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HomeMy Public PortalAbout9085 WOOLLEY ST_Electrical__ COUNTY OF Los ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & :SAFETY i• WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN IbJ I. \D S 19. RECEIVED BY READY FO DATE ISSUED ADDRESS /2 �k FIRST INSPECTION CITY Iii IJ TEL �NO. -r�"y� YID 1'-` `d - COUNTY LICENSE NO. EXPIRES 7 BUILDING J PERMIT FEES ADDRESS P�V6 ANEI NUMBER EACH FEE LOCALITY X /4211—lam LIGHT OUTLETS5 _ NEARESTo '7 RECEPTACLES CROSS ST. t c, G A qo.^ WALL SWITCHES- OWNER 5c,14IL)(a—e]2 TOTAL OUTLETS L Be M 0. ADAL �y KS ELEC. RANGES 25 ELEC. HEATERS 23 CI.TY fJd] y- �v(d �S`N TEL. NO_. / 7q6M FIXTURES r / B Ol!r 1 HEREBY ACKNOWLEDGE`THAT I HAVE 'READ THIS MISC. �'`� APPLICATION AND STATE THAT THE ABOVE 'IS CORRECT NUMBER OF LIMCIT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT 1 POSSEBB THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. %2 & LEas S .25 SIGNATURE OF 3 I/2 B .50 ( ff PERMITTEE Lkl\ 2 s 1.00 INSPECTION RECORD 5 18 1.50 15 SO 2.50 50 200 5.00 200 Boo 10.00 J Soo 1000 15.00 per+q Q Z OVER 1000 20.00 + r I9 K.G. SET/FREQ. CHANGER-HP �a WELDERS:AC-KVA Q'��/Sl� O GENERATORS - KW ��� TRANSFORMERS r KVA TEMP. MOTORS (75% of ORIo.) MOVED MOTORS (75% OF GRIM.) O , SIGNS NO: ND.TRAN ,i h PIT S. NO. NO.LAMPS APPROVALS FOR EACH PERMIT. DATE INSPECTOR'S NAME WIRING 51,E CONDUIT •� r ��++��j!77 FIXTURES sll= WIRING �G ��J L•C4l�� UPPLEMENTARY .SO FIXTURES Lb") r 4 " 7 POWER / �q TOTAL FEE UTILITY CO.NOTIFIED 1Ar�JI b FINAL 76A663 D88#5A 2-53 01 .A � .. c r � Ip Fs 14: I 1 I 1 I 1 1 t � 1 Fin■■■■D■■■O ffi�■n■C■■KKAn■■ .. s ten■■■■■■■■o . ®■u■■■o■■■� h 1 i 1, E: �■n■■■n■■■a ■■n■■no■■ ■ ■■mmmm"■ ■ !�■ alb WORKERS'COMPENSATION DECLARATION 76-663 10/e1 APPLICATION FOR ELECTRICAL PERMIT tt w 'y L h2 by affil hat I have a certificate of consent to self insure, CE-606G ,dr a certifL of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,iab.C.) Policy NO. Company FOR APPLICANT TO FILL IN JOB !1 �- ❑ Certified co is hereby furnished. EACH NO. FEE ADDRESS ©,,' W&Adf ;S MA4 Cirr PY Y New Residential Bldgs.8 Pools LOCALITY � i ❑ 1 8 2-Family,Sq.Ft. $ _ $ Certified copy is filed with the county building inspection NEAREST CROSS ST department. Multi-family Sq.Ft. f�� ��. Date Applicant Residential Swimming Pools OWNER OR +/.. FIRM NAME � CERTIFICATE OF EXEMPTION FROM WORKERS' �!0� " MAIL +� COMPENSATION INSURANCE Outlets:Rec—Light 4 ADDRESS � r 5 ��'� f� A J (This section need not be completed if the work involved by the First 20'�iy CITY �,n Tel.No.L� permit is for one hundred dollars($100)or less.) Total No. Additional ` fi)11 ..G I certifythat in the performance of the work for which this permit PLAN CHECK P P APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS � Total No. Date y/� Additional CITY Tel.No.Applicant y a Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ APPLICANT provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATION Hood — Fan OtherCITY Tel No. _ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. UCENSE OR, Class (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances DISTRICT NO. PR D.BY Size 8 Type HP,KW,KVA,or KVAR 'STv Q License Number Lic.Class Up to 1 Incl. FINAL CJ Over 1 to 10 Incl. DATE Contractor Date Over 10 to 50 Incl. VALIDATION O ❑ FIN (� I am exempt under Sec. Over 50 to 100 Inc. BY WW B.BP.C.for this reason Over 100 IL fn Services,Swbd.,MCC 8 Panelboards Z Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V ❑ Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole 8 Appurtenances 0 0 0 0 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o 0 'i a C I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits �, , '• , n a C Code): o !�:S f 0 Ji 1,as owner of the property,will do the work and the structure Misc.Conduits 8 Conductors ` is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 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 issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE Lender's Name • PERMIT ISSUING FEE Q Lender's Address I certify that I have read this application and state that the above TOTAL FEE (i(r! 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 property for inspection pur es. SEE REVERSE FOR EXPLANATORY LANGUAGE ZJAh,a-0 .- Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 78-8 70/87 CE-80806G APPLICATION FOR ELECTRICAL PERMIT {� I Rereby�affirm that I have a certificate of consent to self insure, L1 or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) � cy No, ESS � Company FOR APPLICANT TO FILL IN JOB S Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADD R ® � E] Certified &2-Family,Sq.Ft. $ _ $ LOCALITY C ��� Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST VI S+ Date Applicant Residential Swimming Pools OWNER OR � ffffjj 1 FIRM NAME -.I se CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL /o Q�� Woo" �� Outlets:Roo—Light— t 2 — / �/ COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work Involved by the First 20 aW ,60 permit Is for one hundred dollars($100)or less.) Total No. Additional CITY �� c Tel.No. I certify that in the performance of the work for which this permit APPLICANT PLAN CHECK is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Q _ Additional ®'� '6®Applicant`s"A5 AAW Total No. CITY Tel.No Date Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — 'FAU 5Z W.H. _ LICENSED CONTRACTORS DECLARATION Hood — Fan _ OtherCITY Tel.No. _ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Class (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. ' PROCESSEQW Size&Type HP,KW,KVA,or KVAR 5 Q License Number Lic.Class Up to 1 Inc[. FINAL Over 1 to 10 Incl. DATE O /�—�� VALIDATION 0 Contractor Date Over 10 to 50 Incl < Ci FINAL V ❑ I am exempt under Sec. Over 50 to 100 Inc. BY J W BAP.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V ;90839A 0 0 0 0 o 'Z SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o21.00 I hereby affirm that I am exempt from the Contractor's License Law additional Sign Branch Circuits o 0 0 2 1, _ for the following reason(Section 7031.5,Business and Professions 5 Code): Misc.Conduits&Conductors 0.05-88 I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ 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 issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE Lender's Name , PERMIT ISSUING FEE (� Lender's Address D I certify that I have read this application and state that the above. TOTAL FEE 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i /0_4--66 nature.oyQermtem 4 Date