HomeMy Public PortalAbout9636 VAL ST_Electrical__ 7GAa83 C"" ,o as APPLICATION FOR ELECTRIC PERMIT 1
WELDING AND SAFETY DIVISION
Department of County Engineer 5uILDINo
County of Law�� AD
DR E88
JOHN ALAIE COUNTY ENGINEER
CASSATT D GRIMM.Bun roP BUILama LOCALITY
NEAREST
FOR APPLpLIICCAA�f TOOSFILL INCROSS
LIGHTS n[CRRACLES / OWNER
[WITCHSD
HUXS[n 1 T[M EACH PEE MAIL
ADDRH88
TOTAL OUTLET[ � 10 �
RISC RANGES WATS■ NEATENS CITY TEL NO
CLOTHES DRYRRS so/ ELECTRICIAN RC SMC[ HEATERS STAT T COD[
ING URITS GARSASR DISPOSER[ ADDRESS
Iris
AUTO WASHERS DISHWASRER 25 r
LIGHTING FIXTURES 10 J CITY TEL NO
MOTORS STATE O
LICENSE N
HORSEPOWER
H n n OY[ INC I IC NO GrP )O_11 READY me INSPECTIOR
N
V. LESS 25 R
2 50 INSPECTION RECORD
2 5 too
6 15 1 50
I5 50 250
50 200 500 T
Nuw a/ / y7�
/ , e
s
SIGNS NO TGNa
HO LAA!" /
SERVICE O.500V 100
SERVICE OVER e00V boo j
WIRING PERMIT 1 00
FIXTURE PERMIT 100 SQ 72Yn �GY��/✓SP/✓
SUPPLEMENTARY PERMIT 5011 7
TOTAL FEE CA �E. —Vis-IA�TO �7
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR 8 SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING _
1 HERESY CERTIFY THAT I AM PROPERLY RESISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I A E LEGAL OWflatt OF TXE ABOYH POINBN
DESCRIBED RESIDENTIAL P P I
SIGNATIlRM � UTILFTY CO NOTIFIED
OF PSM ITTE! FINAL $ygI
JOHN A�LAMB16. VALIDA�' QPI SU�viING ELIDCTRICAL 6NOIN5
I UNTY NOINS�t CN Yo wN
1
- O2"9 7 1D.; OCT 4 2 505 g
• 7dML ME BA a-[D APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY ELECTRIC i
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX. CHIEr EHCINEER
FOR APPLICANT TO FILL 1 DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN
RECEIVED SY READY rOR DAT[ IBBuED
AGGRESS rIRST INRPECTIDH
CITY TEL. NO vs?
COUNTY10 A N o Y [XVI ADDRESS
PERMIT FEESrim
6L�G
NUMBER EACH LOCALITY
LIORT OUTLETS NEAREST
RECEPTACLES L 6ROBB ST.
C
WALL SWITCHts OWNS rx
TOTAL OUTLETS 4-1-1 Sc 0O U MAIL 42
[LEO RANGES LB ADDRESS
[LEC HEATERS LB CITY TEL NO
FIXTURES L B 0 1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS
MIBO APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT
T
NUMBER OF LIGHT CIRCUITS AND AGREE O COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Or RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 C[RTIrY THAT I POBBWS THE ABOVE VALID LOB
NIIHRER HCRBZEPO�RE ANG-Ka COUNTY LICENSE. OR I AM THE LEGAL OWNER
NE.v Mw MP ov[RCH Or THE RESIDENTIAL PROPS D CRIB[D ABOVE.
'>lsBIGHATURE O60PERMITT[�LDO INSPECTION RECORD
B1 BO18 BOBOOD 00 00 =
overDD p
M G BET/FREq. CHANGER-HP Q'
WELDERSt AO-KVA D
GENERATORS - KW
TRANSrORM[RS - EVA
TEMP MOTORS 76 Or ORIo)
MOVED MOTORS (78or RRIR
MIBO
SIGNS
NO NO TRANS. APPROVALS
NO NO
FOR EACH PERMIT DAT[ INSPECTOR'S NAM[
WIRING BLDG OO CONDUIT
rtxTURO •1.00 U U WIRING
N7 RY SO rIXTUR[S
POWER
TOTAL FEE •vt 00 UTILITYCO.NOTIr1ED ,
C FINAL
fr-Y"r COMPENSATION DECLARATION CE-80O ,P,e, APPLICATION FOR ELECTRICAL PERMIT
frdreby Minn treat I have a ceridtcale d consent to self amore
CE-9eeG
or a catuficate owub.kers Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(sec 3800 Lab C) "fl
Policy No Company FOR APPLICANT TO FILL IN JOB p T
[_1 Certified copy.hereby furnished New Residential Bldpa a Pools EACH NO FEE ADDRESS �`�^3� �• �L S/
— T'Efh�LL C/T
E] Certifiedcopy is filed with the county building irrspectbn 1 8 2-Family s9 Ft $ $ LOCALITY'—
department Multi-family Sq Ft CROSS ST NEAREST / rC• VL✓4
Date Applicant Residential Swlmmm Pools 01 N 13 08
FIRM NAA /'isi Fu LLr'.(
CERTIFICATE OF EXEMPTION FROM WORKERS Z FIRM
COMPENSATION INSURANCE Outlets Rec Light �` Sw =ESS R S- /r16—
First 20 CITY Tel No
(This section need hot be completed the work Involved by itis Total No / Additional
permit Is for one hundred dollars($100)or leas)
f certify that in the performance of the work for which this permit PLAN CHECK -
Issued not empty srry person in any manner eo as to AM"NT
bm
becoe subject
to the Workers Camperisetnon Laws Lighhrig Endures First 20 ADDRESS
Date J gT_ AppfoaM `��"'—" Total No � Additional! CfTV Tel No
NOTICE TO APPLICANT , after making this Ceddlcate of Food Appliances Not Over 1 HPRMIT
Exemption,you should become
Re subject to the VbCompensation Range— Heater— DIN — PESA2•I
mrkem &
provrsore of the Labor Code,you must W11-wrth compy, with such Oven _ DryerW M ADDRESS
promore or this Permit shall be deemed revoked Tap _ FAU — W H —
LICENSED CONTRACTORS DECLARATION Hood — Fan Other CfTY Tel No
—
I hereby affnm that I am acensed under pm nsiarts of Chapter 9 DOP — Room Art Cord LICENSE OR Claae
(commencing with Section 7000)of DNi.won 3 of the Business and REG NUMBER
Professions Code and my license m In full force and effect DISTRICT NO !1 I'ROCE By
Power Apparatus a terga Applleroes (f
Size a Type HP KW KVA or KVAR r
License Number Ld Class Up to 1 Ind FlNAL
Over 1 to 10 Incl DAA VA O
Contractor Date Ovar 10 to 50 Intl 0
❑ I am exempt under Sec Over Soto 100 Inc Fl
By U
BV lOy.
B BPC for this reason Over 100 42964.5A
N
Date
Servlp s Swbd MCC a Panelboerds 2 Z
ScW p-200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V 1 - 6.1.25
❑
Over 1000 Amp or Over 600 V Exemptron for Reg Main[ Elect
• • • 61.25
SINGLE FAMILY Temp Power Pole a Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit OS 2 0-8 8
1 hereby affirm that I am exempt from the Contractors Lcense Law
for the fdbvirrig reason(Section 70315 Busiress and Professions Additional Sign Branch Grads
Code)
ER I as owner d the property .11 do the work and the structure L6sc Condwts a Caductors
is net intended or offered for sale (Seder 7044 Business Other(See Complete Fee Schedule) — , r
and Profession Code)
CONSTRUCTION LENDING AGENCY
I 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)
PLAN CHECKING FEE
Lenders Name _
PERMIT ISSUING FEE
Lender Address
I certify that I have read this application and state that the above TOTAL FEE v
information m correct I agree to comply with ell Canty ordinances
and Slate Iswe regulabng Electrical mnng and hereby authorize
represamahwa or the Canty to enter upon the above-mentioned
Property for inspection purposes�
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date