HomeMy Public PortalAbout9124 WOOLLEY ST_Electrical__ %AidliCE-60616/78) APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 9124Wooley Street
1 &2-Family,Sq.Ft. $ .025 — $ LOCALITY
Multi-family Sq.Ft. •02 — NEAREST
25.00 CROSS ST.
Residential Swimming Pools OWNER OR
FIRM NAME HaStin
Outlets:Rec 1 Light Sw. 1. 50 MAIL
First 20 .50 ADDRESS 912h Wbolgy .Strveet
Total No. Additional .30 CITY Temple City Tel.No. 285-37
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 .50 ADDRESS
Additional .30
Total No. CITY Tel.No.
Fixed Appliances Not Over 1 HP PERMIT
APPLICANT Morales I�.E;CtriC_
Range—Heater—D.W._ ADDRESS
Oven_Dryer—W.M.— NO IdElsion Dribre
Top _FAU —W.H.— CITY Tel.N
Hood_Fan —Other
Rosemad2.50 LICENSE OR
Disp._Room Air Cond. — REG.NUMBER 22 Class.62 C. 10
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCA-
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP,KW,KiCOMPLY WITH ALL COUNTY ORDINANCES AND STATE. LAWS
Up to 1 Incl.
nd.or KVAR Z'
2.50 REGULATING ELECTRICAL WIRING.
SLIM A70over 1 to 10 Incl. 5.00 ], M LICENSEDEREBY AS REQUIRED BY LOS ANGELES COUNTY AND TATdE/OF
Over 10 to 50 Incl. 12.50 CALIFORNIA OR.THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY
. ®j
Over 50 to 100 Inc. 25.00 pERMITEE Iy. 1
Over 100 40.00 SIGNATURE ���� `
Services fDR ED BY0.200 Amp.Under600 V 12.50 1 12 �` f�201-1000 Amp. Under 600 V 25.00 / U0/Over 1000 Amp.or Over 600 V 50.00 Z
O
Temp.Power Pole&Appurtenances 10..00
Sign with One Branch Circuit 10.00Additional Sign Branch Circuits 2.00ION
10.0o TIONbd
Misc.Conduits&Conductors ERSEOther(See Complete Fee Schedule! W 0 1 9 a 3 A
QZ
g # 0 0 0 0 0 2
PERMIT.FEE (Sub-Total) 2 - -2500
PLAN CHECKING FEE (One-Fourth Permit Fee) OZ. 0 0 0 2 5 0 0
r
PERMIT ISSUING FEE $7.00j
220-78
TOTAL FEE >
I
INSPECTION FINALED o
W
date: By IL ®s
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer � � ��
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. mROUP ZDNrE PERMIT NO.
ELECTRICIAN S !
ADDRESS 0 0 _ !';�7�: RECEIVED BY FIRST INSPECTION DY FOR DATE ISSUED
CITY �46t91MA—
TEL.N
COUNTY LICENBE NO. EXPIRES BUILDINS
PERMIT FEES ADDRESS I �'t�r —�`—•, d
NUMBEREACH FEE LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST. "lam
WALL SWITCHES OWNER
TOTAL OUTLETS Sc 18 / MAIL
ELEC. RANGES 25 °
ELEC. HEATERS 2B CITY B TEL N
FIXTURES 8 6 S 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
M19C. APPLICATION AND STATE THAT THE ABOVE 18 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 i POSSESS THE ABOVE VALID LOS
11
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEw MVD. HP OVER T INC. EACH OF THE RESIDENTIAL PROPER D SCRIBED ABOVE.
I/p A LESS S .25 SIGNATURE OF
%z 2 .50 O PERMIT
2 B I.Co INSPECTION RECORD
5 18 1.50
_
is so 2.50
913 200 5.00
2013 1300 10.130 J
_ 51313 1000 15.00 Z
OVER 1000 20.00 0
M.G. SET/FREQ. CHANGER-HP it
WELDERS.AC-KVA 17
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (713% OF CRIB.)
MOVED MOTORS (75% or CRIB.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
FOR EACH PERMIT. DATE INSPECTORS NAME
WIRING $1.00 bO CONDUIT
FIXTURES $1.00 O WIRING
UPPLEMENTARY .50 FIXTURE8
POWER
TOTAL FEE R �.U UTILITY CO.NOTIFIED
FINAL
76A663 DSS#SA 2-53
e. WORKERS'COMPENSATION DECLARATION saool9DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT Q
I hereby-affirm,that I have a certificate of consent to self 71~ APPLICATION
• ins(i& or'a cer%ficate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a f ifieg cop'Xthereof(Sec. 3800, Lob. C.)
Policy Nal' Company FOR APPLICANT TO FILL IN JOB /
Certified y by furnished. New Residential Bldgs. & Pools EACH NO. FEE ADD
❑ copis hereRESS Iw
i. je��
_
IDtion
copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ $ LOCALITY
_
tion department. Multi-family Sq. Ft. NEAREST
CROSS S7.
Residential Swimming Pools
Date Applicant OWNER OR
rA
IRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' - I_Ui Qj AIL j_
Outlets: Rec ght_ Sw._ / aDDRESS C. LV78. v
COMPENSATION INSURANCE First 20 �p l[� /
(This section need not be completed if the work involved by Total No. Additional CITY t 6, Tel. N �V/e
the permit is for one hundred dollars($100)or less.) PLAN CHECK �^ v �� '�t
I certify that in the performance of the work for which this APPLICANT C9 �l r/�?� G.p✓t/
permit 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 q12A1, E. U/
Additional `
Date Applicant Total No. CITY ��'t- Tel. No.
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. — Room Air Cond. — Class.
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER
(commencing with Section 7000)of Division 3 of.the Business Power Apparatus&Large Appliances DISTRICT NO. PROC SED BY a
and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR �v O
License Number Lic.Class U
Up to 1 Incl. FINAL p cc
1 to 10 Incl. DATE 2, Z 0 -6/ VALIDATION O
Contractor Date Over 10 to 50 Incl. FINAL JrV
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C. for this reason Over 100 Il
Services, Swbd., MCC&Panelboardsb. Z
Date: 0-200 Amp. Under 600 V PV
Signature 201 - 1000 Amp. Under 600 V
❑
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION _1 n
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ;•jL,�_ ,�
Low for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits •730, 2
Professions Code): `'``')' t }1'�' -1°
1t Misc. Conduits&Conductors
L i i r i'i�
I, as owner of the property, will do the work and the
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)— ® 1 O h- 21- 10
Business and Professions Code). .- b ' i i.
1a;
CONSTRUCTION LENDING AGENCY
I hereby affirm that there'is a construction lending agency for '111ANN E*
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE yi ip t!1_I_(_I;
Lender's Name Ii
PERMIT ISSUING FEE 00 4343 1 AN11 `;1
Lender's Address TOTAL FEE �` �/ /Q
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and j
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
M-,. , l- 7--9l
Signature of r :ttee I Date I ®'