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HomeMy Public PortalAbout6236 AVON AVE_Electrical__ .+a�.e--- �� � t -' St{ ,i` q� w. -s, � 1#•; sr. .7�r q 'w. h DEPARTMENT OF BUILDING APPLICA•rION FOR P1 M11-T COUNTY OF LOS ANGELES ` FT Fr'ERIC z' :7 I NA'CUKa; VrNS ALLATWIN DIST o. --onoup TYPE PERmir Pao. y. ( WIRING I FIXTURES I SCR VICE i- - .•+–... - , - - - _ - _---._ ry I DAT£ 193��—� ` RANGE I HEATER � I POWER FIRST INtpECT10N t SrON� MISCELLANEOV3 -• t .� - APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY i 1 IY" 1 JOB .. : NAM[ I_�_.. •_ A[]f1RE45 4 ADDRESS II 1 �Ilr d ` - LOCALITY ' I a f17 or;j' ,{ J� 1 f. a — NEARERT i1 i 1 \ \ • --ice M I CITY ,/t'' Gl 1�-N1 V Y,A-TEL. NO. �2 CROSS ST.1�>�Y 1 hr� {GS 1 / STAT[ COUNTY A I. - -:•�:• I LICENSE NO. �O REG. NO. !�{ I DESCRIPTION OF HORS I Z MAIL •,;; I Z ADDRESS _ NUMBER OF OUTLETS ON CIRCUITS ^� 0 CITY TEL NO LOCATION BY ROOMS• : I LIGHT OUTLETS �-. .� ru:a_ ' r-ORRF,CTIONS f_1u�11IT I I a I r E , I P I G I H I f i DINING ROOM MRnF -BATH v. LLl" 'I I I I I 1 I 1 I I HALL No. FRONT ^ORrH SERv. PCH. I T IW! 1~ j I ! / I I ! f l ; .'i"?i!'�'+."'.:^L�::..s•11`?r^ -.+`+.+-. :4'�'3n?•da`•'4"'• •'^'.+,�;`ty�''�..C-.'-:`.�:.iv->k'.=�,t',--W^�.•e,�^r" - -..�,...4�i 'CLOSET _.. i�.j�.'.. .L• i .-�.,a -.1... .I. ..t. L.._..... . .'Y __..,... ..- -�:w -...•�. �..SSA..}rF.. .u� � ^ .. SDRM. Na. 2 , I h �J. I Ci• '�`;T - r CLOSET i2•': ,� I - I i 1 TOTAL /,--j // .!n R n 7Al 1 NO, OF oUrLtsTe -APPROVALS I A I NO. OF FIXTURES• �- ) - DAT[ P. - - tftattROe's r[art -- -rvrta R. . � t "1 CONDUIT l NO.`OF BIONS - TRANS. .. its R "WIRING :,� - I�• 7 L--V I-NO.'OF RANGES:OR "HEATERS �Si' FIXTURES t•+x`vo I! MtR^ELLANFOUS - 111E '�c POWER -^f7 - - •.,y.•. •..,• PERMIT FEE • r IS! UTILITY CO NOTIF TOTAL Fcr '.. .ti• t TINA -r � e'tpSt, rti. �ar L��I�7F.I :. � \.,.'.: j, T •..47ie+t rr. >f.' .-.. .rr >' L c...� V ) t♦ ,Y },�+.ity, 1�1 � .,3 ��;�"-��:'�s.�`A'.�.'•Alr-'�+a��-�1��.•M�'{FfiR.ta,R'�'!�!!�'4�, t.• c-,. '-„9[L' 1� T APPLIOAT!ON FOR ELECTRIC PERMIT DIVISION OF BUILDING AND SAFETY L D.pa:tns%t of County Eughm r County of Los AAgmeles F!U 1 L D i NC i WM.J. FOR. COlTtiT11 ENatwvm ADDRESS CA"ATT IL OaIr:11 t.Z= v or mume MS � FOR APPLICAN?TO FILL IN —� � Rr+�r FES CROS;s. L v rr e x itr FEE fvur+le[r�ucM_ � LsGHT OUTL[Tf OWNER RCC£PTACLL! .NASI. -ADDRESS WALL SV.'t'rHEf I TOTAL OLm[TS s♦ f `CITY__S>rM�+d ELEC'. RAMCIEs� 'm 25 r-LECTR:CIAN [LtC. M£AT[Rf 25 A0DRfS6 KW EA 3 I CITY TEL RIO. tVlX11 TUP.[S LICENS[My[ROF LIGHT CIRCUITS DISTRICT O. GROUP ZONE , •u�� .aw 's►tcTlo� rMwry nor wrrrpTAC f 1-7" �� o MOTORS Mumm" i HOREEPOWFR I FF£ ( I1 -FECIION RECORD — , M[w I WYO. MP j iMG. I (AGM I A L_ss i f _2s 2 I _a �——2 CIO — --— — 2_50I I 200 I 5.00 ff --- -- i MISC. I — ------ -- I I 3� NO SIGNS '+t rRAfYf. ftO. 1 N NO. LAM" 1 _ Oft I IR A INGRMI .,...,._.�....._.. _ 1 _ 1f7fTVR£4 f .00 l " M AF f0 TOTAL FEE I 1 OAT& �w pie ATV" f WEST ACSROWLLOK Txar t r" 2 tlAO Tws arv"CArf� I _ ANO STATE TXAT TNG AOOsft rf CO►. _CT ANO AGM TO coap%w ■IIN ALL COYNTV 04a"L NCL, I" STATE LATS S[OV AT-14 ;rr_� ( (� CLACTSICAL WfSINS I WC2221 C13MfT TWAT I 1■ "09MT tf4tfrS•:r RitLw rr • = �. ;� ttCEN!!? Al It[OUfs[O Let lLfLm"LS.s COtlw ANO STATE of tA11tORNI,; OR flUt Osltot+ rta AlOQ R �_ Z Y a rt3c*fSEA RUN" MOXt:ATURLRn g Or rflltfirm FINAL f f .. - �R : LECTRiC::P APPLiCA i I QNF - ,,,-=AG AND +:I rMOIq OF B=IN �nolia cd CosatT SII r*pulLOlrw _ C,..tT of ion -AppREss , YJM. J. FOX.COUNTY ENOINimt ; CAifATT R Gptt+TlN.go" mu:arswa 'LOCALITY FOR APT:-1C`NT TO FILL 04 HuRcsT cRoss ST. �_ FF.�NII? Fffi ru LIG 1iT,ll1TLET S —.AOO^D D � RE E � pcC 2 CiTf ~�• L TC NV. WALL SV1ITCHES 51 •�••� �, T=A 2-9 2c E_LECT. I [AFIE CLEC. RAJ O 1 29 -AOORE S TEL- NO [LEC HCATERS CITY -LtCiNa NO. FiXTvREf i-nn�ID 1 ZQ1wE aa•a+.o■ =Tt OISTFi�%: }Hll. ; l el NUMpCR OFA LIQ CIRCUITS � 1 rJTr_ I o�DO�r NVMIS A MOTORS HORswLt! FLIM �all�- r. -------- _.t trach 1dJYt f?.r HT ! ovs� �n_. �c� arvv. rte— - 1 •I_us f !aS 6.00 -- ,� ;.,,�✓� �/ 50 1 200 /(.d Not _ No TR' JI M +* j t oo _ WIR[ - pp -� ApPROVJ�Las a CIAM TR�-- :. TOTAL I Vii_-. aA 'tf wi1►De1[ �T( TI1At3 T" Am" pggeTi low", Iff Ra�tN� J s 1f1RaK two six= ge UFO y. 7 ``" i -► 4� rte' �. btzT 75Al53 CR`� 1,10 APPLICATION FOR ELECTRICAL PERMIT �2 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION ADDRESS r 29C1511 JOHN A LAMBIE COUNTY ENGINEER LOCALITY C COLEMAN W JENKINS SUPERINTENDENT OF BUILDING FOR APPLICANT TO FILL IN CROSSSST iYY,C/s D' OUTLETS NO EACH I FEE OWNER //" RECEPT' G $ $ MAIL S U 3 LIGHT < TO SAL FIRST 20 7 20 ��^^ OVER 20 CITY TEL NO SWITCH C 10 PLAN LHECK LIGHTINGTOTAL FIRST 20 L 20 �D APPLICANT FIXTURES 10 OVER 20 ADDRESS APPLIANCES CITY TEL NO PERMIT RANGE-/-DRYER_WTR HTR_ APPLICANT STA COOK--EDISP j__F A U ADDRESS � 007 SPACE HTR AIR COND CITY TEL NO CLOTHES WASH DISHWASH J- LICENSE NO �,(� CLASS FAN OTHER 100 c 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION v AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS ETC HP KW KVA ELECTRICAL WIRING SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1001 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO 1 - 10 300 RESIDE IN THE ABOVE DESCRIPED RESIDENTIAL PROPE TY a SIGNATURE Q 10 - 50 500 OF PERM ITTEEV 50 - 100 1000 DISTRICTNOL S GROUP ZONE P CESSED BY 0 100 - 500 1500 ��S r le-1 V W SIGN GAS SIGN AND ONE CIRCUIT 300 NOTES O_ TUBE OR H Z MARQUEE ADDITIONAL CIRCUITS 100 - SERVI CE NOT OVER 600 VOLTS OR 200 AMP 200 L✓f &0 V APPROVALS DATE INSPECTOR S SIGNATURE SERVI CE OVER 600 VOLTS OR 200 AMP 500 TEMP POWER POLE TEMP SERVICE POLE &APPURTENANCES 300 UNDERSLAB WORK TEMP LIGHT OR RECEPT SYSTEM 300 ROUGH CONDIUT WIRING PERMIT FEE (SUB TOTAL) FIXTURES 17 POWER AUTHORIZED PLAN CHECK FEE (507 PERMIT FEE) UTILITY CO NOTIFIED PERMIT ISSUING FEE 200 rL � (,J r FINAL l SUPPLEMENTARY PERMIT ISSUING FEE 100 JOSEEI ROC 9AN TOTAL FEE �� SUPERVISING ELECTRICAL ENGINEEP PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION 0 M Q CASH gr, 9 4 8 6c= APR 1 2 D 1 3,60 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 78A 883C CEBOBB 12/73 APPLICATI FOR ELECTRICAL PERMIT aA BUILDING D SAFETY DIVISION 'fl FOR APPLICANT TO FILL IN JOB l New Residential Bldgs &Pools EACH NO FEE ADDRESS >� 4 - LOCALITY 1 &2 Finaily Sq Ft 1-(— r Multi family Sq Ft - NEAREST / CROSS ST L y Residential Swimming Pools OWNER OR FIRM NAME t1 Outlets Light Switch& Receptacle MAI L ADDRESS Aj 6,0D AJ First 20 Additional CITY � � Tel No � �t PLAN CHECK Lighting Fixtures � / APPLICANT First 20 ADDRESS Additional CITY Tel No PERMIT dJ �f /fl Fixed Appliances Not Over 1 HP APPLICANT /� /` Range Heater_ D W ADDRESS Oven Dryer W M CCN Top FAU W H CITY � ' Tel N � Hood Fan LICENSE R a REG NUMBER Class Disp A C v I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING (- Size&Type HP KW KVA or KVAR ELECTRICAL WIRING U w 0- Up to 1 InclI HEREBY CERTIFY THAT I AM PRO Y REGISTERED ANO/OR N Over 1 to 10 Incl LICENSED AS REQUIRED BY AN OUNTY AND STATE OF Z CALIFORNIA OR THAT I T G WNER OF THE ABOVE Over 10 to 50 Incl DESCRIBED ENT RESIDOP T Over 50 to 100 Incl PERMITEE Over 100 SIGNATVRE fDTRI NO ROC Services 0 200 Amp Under 600 V201 1000 Amp Under 600 V APPROVALS DATE I SPECTOR S Over 1000 Amp or,Over 600 V SIGNATURE MP POWER POLE Temp Power Pole&Appurtenances I EUNDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT �) Additional Sign Branch Circuits -7 (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub Total) UTILITYCO NOTIFIED PLAN CHECKING FEE (One Fourth Permit Feel FINAL PERMIT ISSUING FEE NOTES TOTAL FEE PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION rClc'l, M O CASH 9 4 0 AUG 2 2 D 5 77 0 Atd © 1/o:> +. WORKERS'COMPENSATION DECLARATION CE-806G 10/81 APPLICATION•E®R ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab. C.) Policy No. - Company FOR APPLICANT TO FILL IN - JOB ❑ Certified copy is hereby furnished. EACH - NO. FEE ADDRESS v-3 _✓r/ New Residential Bldgs. & Pools ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY �^ Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. ��ps Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec� � Light ! Sw. MAIL COMPENSATION INSURANCE �^ ADDRESS P f"C;tj (This section need not be completed if the work involved by the First 20 l N Total Additional �' CITY L `<< ,Tel.No. permit is for one hundred dollars($100)or less.) ToPLAN CHECK I certify that in the performance of the work for which this permit 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 Jr ADDRESS Total No. Additional // �,� � � _ CITY Tel.No. Date� Applicant Fixed Appliances Not Over 1 HP NOTICE TO-APPLICANT: If, after making this Certificate o PERMIT c� 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 Other_ CITY 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 .3 ` nZ ��y9 Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. p P S ED BY . Size& Type HP,KW,KVA,or KVAR �C>d p Licer se Number _s Lic.Class C ~' Up to 1 Incl. FINAL V /J Over 1 to 10 Incl. DATE Contractor/Cml � Date r VALIDATION U Over 10 to 50 Incl FINA I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.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 ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r_ 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 Code): -gip- 41 it ElMisc.Conduits& Conductors 'i`f' I,as owner of the property,will do the work and the structure f +=' is not intended or offered for sale (Section 7044, Business Other,(See Complete Fee Schedule) f.F'h� and Professions Code). � � 7- 1 0{{.d.._u CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the �^;r f r,;(Y a c, performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) - Civ. C.). PLAN.CHECKING FEE. . Lender's Name J -w - PERMIT ISSUING FEE D ^t;,_.-. a Lender's Address I +j I certify that l have read this application and state that'the above TOTAL FEE L 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. C SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date kVORICER'S COMPENSATION DECLARATION 720-0019 6A663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I'nave a certificate of consent to self insure, or at certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. -copy'thereof(Sec. 3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS ❑. Certified co is hereby furnished. NO. EACH FEE PY Y New Residential Bldgs.&Pools $ $ LOCALITY El Certified &2-Family,Sq.Ft. _ Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR O ` (O PAGE PARCEL COR ERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.-F��Light Sw. OWNFIRM NAME COMPENSATION INSURANCE /Q First 20 MAIL / (This section need not be completed if the work involved by the Total No. Additional ADDRESS G �3 /jam permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No -/T s issued, I shall not employ any person in any manner so as to PLAN CHECK b become subject-to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT :J P Y P Y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. L11 �,,�!�} (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. lllIJJJJ v'r G`f [ Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Class. Over 50 to 100 Incl. REG.NUMBER s. Q. Over 100 DISTRICT NO. eeROCCESSED BY 0 License Number Lic.Class Services,Swbd.,MCC&Panelboards X Contractor Date 0-393 Amp.Under 600 V FINAL O DATE ❑ 400-1000 Amp. Under 600 V _� GI I am exempt under Sec. VALIDATION W Over 1000 Amp.or Over 600 V FINAL B.&P.C.-for this reason BRANCH CIRCUIT FEES BY 0- CD Date: 15A,or 20A, 120V,Lighting or Recepf. Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY- Temp.Power Pole&Appurtenances a HOME OWNER-BUILDER DECLARATIONi:i:�,'� I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit a for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): I, as owner-of the property, will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) �,.jT ;66 - 02 and Professions Code). (; (=_;, ._i(._, CONSTRUCTION LENDING AGENCY p�� € u z i It, I hereby affirm that there is a construction lending agency for the syfll'6N performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name •J PERMIT ISSUING FEE ly �-'r N i_ 3. f'..d Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE �' 6 that the 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 i sbeln purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE 11 r/-2 _ 3` SI N TURE OF PERMITTEE DATE that I COMPENSATION OMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby aftirrn that have a certificate of consent to self insure, 76A663 of a certificate o[Wprker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy tnereot(Sec. 3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ^^ ` ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE O ` $ $ LOCALITY � � ✓L ❑ Certified co is filed with the count building 1 &2-Family,Sq.Ft. copy y. g inspection _ department. Multi-family Sq.Ft. NEAREST ` CROSS ST. (i�yt Date Applicant Residential Swimming Pools ASSESSOR ` MAP BOOK t PAGE O O Oil PARCEL ©` CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.L Light t_Sw. OWNER OR COMPENSATION INSURANCE First 20 FIRM NAME (This section need not be completed if the work involved by the r v MAIL permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS6..)-39 I certify that in the performance of the work for which this permit CITY a. Tel.No. ' r _ is issued, I shall not employ any person in any manner so as to 7 become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 PLANICANTK Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLI S C /E 3 P.NOTICE TO APPLICANT: If, after making this Certificate of. CITY Tei.No. Exemption,you should become subject to the Workers'Compensation .OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT L LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS .Z I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITYY Tel. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Incl. LICENST OR Class. REG.NUMBER d Over 100 DISTRICT NO. PROCESSED BY O License Number Lic.Class V Services,Swbd.,MCC&PanelboardsQ Contractor Date 0-399 Amp.Under 600 V FINAL DATE O 400-1000 Amp.Under 600 VU ❑ I am exempt under Sec. Over 1000 Am O600 V 3-50 VALIDATION LLI Amp.or FINAL IZ B.&P.C.for this reason BRANCH CIRCUIT FEES BY CD Z Date: 15A,or 20A, 120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits _ Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances e HOME OWNER-BUILDER DECLARATION F I hereby affirm that I am exempt from the Contractor's License Law . Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits --•-- - __ Code): i y =: I,as owner of the property, will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ?f-'! j 60 a '=t and Professions Code). C �.: -Iq E� l. 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 s It_}{f°moi <L+f.. 1 T :'21,12 f Lender's Name �� ( AM'!i-y PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE I that the 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 fo;ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE av- _ 3 SI NATURE OF PERMITTEE DATE