HomeMy Public PortalAbout9731 WOOLLEY ST_Electrical__ DBS-BA 12-54 APPLICATION FOR ELECTRIC PERMIT
DMSION OF BUILDING AND SAFETY
Department of 2:1�tY Engineer
County of BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
r-ASSATT D.GRIFFIN.SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN
NEAREST 17
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ADDRESS
LOCALITY
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NEAREST
PERMIT FEWC&ROSS ST T
NUMBER EACH
OWNER r
LIGHT OUTLETS
M M IL
AIL
RECEPTACLES ADDRESS_
WALL SWITCHES
TOTAL OUTLETS s TEL.N
0.
ELEC.RANGES 25 ELECTRICIAN 16;6-CA/
ELEC.HEATERS ' 25 ADDRESS Z"'
KW EA =7 CITYTELNO.
FIXTURES 70-7 LICENSE NO.
NUMBER OF LIGHT CIRCUITSREADY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS DISTRICT NO GROUP I&N7
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MvO. HP OVER INC. EACH
Y- PA/ 1i+2&LESS $ .25
2 So
5 LOCI
5 15 1.50
is 3.0 2.50
so
200 5.00
MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS
FOR EACH PERMIT:'-
WIRING $t.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE DATE.9 8Sr INSPECTOR'S SIGNATURE 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
-4- /f-- M
ELECTRICAL WIRING. r-e�flr
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/Olt FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
OR THAT f AM THE LEGAL OWNER OF THE OVE
CALIFORNIAtD RKSI,ENTI, -,r ?Vt=P
DESCRIBED p NOTIFIEDF
,rt q-i
SIGNATURE L-t?"
OF PERMITTEE Mal EINAL
'ILLIAM J.FOX,COUNTY ENGINEER VALIDATION 2 6.10
'-t2 6 4.tiro APR 15
BY
DEPUTY ,
76A663
- yORKEthot I have
a certificate
DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
C herek cffycm that I have a certificate of consent to self CE-806G �j
insure, ora certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY IuI
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB a ,rte
Certified copy is hereby furnished. [New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 7 y 4 a�LZ.i7
❑ 1 &2-Family, $ — $ LOCALITY e
Certified copy is filed with The county building inspec- y, Sq. Ft. TCt;� L�` Ili
tion department. Multi-family Sq. Ft. — NEAREST
CROSS ST. V UA-L. ri k1A1,F C/t:0 I l-)
Residential Swimming Pools OWNER OR
Date pplicanf FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec /'J" Light Sw.� MAIL
COMPENSATION INSURANCE ADDRESS
First 20
(This section need not be completed If the work involved by Total No. Additional CITY Tel. No.
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 y person in any manner
so as to become subject to the Wo rs'Qbmpensation Laws. Lighting Fixtures First 20 ADDRESS
Z j �6 ( Total No. 0 Additional
Date Additional
CITY Tel. No.
NOTICE TO APPLICANT: If, ter aking this Certif' a of Fixed Appliances Not Over 1 HP PERMIT
Exemption, you should be Range Heater_D.W. _ APPLICANT subject to the orkers' 9
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. CITY Tel. No.
p'
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other—
Dis _ Room Air Cond. �j LICENSE OR ,
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class.
(commencing with Section 7000) of Division 3 of the Business power Apparatus&Large Appliances DISTRICT NO. PROCE D Y O}..'
and Professions Code,and my license is in full force and effect. O V
Size &Type HP, KW, KVA, or KVAR
License Number Lic. Class
Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE O
Contractor Date VALID ION
❑ Over 10 to 50 Incl. FINAL W
I am exempt under Sec. Over 50 to 100 Inc. BY N
B.&P.C. for this reason Over 100
Zn
Dote: Services, Swbd., MCC&Ponelboards
0 -200 Amp. Under 600 V
Signature i 201 - 1000 Amp. Under 600 V A.,
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION ISign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Low for the following reason (Section 7031.5, Business and
Professions Code): Q 5 1 a 7 A
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors # o 0 0 0 0 `Z
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). o o47.75
CONSTRUCTION LENDING AGENCY o 0 0 4 7.7 5
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.). O Z 2 3-8 6
PLAN CHECKING FEE
Lender's Name
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
th bove- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign ure of Permittee 0Date