HomeMy Public PortalAbout9567 WEDGEWOOD ST_Electrical__ 76A663 Des BA 11-50 APPLICATION FOR PERMIT '
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC I
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRIC? NO. GROUPrUZONE1 PERrMIT NO.
ELECTRICIAN .,g7 I �/ r / I
/ ---- RE IVED BY READY FOR DATE ISSUED
ADDRESS �I ✓�Lye- FIRS I P'ECTt)ON.
CITY /ri? TEL. NO. / 03
COUNTY LICENSE NO. o-v EXPIRES [!! L��l BUILDING �/
PERMIT FEES ADDRESS (O -
NUMBERIEAC;l
FEE LOCALITY
r
LIGHT OUTLETS NEAREST
RECEPTACLES
�l .� CROSS ST.
oG,
WALL SWITCHES OWNER
TOTAL OUTLETS Sc ffi MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES I s
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER ANGELES COUNTY LICENSE, OR. I AM THE LEGAL OWNER
FEE OF THE RESIDENTIA PROPERTY DES R ED BOVE:
NEW MVD. HP OVER INC. fiACH a
±%221/R fi LEGS S .25 SIGNATURE OF
1/2 2 .50
PERMITTEF,� a bbb II
2 5 1.oo INSPECTION RECORD
s IS 1.50
Is so 2.50
50 200 5.00
200 Soo 10.00 J
Boo 1000 15.00 Z
OVER 1000 20.00
M. G. SET/FREQ. CHANGER-HP -
WELDERS:AC-KVA
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%-OF 01116.)
MOVED MOTORS (75%OF ORIG.)
MISC.
SIGNS
NO. NO.TRANS. I APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT:
DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT
FIXTURES $1.00 V WIRING "_ '� 'SZ'
SUPPLEMENTARY .50 FIXTURES 6— QAt a
// ey 3 POWER e�
TOTAL FEE S ,+Z 0 UTILITY CO. NOTIFIED 141— 1y �a / -
® v �+ FINAL o -` L- 5 W z—A.'
►l 1
WORKERS'COMPENSATIONDECLARATION
CE-806G (2-801 APPLICATION FOR ELECTRICAL PERMIT
CE-806
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab.C.) �
FOR APPLICANT TO FILL IN JOB
Policy No. Company ADDRE
New Residential Bldgs.&Pools EACH NO. FEE
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ 1 LOCALI Y
Multi-family Sq. Ft. CROSS STC e
Certified copy is filed with the county building inspection
department. Residential Swimming Pools OWNER OR
FIRM NAME
Date Applicant Outlets: Rec, Light_Sw. ADDRESS LvG
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY IV
Tel No.�� — O d
COMPENSATION INSURANCE PLAN CHECK 0
(This section need not be completed if the work involved APPLICANT U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS cc
Total No. Additional 0
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. U
permit is issued, I shall not employ any person in any manner PERMIT UJso as to become subject to the Workers' ompensation Laws. Range_ Heater_D.W. APPLICANT L CL
to
Oven _ Dryer_W.M. ADDRESS, , ui�h�c h S-7' z
Date Applican
o Top _ FAU _W.H. _
Hood _ Fan _Other_ CITY 23 t'LTeI No.��
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._ LICENSE OR
Exemption, you should become subject to the Workers' REG. NUMBER Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances kDISTRICT NO. / PROCESSED BY
with comply with such provisions or this permit shall be Size&Type HP, KW, KVA,or KVAR
deemed revoked.
Up to 1 Incl
Over 1 to 10 Incl. FINAL
LICENSED CONTRACTORS DECLARATION DATE ,.� �/ VALIDATION
Over 10 to 50 Incl. G
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY
ness and Professions Code, and my license is in full force and
effect. Services
W� -200
License Number3 , Lic.Class �� 0 mp. Under 600 V �J
201-1000 Amp. Under 600 V
Contractor&/ /3 L—LEL Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors
❑ I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section
7044, Business and Professions 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 PERMIT FEE (Sub-Total)
issued (Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE f fj
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- entioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date