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HomeMy Public PortalAbout9860 VAL ST_Electrical__ 76AG63-CE80610/74 APPLICATION FOR ELECTRICZNPEi&JT 't COUNTY OF LOS ANGELES Ila DEPARTMENT OF COUNTY ENGINEER pDDfiEsB �, �/ BUILDING AND SAFETY DIVISION LOCALITY ti NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLE $ NO. EACH FEE OWNER OR rY �njo $ $ FIRM NAME RECEPT. g MAIL LIGHT, TOTAL d .,2 .�- ADDRESS FIRST 20 .30 OVER 20 Jb , r-� CITY TEL. N0. SWITCH PLAN CHECK LIGHTING FIRST 20 APPLICANT TOTAL FIXTURES .f0 OVER 20 ADDRESS � RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT ` RANGE DRYER_WTR. HTR. APPLICANT l ���?G STA. COOK DISP. F.A.U. ADDRESS &Loe SPACE HTR. AIR COND. CITY j TEL. N0. _,0, j CLOTHES WASH.j-DISHWASH. REGENNUMBER S,/ CLASS.GI SA FAN OTHER 1.00 �`�j` 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION VV AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING. SIZE & TYPE OVER " TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O - Ii�pp LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI 1 AM THE LEGAL OWNER OF THE ABOVE 1 - 10 9.00 OESCRIBED RESIDENTIAL PROPERTY. PERMITEE CC 10 - 50 5.00 SIGNATURE BO - 100 10.00 W DISTRICT N0, SED BY p, 100 - 500 15.00 V U 8 MUNE,OR SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPEC 'S SIGNATURE MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICE NOT OVER 600 VOLTS OR 200 AMP 3.00 !� �� UNDERSLAS WORK SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH'CONDUIT TEMP SERVICE,POLE,IN APPURTENANCES 5.00' WIRING 7 TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL 1 -2J/74 PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 TOTAL FEE a.� PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE �,' 78A669-CE110-Y APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES 'DEPARTMENT OF COUNTY ENGINEER JOB ` t BUILDING AND SAFETY DIVISION LOCALITY' f� NEAREST • FOR APPLICANT TO FILL IN CROSS ST, / OUTLETS NO. EACHIII FEE FIRM OWNER NAME S RECEPT._ MAIL LIGHT TOTAL FIRST 20 25 ADDRESS S����r4_1 OVER 20 CITY TEL. NO. SWITCH_ 10 PLAN CHECK LIGHTING TOTAL •10 FIRST 20 25 APPLICANT FIXTURES OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMITRANGE DRYER_WTR. HTR, APPLICANT �1 / C STA. COOK DISP. F.A.U. ADDRESS 3 P. ��"�^ �� .07 SPACE HTR. AIR COND. CITY od �tijQ,- TEL. NO.790-Am/ CLOTHES WASH. DISHWASH. LICENSE OR REG. NUMBER pl�J cJ CLASS. �(� FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND, HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF y CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE �� 1 1 - 10 3.00 /5F ^® DESCRIBED RESIDENTIAL PROPERTY. V • PERMITEE �Ir ' m 10 - 50 5.00 SIGNATURE / C3 50 - 100_ 10A0 Lu DISTRICT NO. PROC SED BY y 100 - 500 15.00 `� Z SIGN, GASSIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICENOTOVER600VOLTSOR200AMP 3.00 UNDERSLAB WORK SERVICEOVER500VOLTS OR200AMP 10.00 ROUGH CONDUIT TEMP SERVICE,POLE,&APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 'yJf � TOTAL FEE 9 a0 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH 1 2 4 ti­Av 47 2 D 9.0 0 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ` DEPARTMENT OFTUTU M AND SAFffff A g.IICA'i'BOAT FOR FER161IT UNTY.OF LOS ANGELES _ E'1 L C IC . �1 M. _ OX CHIEF EmrmNzERA P AM6 �rra� , /J /Q DISTRICT N0. C3ROUP ZONE P•E�RfMIT NO-.d ADDRESS v'%r .1 1� ' '�1�~Ci-! r_ .J CJ �✓ CITY gyp•i�lr .r''G+4.EL.NO. � 493 A RECEIVED BY FIRST READYN PEECTTION COUNT ATE ISSUED CO. & 6 D EXPIRES �� � APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS ����4! /U�V NUMBER OF OUTLETS ON CIRCUITS LOCALITY/ / Flo LOCATION BY ROOMS NEAREST a y� P s LIGHT OUTLET$ SW. PLUGS R*r CROSS i%)-QJ �xO-A4 ioj �f•+D CIRCUIT A B ICIDI E F Jr. IN m NAME x ADDRESS s CITYTEL.NO. y 1 AM THE LEGAL POSSESSOR OF THE ALOS ANGELES.COUNTY CERTIEI�_ TjE OF QUALIF10 4.. P ELECT -IAN. 17— z OVE TH6 L6RiAl.OWNBR OF TIIE PROPERTY DESCRIBED ��IDIDyy.� rr���� 7�Q OWNER. cOd&�:�enoNS • � r O J Q D O rNO. OUTLETS ffi J S APPROVALS FIXTURES ffi DATE INSPECTOR'S NAME MOTORS H.P. ffi CONDUIT / v SIGNS TRANS. $ WIRING RANGES OR HEATERS ffi FIXTURES LANEOUS ffi POWERFEE ffi USILITYCO.NFEE ® RIVAL OB8 SA SSM SETS 7-48 AMA•Rf'IARrfiI N FOG Rlt PEIM HDEPARTMNT -Om 7B�UMDM eMy UFM IIIII/ELECTRIC ^elljlll�,LL�bilii[yy�WW//9911�����♦.yy77 YY''IIDD a5s�/Yl�iy,��B ♦SHL COMM.O iLiH�Y/ilLi�l E�1�f�JV� i���/ �! W H R NAME DISTRICT O. E'aROUP ZONE PERyMIIT NNO. U ADD - �'� I• �� / CITY s 7� RBCE(VED 13Y READY FOR DATE IIkSUED FIRST INSPECTION r �� J COUNTY W CERT.NO. (/` !31(PIRt78 "PLICAL FII.L IN MAVMY OUTLEMEHD IFDR'I'HON O JOB IIDESCRMON OF WORK ADDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS 1SW. Inift C SST. CIRCUIT A 113 C ® I E F IG H IC NAME tg Z MAIL (! a ADDRESS I 5 CITY TEL.NO. 1 AM THS! EGAL POSSES OF THE ASO V S ANGELES CO CERT@FI OF gUALIF AA ICIAN. I AN THIK. AL OlNN OF TFI�PROP DESCRIBED OWNER. V�'8p.{1l1itJ�{A 81®�� O — a -Z o - o VNOF TS ffi ® "PROVALS RES ~ _ ffi DATE INSPECTOR'S NAME r RS H.P. ffi CONDUIT �./ , �, g I TRANS. ffi WIRING OR HEATERS ffi FIXTURES / N U ffi / SOWER PERMIT FEE ffi L .� ILITYCO.NOTIFIED _TOTALIN WORKERS' COMPENSATION DECLARATION 2DPW 3/87 I 76A6636A663 APPLICATION FOR ELECTRICAL PERMIT hereby affirm that I have a certificate of consent to self ce-eo6c LI insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Polic a. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS V �3 l/ >+ ` ElCertified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY `�Q\� v,\ tion department. Multi-family Sq. Ft. — NEAREST ,C_r.�— CROSS ST. M Date 3. "/— Applicant Residential Swimming Pools OWNER OR p r_ FIRM NAME CERTIFICATE OF EXEMPTION FRO WORKERS' i� w COMPENSATION INSURANCE Outlets: RecLight Sw._ U MAIL First 20 ADDRESS (This section need not be completed if the work involved by Total No. Additional t CITY 'Pm. Tel. No.-r/—'—R 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 Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION 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._ ADDRESS �' G with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITYkW Tel. No. 73C U LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— LICENSE OR B IE `� I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR SED BY and Professions Code,and my license is in full force and effect. n r/ T s�� ,1` Size&Type HP, KW, KVA, or KVAR L !I O 0 License Number X15 1 Lic. Class ii \V Up to 1 Incl. FINAL Contractor R�YW M` Date Over 1 to l0 Incl. DATE:' Z� ( VALIDATION 0 ❑ Over 10 to 50 Incl. FIN, ( / ~ I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 d Services, Swbd., MCC& Ponelboards <n Date: Z 0-200 Amp. Under 600 V Signature XM4201 - 1000 Amp. Under 600 V ❑ \J Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION ` I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit 'T Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits I ....... Professions Code): ^- - ''= ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , TOTAL 39 - 40 Business and Professions Code). _ CONSTRUCTION LENDING AGENCY "•ADd'K I hereby affirm that there is a construction lending agency for �. { i {jE the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ZA- (Sec. 3097, Civ. C.). PLAN CHECKING FEE " Lender's Name 22 I_!_i(,lL5—:,Iti»)i PERMIT ISSUING FEE 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 hereby authorize representatives of this County to enter upon the above-mentioned p perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �kl3-/ --`j 1 Signkle of Permittee Date ©s