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- DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ELECTRIC
�Vd1/M. J. FOX CHIEF ENGINEER
a NAME yy AA7 i DISTRICT O. GROUP ZONE PERMIT NO.
ADDRESS
CITY miL+aa
I' _.-..m TEL.NO. RECE`�V ION BY READY FOR DATE ISSUED
JJ� FI ST IN
COUNTY /_ EXPIRES6-3I1-4e f+ (�
w CERT.NO. f7
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
DESCRIPTION OF WORK A DRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY 7
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW.I PLUGS FIiT CROSS ST.
CIRCUIT A B C I D I E F G IH I w NAME � "'`-��>✓�
wAIL
MAIL
�s
3 ADDRESS
O
CITY ' TEL.NO.
I AM THE LE AL POSSEsjp R OF THE ABOVE LAS
a ANGELES COUNTY CERTIFICATEIOF U(14(F�ICATIONN..o
44
7 ELECTRICIAN.
t AM THE I.EGAL OWNER OF THE PROPERTY DESCRIBED
P ABOVE
OWNER.
�j CORRECTIONS
Ar",
L Q
z
D
TOTAL I
NO. OF OUTLETS $ 'O APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
I
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING 2--yp
NO.'OP"""""' HEATERS S FIXTURES
MISCELLANEOUS S POWER
PERMIT FEE S A S UTILITYCO.NOTIFIED
TOTAL FEE FINAL
T6A009-CESO6-11-DY, APPLICATION FOR ELECTRIC PERMIT 1'
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DBM7BSION ADDRESS
CASSAT[D. GRIFFINC RByyI o1$1nn=w LOCALITY
FOR APPLICANT TO FILL IN NEAREST L7"
PERMIT FEES
ITEM NUMBER EACH FEE OWNER
OUTLETS: 5 5 MAIL
LIGHTS RECEPT. SW. .10 y ADDRE�SS� /��-
LIGHTING FIXTURES d' .10 d CITY 79� ,* ✓ ,Q (.-i/! TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN y
WATER HEATERS .50
ADDRESS
ELEC.SPACE HTRB. DISHWASHERS
GARBAGE DISPOSERS AUTO.- CITY TEL.NO.
WASHERS STA,COOKING UNITS 25 STATE
LICENSE NO.
MOTORS: OVER INC. H.P.
0 — VE .25 DISTRICT NO. jj� UP ZONE READY POR INSPECTION
+/z — 2 .50 �/ � — /
2 - 5 LOO INSPECTION RECORD
5 — IS LSO
15 — 50 2.50
50 — 200 5.00
' SIGNS: NO.TRANS.
I LAMPS
SERV ICE 0-600V 1.00
SERVICE OVER 600V 5.00
MI50.
WIRING PERMIT 1.00
FIXTUREPERMIT ,1,00
SUPPLEMENTARY PERMIT .50
TOTALFEE 5 APPROVALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES ANDSTATELAWS REGULATING
ELECTRICAL WIRING. WIRING 1
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR IA
LICENSED AS REQUIRED BY LOS ANGEL NTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AER ER OF THE ABOVE ' P
DESCRIBED RESIDENTIAL RO POWER
SIGNATURE UTILITY CO. NOTIFIED � y
OF PERMITTE FINAL
/ ARTHURC.VETT.
�LIDATION �GI -
crc No CASH SUPERVISING ELECTRICAL ENGINEER
Lpro 5 5 1 1 OCT 6 2 A 2.4 0 M
WORKERS' COMPENSATION DECLARATION CE-806 1081 APPLICATION FOR ELECTRICAL PERMIT y�
I hGre6y affirm that I have a certificate of consent to self CE-806G,
nsure,;.or ager ficate of,Workers' Compensation Insurance,
4 COUNTY OF LOS ANGELES BUILDING AND SAFETY
or vcertif'ied cop t erect (Sec. 3800, Lab. C.)
Poll Al om an -Pl`jisi� FOR APPLICANT TO FILL IN JOB �s
�orf ified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
ertified copy is filed with the co my building spec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY
hon department. Multi-family Sq. Ft. — NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
FIRM NAME
Date6Applicant ..r e
CERTIFICATE OF EXEMPTI N FROM WOR S' Outlets: RecLightSw. MAIL
COMPENSATION INSURANCE ADDRESS
( if the work involved by This section need not be completedFirst 20
CITY T.I. No.
?,ri.
the permit is For one hundred dollars ($100) or leas.) Total No. AdditionalPLAN 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 Fixtures First 20 ADDRESS
Total No. Additional
CITY TeL No.
Date Applicant Fixed Appliances Not Over 1 HE PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT G
Exemption, you should become subject to the Workers' Range_ Heater—D.W.
Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M.— ADDRESS ��f �
with comply with such provisions or this permit shall be Top — EAU —W.H. — 4 .
deemeci revoked. CITY ^ 4 Te o. S✓07
LICENSED CONTRACTORS DECLARATION. Hood _ Fan _ Other_
/ 7 /'�
I hereby affirm that Disp. Room Air Cond. LICENSE OR ClassG
am licensed under provisions of Chapter 9 -REG. NUMBER / 7J
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. CE SED BY
and Professions Code,and my license is in full force and effect_ Power Apparatus 8 large Appliances fJ }
Size 8 Type HP, KW, KVA, or KVAR Uv 0
.License Num r 56Y Lic. Class /0 Up to 1 Incl. FINAL U
V Over 1 to 10 lncL,4/L' DATE C/ '� VALIDATION
ContractDate, Over 10 to 50 Ind. FIN V
❑ I am exempt under Sec Over 50 to 100 Inc. BY w
B.BP.C- for this reason Over 100
N
Services, Swbd., MCC 8 Panelboard Z
Date:
`e0 - 200 Amp, Under 600 V � x '
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
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
Law for the following reason (Section 7031.5, Business and
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 1111107044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY -2 5 4 5 8 A
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) # o e e o e `Z
(Sec. 3097, Civ. C.). -
' PLAN CHECKING FEE � 9 ) ° - 3250
Lender's Name
PERMIT ISSUING FEE f0, e o o O Z 5 0
Lender's Address
I certify that I have read this application and state that the TOTAL FEE -0 0 9. 1 8-86
above information is correct. I agree to comply with all County
ordinances and State I ws regulating Electrical wiring, and
here authorize repro ntatives of this County to enter upon
th ove-mention d roperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
/Signature of Pe ee Date