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APPLICATIONAOR ELECT C PEI�MIT
'COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING �� N�
BUILDING AND SAFETY DIVISION ADDRESS ageAl
JOHN A LAMBIE COUNTY ENGINEER
CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST
L�
ITEM NUMBER OWNER EACH FEE MAIL
OUTLE $ 1O $ ADDRESS
LIGHTS RECEPT SW
LIGHTING FIXTURES, AL 10 to CITY TEL NO
ELEC RANGES i CLO DRYERS) ELECTRICIAN MM a
WATER HEATERS 50 ADDRESS,�p ✓Y'� �, �'
ELEC SPACE H7 ISHWASHER CITY F� "Ir 0 TEL NO
GARBAGE DISPOSERS i AUTO STATE
WASHERS STA COOKING UNIT IS 2$ #rW LICENSE NO
MOTORS OVER INC HP D1STRoO�I GROUP ZONE I PR=ESDY
O— I/2 2r,
1/2— 2 5o INSPECTION RECO
2— 5 too ,s aN`
5— 15 1 50 i �+
Is— 50 250
50—200 500 9
SIGNS NO TRANS
NO LAMPS
SERVICE O 600V 100 Q�
SERVICE OVER 600V 500
M(SC
WIRING PERMIT 1 00
FIXTURE PERMIT 1 00 ®Q
SUPPLEMENTARY PERMIT 50
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION A APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT A
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTL16 PROPERTY POWER n
SIGNATURE ° UTILITY CO NOTIFIED I hw
OF PERMITTE J i DFIMAL FaP
OF CATION SUPERYISING ELECTRICAL ENGINEER
Cl4 MO CASH
LF+CO A, 6 7 0 AUG 71)5 2 d cam. 6 0 to
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WORKERS COMPENSATIONcate f corse CE 863 10/8I APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE 8066
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELESBUILDING AND SAFETY
or a certified copy thereof (Sec 3800 Lab C ) 1 ,, f
Policy No Company FOR APPLICANT TO FILL IN JOB ` E
Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE
El —
Certified copy is filed with the county building inspec 1 & 2 Family S 9 Ft $ $ LOCALITY
02
tion department Multi family Sq NEAREST Ft � CROSS ST �4 r (/ Z
Date Applicant Residential Swimming Pools OWNER OR I e
r FIRM NAME (9 _C,,
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw_ MAIL >1L^
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work involved by Total No Additional CITY -� Tel No 14e—
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 become subject to the rAh
pensation Laws Lighting Fixtures First 20 ADDRESS
Total No Additional
�� CITY Tel o
_)>�.NOTICE TO`APPLICANApplica'T Ifft` mis Certi is of Fixed Appliances Not Over 1 HP PERMIT
Exemption you should become subject to The Workers Range_ Heater_D W APPLICANT
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 _WH _
deemed revoked Hood CITY Tel No
_ Fan _Other_ `
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER' Class
(commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROCESS BY
and Professions Code and my license is in full force and effect ��,/ d
Size 8 Type HP KW KVA or KVAR `, , o 0
License Number Lic ClassV
Up to 1 Incl FINAL /'
Over 1 to 10 Incl DATE / r VALIDATION 0
Contractor Date❑ Over 10 to 50 Incl ! V FINAL
I am exempt under Sec Over 50 to 100 Inc BY
B&P C for this reason Over 100 t/J
Service Panelboards Z
Date 0 ) W Ufider 600 V ►
Signature 201 1000 Amp Under 600V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maini Elect
SINGLE FAMILY
Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits s 8 9 7 2 A
Law for the following reason (Section 7031 5 Business and
Professions Code)
° ° ° ° ° 2
❑ 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)_ 2i° ° 255 0
7044 Business and Professions Code) ► >
CONSTRUCTION LENDING AGENCY ° ° ° 2 a 5 0 F'
I hereby affirm that there is a construction lending agency for o 1 1 1 —83
the performance of the work for which this permit is issued PERMIT FEE (Sub Total)
(Sec 3097 Civ C )
PLAN CHECKING FEE r
Lender s Name
\ PERMIT ISSUING FEE
c
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 j
ordinances and State jaws regulating Electrical wiring and
hereby authorize representatives of this County to enter upon
,,b mentioned property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
/ .
If —k?3
P
ature of Permitte Date V
i
WORKERS COMPENSATION DECLARATION CE 863 to/EI APPLICAT16 N FOR ELECTRICAL PERMIT
d I hereby affirm that I have a certificate of consent to self CE 806G '
insure or u certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES J BUILDING AND SAFETY
or a ced copy thereof (Sec 3800 Lab C ) I I a
Policy rsif eCompany FOR APPLICANT TO FILL IN J08t�
❑ Certified copy is hereby furnished New Residential Bldgs & Pools EACH PNO FEEADDRESS 1 & 2 Famil S Ft $ $� LOCALITY
f� Certified copy is filed with the county b ilding inspec y 9 / NEAREST
on department Multi family Sq Ft CROSS ST i
Date i _-3 �Apphcant Residential Swimming Pools OWNER OR r�
t FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light ` Sw AIL
COMPENSATION INSURANCE ADDRESS 6
(This blFirst 20
( is section neenot e completed if the work Involved b Y Total No Additional CITY Tel N g
the permit is for one hundred dollars ($100)or less )
PLAN CHECK +
I certify that in the performance of the work for which this APPLICANT
permit is issued I shall not employ any person in any manner
so as to become subject to the Workers Compensation Laws Lighting Fixtu/res, First 20 ADDRESS
r I Total No Additional CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP PERMIT �y� O
NOTICE TO APPLICANT If after making this Certificate of APPLICANT H 1 /-/ �-D 9—
Compensation
you should become subject to the Workers Range— Heater—D W —
Compensation provisions of the Labor Code you must forth Oven — Dryer — W M — 7 ADDRESS "7 L R715" '
with comply with such provisions or this permit shall be Top — FAU —W H —
deemed revoked CITY �7 E Tel N � S-6
'\LICENSED CONTRACTORS DECLARATION Hood — Fan —Other—
LICENSE
I hereby affirm that I am licensed under provisions of Chapter 9 Dis p Room Air Cond REG NUMBER�S 7
(commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PRO ESSED BY
and Professions Code and my license is in full force and effect
1 33"$-) 7 Size &Type HP KW KVA or KVAR 0 1
License Num Lic Class Up to 1 Incl FINAL
V
/L��� Over 1 to 10 Incl t/r� — VALIDATION 0
Contrc or Date❑ Over 10 to 50 Incl �FINAL V
I am exempt under Sec 7 Over 50 to 100 Inc BY 1�, w
B&P C for this reason Over 100 y
Services Swbd MCC & Ponelboards 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 Eject
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Te n Pore 8 Appurtenances
� Signn with
One ne Branch Circuit
j 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) y X 8 5 IL 3 A
❑ I as owner of the property will do the work and the Misc Conduits& Conductors - # oro o • o 2
structure is not intended or offered for sale (Section 7 Other(See Complete Fee Schedule)_
7044 Business and Professions Code) 2 e o 1 a 0
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for o e is 1 5 0 0
the performance of the work for which this permit is issued PERMIT FEE (Sub Total) r 22 3-82
(Sec 3097 Civ C )
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 jaws regulating Electrical wiring and
hereby auth r representatives of this County to enter uponl 1
the above entior,ed property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Z.--Z-3 52—
ign ture of Permittee Date {
WORKERS COMPENSATION DECLARATION CE 806G (2 80) APPLICATION FOR ELECTRICAL PERMIT
t hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure or a certificate olWorkers Compensation Insurance or
a certified copy thereof(Sec 3800 Lab C)
FOR APPLICANT TO FILL IN JOB
Policy No 447586 Company State Fund EACH NO FEE ADDRESS
New Residential Bldgs &Pools
❑ 1;42R Raldwin Avenue
Certified copy is hereby furnished 1 &2 Family Sq Ft $ — $ LOCALITY em le Clt
i Multi family Sq Ft — NEAREST
®,,Certified copy is filed with the county building inspection PCROSS ST 1
department Residential Swimming Pools OWNER OR
FIRM NAME Mr and Mrs Ne"i
Date 4115 822 Applicant AAA Gond, Air, Inc Outlets Rec.—Light Sw MAIL
First 20 ADDRESS 5428 Baldwin Avenue
CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITY Tel No _ �.
COMPENSATION INSURANCE PLAN CH K d
(This section need not be completed if the work involved APPLICANT O
U
Lighting Fixtures First 20 ADDRESS
by the permit is for one hundred dollars ($100) or less) Additional 0
Total No
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No
permit is issued I shall not employ any person in any manner PERMIT
so as to become subject to the Workers Compensation Laws Range_ Heater_D W W
APPLICANT AAA C d t 8.
W
Oven _ Dryer_W M ADDRESS 10160 1 B to
Date Applicant Top FAU _W H ?
Hood __Fan _Other_ CITY El Monte Tel No
579-18001
NQTICE TO APPLICANT If after making this Certificate of Disp _ Room Air Cond_ LICENSE OR
Exemption you should become subject to the Workers REG NUMBER 293529 Class
Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances DISTRICT NOPROCESSED BY
/
with comply with such provisions or this permit shall be Size&Type HP KW KVA or KVAR
deemed revoked
Up to 1 Incl FINAL
Over 1 to 10 Incl do DATE VALIDATION
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl i CJ
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINALBY / F
9 (commencing with Section 7000) of Division 3 of the Busi Over 100 (�-t.•'�
ness and Professions Code and my license is in full force and
effect Services
License Number -1379 Lic Class ('20 0 200 Amp Under 600 V
201 1000 Amp Under 600 V
Contractor AAA Cond Al$ate 4/15/82 Over 1000 Amp or Over 600 V
HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances ¢
I hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit �
License Law for the following reason (Section 7031 5 Busi Additional Sign Branch Circuits ;9- 3r6 6 1 A
ness and Professions Code) �
Misc Conduits&Conductors❑
as owner othe property will the work and # 0,0'0 0 0 2
I of ll dhk d th
Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section - 2 o to 1 4 5 0
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY 1 Q 5
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) 0 4, 1 5-82
issued (Sec 3097 Civ C)
Lender s Name PLAN CHECKING FEE (One Fourth Permit Fee)
Lender s Address
PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE 4- �6
above information is correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring and
hereby autho representatives of this County to enter upon i
the above nU ed prop for inspection purposes -
SEE REVERSE FOR EXPLANATORY LANGUAGE
i
Signature of Permittee Date
� F