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A663-CES 6 5-62 .» APPLICATION FOR ELECTRICAL ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERING
BUILDING AND SAFETY DIVISION ADORESS Q ,
JOHN A. LAMBIE, COUNTY ENGINEER ✓
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. L L F
RECEPT. TOTALNO. EACH FES
LIGHT OUTLETS FIRST 20 2$.2O >$ MAL ER ,
SWITCH. OVER 20 .10 ADDI3E8
T TEL. .
LIGHTING TOTAL 1 FIRST 20 .20 CITY NO4;z 0
FIXTURES 1 ADG'L ,1O ELECTRICIAN_
N
OV R 20 _
RANGE CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.D STA.COOKCITY " TEL.NO.
DISHWASH. AUTO.-WASH. STATE
SPACE HTR9. STA.APP.(Y$H.P.MAX.) .50 LICENSE NO. ~�
MOTORS, OVER NOT OVER H.P. DIS TR T N GR� Z PR CE �D Y
O 1 1.00
I 3 11.50 INSPECTION RECORD
s s
2.00- . Q /� (} _iar,
B 1s 2.50 0
, -
18 50 3.00 f � U
S0 100 5.00
SIGNS,
NO.TRANS.
e;,.e •rr.�R.., W
NO.LAMPS ---r.:• .. -• d
SERVICE O-SOOV-NOT OVER 200A 1.00 Q Z
• SERVICE 0.600V-OVER 200 A: 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 12.00SUPPLEMENTARY PERMIT ISSUING FE
TOTAL FEE
I
HEREBY ACKNOWLEDGE ac
THAT 1 HAVE READ THIS APP (CATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL•COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE i n
DESCRIBED RESIDENTIAL PROPERTY. POWER /1 _ f; fk _.• ' 1!'f
SIGNATURE UTILITYCO.NOTIFIED CfJ{♦�+lV� ,.k '1,i1't �✓ t+
OF PERMITTEE ' FINAL ✓p6i
VALIDAT� ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
iAGO7 5 0 6'Q` NOV 28 2 D 4.50- v
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7 6 A S S 3 D S S 5 A 1 1 - 4 9 A P P L I C A T I O N F O R P E R M I T
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C O U N T Y O F L O S A N G E L E S
W I L L I A M J . F O X , C H I E F E N G I N E E R
F O R A P P L I C A N T T O F I L L I N D I S T R I C T O . G R O U P I Z O N E P E R M I T N O .
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A D D R E S S 0 2 F I R S T I N S P E C T I O N
C I T Y / ( T E L . N O .
C O U N T Y L I C E N S E N O . 7 t i E X P I R E S " 4 ' - - J B U I L D I N G
P E R M I T F E E S A D D R E S S
N U M B E R O U T L E T S E A C H F E E L O C A L I T Y /
L I G H T S c $ N E A R E S T
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R E C E P T A C L E S
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N U M B E R O F C I R C U I T S I N S T A L L E D : . I H E R E B Y A C K N O W L E D G E T H A T 1 H A V E R E A D T H I S
T O T A L t i > A P P L I C A T I O N A N D S T A T E T H A T T H E A B O V E I S C O R R E C T
" 1 Y I L I G H T S D R E C E P T A C L E S A N D A G R E E T O C O M P L Y W I T H A L L C O U N T Y O R D I N A N C E S
M O T O R S A N D S T A T E L A W S R E G U L A T I N G E L E C T R I C A L W I R I N G .
N U M S E R H O R S E P O W E R F E E I C E R T I F Y T H A T I P O S S E S S T H E A B O V E V A L I D L O S
N E W M V D . H P O V E R I N C - E A C H A N G E L E S C O U N T Y L I C E ; , O R 1 A M T H E L E G A L O W N E R
O F T H E R E S I D E N T I A L P P E R T Y D E S C R J A E D A B O V E .
V 2 S L E S S $ . 2 5
% 2 2 . 5 0 S I G N A T U R E O F
2 S 1 . 0 0 P E R M I T T E E
s i s 1 . 5 0 I N S P E C T I O N R E C O R D
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T R A N S F O R M E R S - K V A
T E M P . M O T O R S ( 7 5 % O F D R I D - )
M O V E D M O T O R S ( 7 S % O F D R I D . )
M I S C .
S I G N S
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T Y P E : N O . L A M P S A P P R O V A L S
F O R E A C H P E R M I T : D A T E I N S P E C T O R ' S N A M E
W I R I N G $ 1 . 0 0 I C O N D U I T
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F I X T U R E S $ 1 . 0 0 ( J W I R I N G
S U P P L E M E N T A R Y . 5 0 F I X T U R E S
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T O T A L F E E $ U T I L I T Y C O . N O T I F I E D
F I N A L
Y
oa 'A 11.55 APPLICATION FOR ELECTRIC PERMIT
DIVISION OF OF BUILDING AND SAFETY
Department y Of CountLos Angeles
Engineer BUILDING
Ci011IIt Of 1.06 AII e10S ADDRESS
JOHN A.LAMBIE,COUNTY ENGINEER
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL INMMM�f NEAREST
PERBUT FEES Coss sT.
NUMBER OWNER
LIGHT OUTLETS MAIL
RECEPTACLES ADDRESS
ER WALL SWITCHES FEE CITY TEL.NO.
TOTAL OUTLETS @ 5¢ $ ELECTRICIAN
C. RANGES 25 ADDRESS
ELEC. HEATERS 25
KW EA CITY TEL.N
STATE ?�
FIXTURES 5 LICENSE NO. �1��p I
MOTORS DISTRICT NO. I GRyr ZONE I READY FOR INSPECTION
NUMBER HORSEPOWER FEE 7/ h/__ I 1
NEW MVD. HP OVER INC. EACH IA
,h&LESS $ .25 INSPECTION RECORD
1� 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 M-00 1
1
misc.
NO.SIGNS NO.TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE $ DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRD � 1`S � -
I HEREBY CERTIFY THAT I AM PROPER GIT RED AND/OR FIXT
LICENSED AS REQUIRED B OS ANGEL C NT b S TE OF
CALIFORNIA OR THAT I THE LEG N T ABOVE POWER
DESCRIBED RESI IAL OPERTI6. UTILITY CO.NOTIFIED
SIGNATURE >
OF PERMITTEE FINAL
JOHN A.LAM ,COUNTY ENGINE R I,I O CATION ARTHUR C.VEIT,CHIEF ELECT.INSPECTOR
K/) MCASH
I"� rP 7 3 .2
WORKERS'COMPENSATION DECLARATION 76A66310/$1 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to sCE-806G elf insure, CE-806C,
or a certificate of WAers' 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
ADDRESSJ. QY-(f(��
❑ dve-
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE � e
❑ Certified copy is filed with the county building inspection
1'& 2-Family,Sq.Ft. $ — $ LOCALITY, 7
•s
department: Multi-family Sq.Ft. NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
Date Applicant FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
Outlets:Rec Light ,Sw.
� COMPENSATION INSURANCE ADDRESS 0All 8ELYe-JC,✓ �
This section need not be completed if the work Involved b the First 20
( P Y' r'
Teyf
permit is for one hundred dollars($100)or less.) Total No. Additional CITYl.NoZgG 'f��`
PLAN CHECKA, ,
I certify that:in the performance of the work,for which this-permit APPLI ANT K,'
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 ADDR
/�_ j J Total No. Additional CITY Tel.No. j
Date .Applicant 14 46✓CnGr /L C
NOTICE. TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
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. CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan Other_
I hereby affirm that I am licensed under provisions,of Chapter 9 LICENSE OR
Disp. Room Air Cond. REG.NUMBER Class.
(commencing with Section 7000) of Division 3 of the Business and,
Professions Code,and my license is in full force and effect.' DISTRICT NO. PR SED BY
Power Apparatus&Large Appliances
Size&Type HP,KW,KVA,or KVAR 0
License Number Lic.Class Up to 1 Incl. FINAL �� 0
Over 1 to 10 Inc[. DATE 0'
Contractor Date VALIDATION 0
Over 10 to 50 Incl. FINAL H
❑ I am exempt under Sec. Over 50 to 100 Inc. BY 0
W
B.&P.C.for this reason Over 100 IlLN'
Services,Swbd.,MCC& Panelboards , 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.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit _ -.
I herebyaffirm 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):
Misc.Conduits& Conductors V -
_ I,as owner of the property,will do the work and the structure -
j is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
i
and Professions Code). too.
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
Lender's Name
PERMIT ISSUING FEE r•
Lender's Address
I certify that I have read this application and'state that the above TOTAL FEE 7 7
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 u on the above-mentioned
property for ins pec ion p oses.
/ SEE REVERSE FOR EXPLANATORY LANGUAGE
! a�
Signature of mittee Kate