HomeMy Public PortalAbout6453 TRELAWNEY AVE_Electrical__ ).A,N(i .Oe le/Tel APPLICATIO -FOR EL TRICAL PERMIT
COUNTY OF LOS ANGELESGp BUILDIINNG AN SAFETY
FOR APPLICANT TO FILL IN ADDRESS Js
New Residential Bldgs 6 Pools EACH NO FEE
182 Family Sq H S 025 — S LOCALITY L/ r
Multi family Sq Ft 02 NLARtbi
T
Resldennal Swimming Po25 00 ols WN
IRM NA SC/9-ole G,�D,0!5oZ
Outlets Rec_Light_Sw -2- MAIL
First 20 50 - ADDRESS
Total No Additional 30 CITY L Tel No
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 50 ADDRESS
Addnlonol 30 _
Total No CITY Tel No
Fixed Appliances Not Over 1 HP "MITE = G
Range_Heater_D W
Oven—Dryer_W M_ ADDRE 0 _
Top —FAU — WH — CITY�r 9rxoe Tel g' a��
Hood_Fon —Other— LICENSE OR
Dnp _Room Au Cond 250 REG NUMBE 6 Class C.Io
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA
Power Apporatus&Lorge Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Sae A.Type H KW, KVA or KVA COMPLY WITH ALL COUNTY-ORDINANCES AND STATE LAWS
2 50 REGULATING ELECTRICAL WIRING pro 1 In<I � I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AN
�j Over 1 to ID ImIZ(7 500 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Over 10 to 50 Ind 1250 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 50 to 100 Inc 25 DO
DESCRIBED RESIDENTIAL PROPERTY
PERMITEE r
Over 100 4000 _
SIGNATURE
Services - DISTRICT NO E ED BY
0 200 Amp Under 600V 1250 U a
201 1000 Amp Under 600 V
2500 v
Over 1000 Amp or Over 600 V 5000
Temp Power Pole&Appurtenances 1000 i
Sign with One Branch Circuit 1000 3`G
Additional Sign Branch Circuits 200 INSPECTION
M,s1000 INFORMATION 2 2 8 3 3 A
Other
CSee City 8 ConductorsaSchedule)—
ON REVERSE
Other($ee Complete Fee Scheduler_
SIDE = ge . . . e2
2 • • 2800
PERMIT FEE (Sub Total)
PLAN CHECKING FEE (One Fourth Permit Feel O 0220-79
F
PERMIT ISSUING FEE
$700 O
TOTAL FEE >
INSPECTION FINALED
dote By IIICCC m+
',%e WORKERS COMPENSATION DECLARATION 76A663 ID/Bt APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm'tho�i I hove a certificate of consent to self CE 806G'insure �r a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 38DO Lab C )
Poli<y No Company FO[APPLICANTTO FILL IN AA[RESS /_ 3
❑
Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE K�
IJCertified copy is fled with the county building inspec 1 8 2-Family Sq Ft S — f LOCALITY P
tion department Multi-family Sq Ft — NEAREST
DoteOWNER
/b NLS
Residential Swimming Pools CROSS ST
Appbcant n� LL/� FIRM N� c
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec—LLrght,�Sw �_ / 'll MAIL
COMPENSATION INSURANCE /� First 20 2V �' ADDRESS ' I 22
(This section need not be completed N the work Involved by Total No� Additional CITY Tel Nog4:r_ J
the perrnit is for one hundred dollars (5100)or Ins)
I certify that in the performance of the work for which this PIAN CHECKAPPLICAM
permit is issued I shall not employ any person in any manner
so as to b o=omm�e sss lbj`ect iD the Workers Compensotro ws Lighting Fixture/s ' First 20 ADDRESS
7 PP / Q'.I'ea��//i^ Total No-4-
1
Additional
Dote pplicont 1... 74— CITY Tel No
Fixed Appl+an<es Not Over 1 HP PERMIT
NOTICE O A LICANT If after making this the Wokficate of Range— Heater_D W _ APPLICANT
Exemption you should become subject to the Workers 0
Compensation provisions of the Labor Code you must forth Oven _ Dryer _ W M — ADDRESS
with comply with such provisions or this permit shall be Top _ FAU —WH
deemed revoked Flood _ Fon OtherCITY Tel No
LICENSED CONTRACTORS DECLARATION _ —
LICENSE OR
hereby affirm that I am Learned under provision of Chapter 9 Dup _ Room Air Cond REG NUMBER Class
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROCIE >-
Size
Professions Code and my license is in full force and effect /1 r
Size 8 Type HP KW KVA or KVAR �/ o
License Number Lic Class Up to 1 Ind FINAL
Over I to 10 Ind DATE
Contractor Date Over 10 to 50 Incl F G
❑ 1 am exempt under Sec Over 50 to 100 Inc au
0 8P C for this reason Over 100 Z
Dote Services, Swbd , MCC 8 Ponelboords 1
0 200 Amp Under 600 V v
Signature 201 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Nwint Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
• ' 8 a 7 5
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 is is is 83755
froIessions Code) Q/j,2 —8 5
I, as owner of the property will do the work and the Just: Conduits 8 Conductor ►
structure is not intended or offered for sole (Section Other (Sea Complete Fee Schedule)_
70" Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby off irm that there is a construction lending agency for
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
Lenders Address
PERMIT ISSUING FEE Q
I certify that I have read this application and stale that the TOTAL FEE
above information n correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring and
hereby authorize repres tives of this County to enter upon
1bg above mentioned op rtn
y for ipection p roosts
c SEE REVERSE FOR EXPLANATORY LANGUAGE _
c
Srgnoture c Permi ftee Date