)
MISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT
FIXTURES $1.00 WIRING; d .
SUPPLEMENTARY ,50 FIXTURES
POWER
TOTAL FEE 5 I UTILITY CO. NOTIFIED '► \ 1, J �� ~ r�,
FINAL 4U+L,--w
76A 663 OBS# BA. 4-0II
V rr, '' WORKERS'COMPENSATION DECLARATION C 10/81 APPLICATION 'FOR ELECTRICAL. PERMIT
J. ('he"rebr affiepi that I have a certificate of consent to self FE-806G
insurg, Be a certificate of WoFkers'Compensation Insurance, I COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof 'SSeetc. 3800, Lab, e.
Policy No + / �npy FOR APPLICANT TO FILL IN. JOB p e,
❑ EACH NO. FEE ADDRESS
Certified copy is hereby furnished. New Residential Bldgs. $Pools C1
1 $2-Family, 5 Ft. $ — $ LOCALITY
Certified copy is filed with the county building inspec- y, q' PF
r3 NEAREST
fio departure. . Multi-family Sq. Ft. CROSS ST.
Date � Applicant Residential Swimming Pools 22M zic /
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re
rALight Sw
-MAIL
COMPENSATION INSURANCE . )ADDRESS
First /JI
(This section need not be completed if the:work Involved by Total No.. Additional CITY
the permit Is for one hundred dollars($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ'any person in any manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel. No.
Date /applicant Fixed Appliances Not Over 1 HP /
NOTICE TO APPLICANT: If, after making this Certificate of AP MG4NT / '
Exemption; 'you should become subject to the Workers' Range_ Heater_D.W. —
Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESSB
with comply with such provisions or this permit shall be Top _ FAU —W.H. —
deemed revoked. Hood _ Fan _Other_ CIT T �. '
..
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I.am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER 7 Clash
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO: P CES BY
and Professions Code,and my license is in full force and effect. Power Apparatus$.Large Appliances 8 r
Size$Type HP, KW, KVA, or KVAR r d O
License Nu er Lic. Class ` Up to 1 Incl. FINAL V
—_-- Over 1•to 10 Incl. DATE �/�}r� VALIDATION O
Cant rac a Over 10 to 50 Incl �/—
❑ FINA
I'am exempt der Sec. Over 50 to 100 Inc. BY Off.
Over 100
B.$P.C. for this reason W
Date: Services, Swbd.;MCC 8 Panelboords
0 :200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600V
Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole$Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
.Professions Code):
.❑ 1, as owner of the property, will do the work and the M.sc• Conduits$Conductors
structure is not 'intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). ;2 Jr 5J R 2 A
-CONSTRUCTION LENDING AGENCY
0 0 0 0 0 '2 ,
1 hereby affirm.that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT PEE (Sub'-Total) 31 1 + 4200
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE 0 0042006:
Lender's Name
. PERMIT ISSUING FEE Q a 9$—$6
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
here'y authorize representatives of this County to enter upon
theOve-mentio ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
�- 2S
gnature of P ittee Date