HomeMy Public PortalAbout9610 VAL ST_Electrical__ DUB 5A 11 ea APPLICATION FOR ELECTRIC PERMIT 1
DIVISION OF BUILDING AND SAFETY
THFarkneDR of county Angel"
7-OWNERAIABOZ4�
p T
DR T.O6 Angel" V
JOHN A LA SIE.COUNT? ENGINEER
CASSATT D GRIFFIN Durr o►BUILDING / I
FOR APPLICANT TO FILL IN FEES
NUMBER C ee ,-?
LIGHTOUTLETS 6�0 /9
MAIL
RECEPTACLES ADDRESS /'
WALL SWITCHES FEE CITY L/ EL NO d
TOTAL OUTLETS 50
ELECTRICIAN i
ELEC RANGES 25 ADDRESS O O O
Of
CLEC HEATERS 25
KW HA. CITY TEL NO Z
STATE
FIXTURES a 2 LICEN81C NO a 0 6
MOTORS DISTRICT N�, GROUP ZONE nuDT roR 1RaremloR
NUMB" HORSEPOWER FEE
N[W I NVD HP OV[R I INC EACH INSPB=ON RECORD
G Llme f 2D Jf, f1LWfLY
Y Y DO
2 D too
D to 150
1B DO 230
iN I a0 200 500 -A
MIBC �Ufiir�b - 4 ar
G2A/o S-rxAP I n/ IIrL/-
/ LDO
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING SI00 J 00
FIXTURES f 100
SUPPLIEMENTARY DO APPEOVAL.S
TOTAL FEE f Z � DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING I
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISMED AND/OR M
FIURQB
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PROPE 7T� UTILITYCO NOTIFIED
SIGNATURE ,Q,Z1_
OFFERMITTE! Y�� FINAL 'L
JOHN A LAMBIE.COUNTY ENGINITOR VALIDATIONS ARTHUR C.VERT.CHIS ELIQGT. RiDPIBCTOR
CN MO 4COA!H
LACO2 9 0 5N NOV30 2 325
71Us¢2 DRB u a-w APPLICATION FOR PEST
DEPARTMENT OFNG AND SAFETY ELECTRIC i
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEr ENSINEER
FOR APPLICANT TO FILL IN DISTRICT NO. BROUPZONE PERMIT NO.
S i4 It SSS
ELECTRICIAN y RECEIVED eY aswor ►Da DAT[ IBSUED
ADDR[BB Z- ) FIRST INBA[OTION RAM �' �O
01 - TEL.No �d6$
COUNTY WCENet'No IREe ADIILOINDREM U
PERMIT
NUMBER EACH Fz< LOCALI
LISNT OUTLETS NEAREST
RECEPTACLES CROSS BT.
WALL BWITCH® OWNE fflL
TOTAL OUTLETS Sc111 1190 MAIL
[LEC. RANSES R6 IADDRKM
ELKS HEATERS am
CITY TEL NO.
►IKTURES S 1 WLED
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MIND APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIONT CIRCUITS AND AOR[[ TO COMPLY WITH ALL COUNTY CRDJNANCKS
NUMBER Or RECEPTACLE CIRCUITS AND STAT[ LAWS RKOULATINB ELECTRICAL WIRIN0.
MOTORS I CERTIFY THAT I POSBEeS THE ABOVE VALID LOB
NIIMK[R HORSEPOWER AHOEL[B COUNTY LIOKNB[• OR 1 AM THE LEGAL OWNER
FEE or THE RIDID[NTIAL PROP DEe RIBED ABOVE
NtW Mw HP ovu IND [�
• u[Ke IIS SIGNATURE OrVE �
9 SOPEaMITTEr • 1
a e IDD INSPECTION RECORD
e is lea
IS SG 200
6o aoo SCC
goo BOC I Do a
600 1000 1500 =
OVER 7000 x0aa p
NO BETFR CHANSKR-NP S;
WELDERS AC-KVA C
BEHERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS 76 or oRID)
mOVKp MOTOpe (7E or GRID)
MISC
BIBNS
ND. NO TRAHB. APPROVALS
D ND LAMPS 77
rOR EACH PERMIT. DAT[ INSPECTOR'S NAM[
WIRIN0 OIA30 O V CONDUIT -
FIJITURVS 01.00 4 Q WIRING
UPPLEM6 rIJRL REB 1J7-- �✓
POWER
TOTAL FEE B UTILITY oo NOTIrIED _
rINAL
,WORKER I haveCOMPENSATION DECLARATION 760653 ORV(12 e„ APPLICATION FOR ELECTRICAL PERMIT LI
70-001
I hereby al/iron that I have a certificate o/ consent to sell Insure
or a certificate of Worker a Compensation Insurance or a certilled COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereoft(Sec 3800 Lab•C) ,
Policy No Company FOR APPLICANT TO FlLL IN ADDRESS
❑ Certllied copy is hereby furnished New Residential Bldgs a Pools NO EACH FEE LOCALITY
❑
Ce _ S S
tertm copy Ie/ilatl with the county bud1&2 Family Sci Ft
ding Inspection
tlepanment Multimlty IaSQ NEAREST Ft CROSS ST
Date Applicant Residential Swimming Pods ASSE53OR
MAP BOOK I P pM
CERTIFICATE OF EXEMPTION FROM WORKERSOutlets Rec L L OWNER OR
COMPENSATION INSURANCE Light_S. FIRM NAME
(This section need not be Total No Atltlrtcompleted If the work Involved by the Firstuonel AOM&RE83
permit Is for one hundred dollen($10-0)or leu)
I certify that in the performance of the work for which this permit CITY TO
IB Issued I shall not employ any person In any manner ea as to
become subject to the Workers Compen n Lawe Ughnrq Fixtures Fist 20 UtHE
Total Na Additional ADDRESS
Date Applicant RESIDENTIAL APPUANCES NOT OVER 3 HP
NOTI T A LICANT If alter making this Ilcete of CITY TN Ni,
Exemption you should become subject to the ars Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and —t'— Over 3 to 10 Incl CITU v Td
Professions Code and my license Is In full force and effect Over 10 to 50 Incl
CEN OR
fill
Over 50 to 100 Ind REG NDMBER Cisse
License Number IKLIC Gass ( —/G Over 100 DISTRICT NO O SSED BY
Services Swbd MCC&Panelboards r Qa Q
Contractor %
0 3AmD Under e00V 16�A DATE` O
F1m exempt under Sec 40I aD 1000 Amp Under 800 V /• VALIDATION W
Over 1000 Amp or Over 600 V FlNAL d
B&P C for this reasonBY
BRANCH CIRCUIT FEES Z
Date 15A w 20A 120V Lighting or Recept
I To 10 Branch Circuit
Slpnalure I I To 40 Branch Circuits
Elxem �— 41 Or Mare Branch Circuits
Eption for Reg Mamt Elect 15A 20A 200V To 27N Ughtmg Br Circuits
SINGLE FAMILY Temp Power Pole&Appurtenances -.�I�
HOME OWNER BUILDER DECLARATION Sign wlgl One Branch Circuit 33W °9.00
I hereby affirm that I am exempt from the Contractor a License Law
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits 1 ITEi1S
Code)
❑ I as owner of the property will do the work and the structure Mlsc Contlums&Conductors TOTAL 89 - 00
Is not Intended or offered for sale (Section 7044 Business Other(Sae Comdata Fee SChetlule)— , (ASH 89,00
and Professions Code) CHANGE .00
CONSTRUCTION LENDING AGENCY
1 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)
CIV C) 0000-0001 7! 3!95
PLAN CHECKING FEE 1149 1 AM10,11
Lenders Name
PERMIT ISSUING FEE o
Lander a Addrasa
I cerbly,that I have reed this application and under penalty of purlury state TOTAL FEE
that the above Informaocn Is correct I agree to comply with all County
ordinances and State laws regulating Electmal wring and hereby authorize
rapres umatrvee of this County to enter upon the above mentioned property
for SEE REVERSE FOR EXPLANATORY LANGUAGE
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