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HomeMy Public PortalAbout6333 TRELAWNEY AVE_Electrical__ COUNTY OF LOB ANGELES APPLICATION FOR PERM DEPDIVISION O of COUNTYBUILDING saGna�a ELECTRIC 1 DIVISION OF SDII.DIIIIG 6 SAFETY WMUAM COUNTY EQGR� FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERM�IIT. NO ELECTRICIAN d ✓ 2 R-� a Q `s J ADDRESS RECEIVED BY READY PORON DATE ISSUED FIRST INBPOCTI CITY !re c / 9jf ` 6 z� COUNTY LICKNAE NO .'2 [REV BUILDING ADD RWS G NUMBER EACH FEE LACALITY LIGHT OUTLETS Aa NEAREST / RECEPTACLES �z 10 `~ WALL SWITCHES OWNER So tre TOTAL OUTLETS ec FLOC RANGES IIS MAIL ADDREBD ELEC HEATERS IIS FIXTURES 0 CITY TEL NO 1 HEREBY ACIOROWLBDGE 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 AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NulmaR HORSOPOWEt FEE ANGELES COUNTY LICENSE OR 1 AM THE LOCAL OWN Niw MVD HP ova INC Ytr OF THE RESIDENTIAL PROPERTY DESCRIBED Ve ..R.a se SIGNATURE OR E 00 PERMITTER II 0 100 IINSPEMION RECORD e 1• 1 so Ie so II Eo SO 200 O 00 loo Boo 1000 J Soo 1 1000 1 IS OO Z OVER 1000 L2000 M 0 Birr/rR&Q CHANGER-HP C WELDERS AC-KVA 0 GENERATORS KW TRANSFORMERS-EVA TEMP MOTORS 7 OF OR IG MOVED MOTORS 707 or oNla -MIBC SIGNS NO NO TRANS AMOVALS FOR DATE INSPECTOR'S NAME WIRING •t OO CONDUIT -A I Q FIXTURES $100 O WIRING SU PLE TAR 00 FIXTURES POWOR � - TOTAL FEE • uTILIn CO NOTIPIBD ` TIM tm Ono w r x 0 WORKER Save a certificate Df consent 20ASM DPW(12 81) APPLICATION FOR ELECTRICAL PERMIT IJ I hereby affirm That 1 here a carhhcete of consent to Bell meun 7°�e3 or a cartlrcattb of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) A N Policy No Company FOR APPLICANT TO RU IN �QOB 7 �el e ❑ CeRifmd copy is hereby fumudled New Residential Bldgs 8 Pools NO EACH FEE LOCALITY ! al ❑ Certified copy is filed with the county,budding mepecuon 1 8 2 Family Sq Ft _ f f department Multi family 9q FI NEMESTCROSS W LP D� Date Applicant Residenual Srnmming Prods A SSORMAP BOOK p� PARCEL CERTIFICATE OF EXEMPTION FROM WORKERSOutlets Roc _ OVn R OR V P A� COMPENSATION INSURANCE Light_Sw Firm 20 LWL P (This section need not be completed If the work Involved by the Total No Additional 0/zv .O permit is for one humdred dollars($100)or less) I certify that m the performance of the wo which this permit CITY Tel No Is Issued I shall not employ any peMgZ2 PLµCHEM become subject Io the Worker° Comp Lghtmg Fixtures Firm 20 APPLICANT Total No Additional Date;'-,2 �� Appllcan ADDRESS RESIDENTIAL APPLIANCES NOT OVER 3 K NOTICE TO APPLICANT U alter making this Certificate of CITY Tel Nc 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 PAPPMLIC T V7 x (N p provisions or this permit shall be deemed revoked Power Apparatus 8 Large Appliances LICENSED CONTRACTORS DECLARATION Sao 8 Type HP KW KVA or KVAR ADDRESS 30 I hereby affirm that I em licensed under provisions of Chapter 9 Over 3 to 10 Incl (commencing with Section 7000) of Division 3 of the Business and CfTI' 0 fel No +�B.�O Professions Code and my license Is In full force and effect Over 10 to 50 Incl LICENSE OR �J� /� } Over 50 to 100 Incl REO NIIkIBER �`� / y✓ a Over 100 DISTRICT NO PR BY O UnseceNum r s Uc Class p 8 Services Swbd MCC&Panelboards Q O Con 'Q Date TV 0 399 Amp Under 000 V I FINAL 0 ❑ I am exempt under Sec 1000 Amp Under 000 V 7,30-13 VALIDATION V Over 1000 Amp or Over 800 V FINAL /J f1 B 8P C fa this reason BRANCH CIRCUIT FEES BY �.a�i�_ i a. Date 15A or 20A 120V Lighting or Racept Z 1 To 10 Branch Circuits Signature 11 To 40 Breach Circular E] 41 Or More Branch Cualb ExemplKrn far Reg Mount Elect 15A 20A 209V To 277V Ljg=Br Cvcuts 4. SINGLE FAMILY Temp Power Pole&AppurtenW e ances W HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 1 ITEMS I hereby affirm that 1 am exempt from the Contractor a License Law for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits TOTAL 63. 43 Code) Lfy LL - [ r_1I as owner of the property will do the work and the structure Min Conduits&Conductore CHECK 63.Td Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)_ CHANGE .00 and Professions Code) CONSTRUCTION LENDING AGENCY nnnn���n I hereby affirm that there is a construction lending agency for the GM0—W01 I�7 /21/`73 per Cance of the work for which this permit Is issued(Sec 3097 PERMIT FEE (Sub-To* 0822 1 AM 7 :3* CivPLAN CHECKING FEE Lender a Name PERMIT ISSUING FEE pulp Q Lender a Address I certlty that I have reed this appllmban and under penalty of purjury state TOTAL FEE 3 that the above mfurmatlon is coned I agree to comply with all County a�dmend Siete law reguleting Electricalwinnp antlherebyeugrorva I dmy to enter upon the ebo+emenuned property QSEE REVERSE FOR EXPLANATORY LANGUAGE /�F PERNIDEE DATE