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76AGAS•D=8A 11-49 APPLICATION FOR PLiLNU
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENMLNEER
FOR APPLICANT TOFILL IN DISTRICT NO. 13ROUP ZONE PERMIT NO.
ELECTRICIAN
RECEIVED ■Y READY rOW DATE ISSUED
ADpRESE Z.1- FIRST INOPIOTION —7
CITY T[L.NO —
COUNTY LIDEMIK"NO. YO Ki.IR[D ■UILDINO �" f
MINIMFEES
/
NUMBER OUTLtTs [ADH
FE[ LOOALrry
y LIGHT 6o III OROISMNKAArT
Y( ORS WT.
1 REOETTAOLLS 5 D
FIXTURED s OW R
WALL SWATCHES 5 —if 14AI
ADDR
LL RANO[S 26
[L[0. HATERS 9S CITY TEL. NO.
NUM7[R OF OIROUITS INSTALL[D1 I HERESY AOKNEWL[DOT
[ THAT I HAVE READ HIS
TOTALAPPLICATION AND STAT[ THAT THE ASOVT 10 OCRR[OT
LI OL AND ADR[[ TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STATE LAW7 REDULATINO [LEOTRICAL WIRING.
HUMMER HORQ[POW[R 1 CERTIFY THAT I POMPI EITHE ABOVE VALID LOB
F[[
Ncw MVD- HP QUER IND. EADH ANGEL[■ COUNTY LICENSE, OR I AM THE ,LKOAL OWNER
i Log .=S OF THE RESID[N ROP DES13RINED ABOVG
1 S •150 ■IONATUR[ O
7 f 1.00 PERMS
a is I.eD INSPECTION RECORD
16 ISO 2.1513
6C SLOG s.CO
700 600 10.00
800 . 1 c= 11S.013 J
wER 1❑ao saoa Z=
M.o. mrr/mEq. crHANO[R-HP p
W[LD[RS1AD-KVA R
GENERATORS - KW 0
TRANSFORMERS - KVA
TEMP'. MOTrDRMl 75Dr oRI■
MOULD MOTOR■ (715Or ORI■
m 1042,
SIGNS
TYPE 1 NCL TRANL
TYPKi EL APPROVALS
FOR EACH P[RMITt
DATE INWEMMR'S NAM[
WIRING 1.D0 O O CONDUIT
FIXTURES •1.00 0 WIRINO
SUlT .S FIXTUREA 1- `
r� POWER
TOTAL FEE f L/ UTILITY CO.NOTIFIED LOOP, j
FINAL
1
7saaa2 yD■a aA 11-49 APPLICATION FOR PERMIT
DEPARTMENT OF BUa.DnQa AND SAFETY ELECTRIC i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. OROLIP I ZONE PERMIT NO.
091 / voq
ELECTRICIAN
RECEIVED BY RF. ON
DAT[ ISSUED
AMD RME L FIRST�La'�fON
CITY TEL N0. llII''.•��''// —2
COUNTY LICKNIIIII NO. D EXPIRES BUILDING
PERMIT FEES ADDRLAI
FEE � V• '�
NUMBER 13UTLJCT■ EACH LOCALITY
LIGHT Bo NEARKirr
OR OM 6T. �-
�Z� REC[PTACLEA B C
F rxTU RES 6 OWNER —
WALL OWIT13HXM ■ MAIL
AD D R EGTA
KLJUL RAN Cl 0 u
[LEO. [A FW 26 CITY T[L NO.
I H[RI■Y ACKNOWL[UO[ THAT I HAVE READ THIS
NU KR OF CIRCUITS IN■TALLIDI
TOTAI APPLICATION AND STATIC THAT THE ABOVE to DO`RRKOT
RICOEFTAOLKIII AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCE■
MOTORS AND STATIC LAWS REGULATING EL.ICOTRICAL WIRING.
Nuw9[R HORSEPOWE RF[[ RI O[ TIFY THAT 1 POSSESS THE ABOVE VALID LOA
N. MVD. HP ANCIEL.[S COUNTY LIO[NAIC, OR I AM THE LEGAL OWNv4
YR A Lt97
OF T [ RR■IDENTIAL PROPERTY D R18100DOI.
D AV.96 H
ys 3 .SC o1GNATURE O
>i ■ 1.00
PER MI'
`
■ 15 1.90 INSPECTION RECORD
1■ BC 3.50
BO ZOO 0.00
900 BOO 10.00
BOO IODO 15.00 Q
OVER 11= 1:0-DO Z
M.D. BET FR 01-IANGER-HP 6
W[L.DERBI AO-"A
- O
GENERATORS - KW
TRANAFORMERls - KVA
TEMP. MOTDRS 75or aRI■
MOVED MOTOR■ ( of DRINJ
MIMEL
BIONS
TYr[1 Na TRANS
APPROVALS
FOR EACH PERMITS DAT[ IN■r[OTIOR7 NAM[
WIRING 1.m (� 0 CONDUIT
FIX1'LJR[AIpl.OD WIRING
F DcTU RIA
POW[R
TOTAL FEE - • to UTILITY CO.NOTIFIED
FINAL
� l
\ �rrrr that
I have
carr DECLARATION CE ,aa, APPLICATION FOR ELECTRICAL PERMIT
I,h reby trfflrr►r that I have a certificate of consent to self {�
Insure,or atertlflcate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY hull
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company I'OR A"UCANT TO FRI IN _K)6
Certified copy Is hereby furnished. New Residential Bldgs. b Pools EACH NO. FEE
❑ $ — f LOCALITY
Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft.
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.
Data Applicant L�Fl
OR
CERTIFICATE OF EXEMPTION FROM WORKERS' AMECOMPENSATION INSURANCE Outlets: R Llght�SJL(This section need not be completed If the work InvoFwd by First 20 Total No SC_LL Additional Tel. No.
the perrrtFf Is for one hundred dollars (=100)or leas.) �I certify that In the performance of the work for which this Nt
permit Is Issued, I shall not employ any person In any manner
so as to become subject to the Workers mpensotlon Laws. Ughting Fixtures First 20 ADDRESS
Total No. f� Addittonal
J CITY Tel. No.
Date �+as
Fixed Appliances Not Over 1 HP PERMIT dq
NOTICE TO (CANT: If, after making this Certificate of APPLICANTExemption, you should become subject to the Worker' Range_ Heater_D.W.
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. Hood _ Fan _Other CITYoR el. No.
LICENSED CONTRACTORS DECLARATION U(�NSE
I hereby affirm that I am licensed under provisions of Chapter 9 Dls T m ASV CgnC J NSR CI--C J
(commencing with Section 7000) cf Division 3 of the Business Mo-Apparatus 8 Large Appliances DISTRICT NO.
and Professions Code,and my license is In full force and effect. /)Q�
`T� X
r�/ �`o Slur 8 Type HP, KW, KVA, or KVAR' 6/t V U
License Number �/. zq— I Ic. Class C Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE VA N
Contractor Over 10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY
B.BP.C_ for this reason Over 100 e Z,61
co
Services, Swbd., MCC b Ponelboards 000 -200 Amp. Under 600 V
Signature 201 - 1000 Amp, Under 600 V
❑ Exemption for Req. Malnt. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
1 hereby affirm that I am exempt from the Contractors License Additional Sign Branch Circuits 6 7,.4 ALaw for the following reason (Section 7031.5, Business and
Professions Code): # o o o o_ a 2
❑ I, as owner of theo Mlsc. Conduits 8 Conductors
pr party, will do the work and the
structure is not Intended or offered for sale (Section Other (See Complete Fee 41Schedule)_ ,
70 , Business and Professions Code) 1 o o 6 a O O
CONSTRUCTION LENDING AGENCY o 0 0 (� a p p f
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permlt Is Issued PERMIT FEE (Sub-Total) as 2 0 6
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Leaders Name
PERMIT ISSUING FEE
Lender's Address a�o
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
thea o-mentioned pro rty for I n pu SEE REVERSE FOR EXPLANATORY LANGUAGE
L4of
Permittee to -