HomeMy Public PortalAbout9712 WOOLLEY ST_Electrical__ COUNTY OF Los ANGELES APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ERGINEB<i ELECTRIC 1
DIVISION OF BUW]IgG& SAFETY
VAUMM I. FOX COUNTY ERGIN=
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN G fw
ADDRESS 1300 .70. Cilt�., RECEIVED BY READY FOR DATE ISSUED
+ FIRST INSPECTION
CITY ALHAMBRA TEL.AQ ,i'i : -�.. ;-� :•�, 1,7,- 1.3'S
COUNTY LICENsJW44 C-10 EXPIRES 5 BUILDING
PERMIT FEES ADDRESS •
NUMBER EACH FEE
LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST.
WALL SWITCHES OWNER
TOTAL OUTLETS 5c $ MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
FIXTURES 5 CITY TEL. NO.
MISC. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCULIM______j AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSE BOVE ALID LOS
Numnox HORSEPOWER FEE ANGELES COUNTY LICENS R AM HE AL OWNER
NEW MVD. HP OVER INc. EACH OF THE RESIDENTIAL P S IBE BOVE.
Va a L888 $ .25
SIGNATURE OF
V/2 2 .50 PERMITT
2 8 1.00 INSPECTION RECORD
5 15 I.SO
18 SO 2.80
80 200 5.00
200 Boo 10.00 J
500 1000 15.00 Z
OVER 1000 20.00
M.G. SET/FREQ. CHANGER-HP 4'
WELDERS: AC-KVA 0
GENERATORS•KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OP ORIG.)
MISC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PKRM1Ts DATE INSPECTOR'S NAME
WIRING $1.00CONDUIT '1-- _ +
FIXTURES $1.00I$ -
WIRING Z- 5 _ 11 i9
SUPPLEMENTARY 50FIXTURES '?`
POWER
TOTAL FEE UTILITY CO. NOTIFIED
FINAL �'A VW�
76A 603 DBS# 6A. 4-82
• �. , •*6,KERS'COMPENSATION DECLARATION °/6A663 10/81 APPLICATION FOR ELECTRICAL PERMIT
I he�ekaffiim that I have a''cartificate of consent to self CE-8066
insUM, 6r a certificate of Workers'Compensation*insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company• FOR APPLICANT TO FILL IN
EACH NO. FEE ADDRESS Q?�
Certified copy is hereby furnished. New Residential Bldgs. &Pools
1 &2-Family, S Ft. $ _ $ LOCALITY
y. q•
Certified copy is filed with the county building inspec- NEAREST Q �
tion department. Multi-family Sq. Ft. CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR a j
FIRM NAME A 67
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec fight Sw._ ,ADDRESMAIL S w YI,.
COMPENSATION INSURANCE First 20 •
(This section need not be completed if the work involved by Total No. Additional CITY '7ade Tel. No.�t_ a
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
so as to bec me bject to the Workers'Compens ion Laws. Lighting Fixtures First 20 DDRESS
f� / Total No. Additional CITY Tel. No.
Date-(6— Applicant f , Fixed Appliance Not Over 1 HP PERMIT
NOTICE A LICANT: If, after king is ertificate of APPLICANT
Exemption, you should become subject to the Workers' Range_ Heater—D.W. —
Compensation provisions of.the Labor Co e, you must forth- Oven —Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top FAU —W.H. — CITY Tel. No.
deemed revoked. Hood — Fan —Other_
LICENSED CONTRACTORS DECLARATION LICENSE OR Class.
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY >,
and Professions Code,and my license is in full force and effect. .�'` ®�/ (/,( IL
Size&Type HP, KW, KVA, or KVAR 0
License Number Lic. Class Up to 1 Incl. FINAL
DATE n U
Over 1 to 10 Incl. ,,I
A1, VALIDA N O
Contractor Date Over 10 to 50 Incl.
❑ FINAL LU
I am exempt under Sec. Over 50 to 100 Inc. BY � /,/ � 1 ®„
Over 100
B.&P.C. for this reason
H
Services, Swbd., MCC&Panelboards
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&Appurtenances .1 - 12-75
1 o 0 1 2 7 v
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1275a
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and 10. 16-84
Professions Code):
lul
kN, I, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ D
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 issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE G
Lender's Address
I certify that I have read this application and state that the TOTAL FEE o�
e
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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signaturof Perm tee IDate