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76AEW'{[E0E "8 APPLICATION FOR ELECTRICAL E T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER DUILDINd
BUILbING AND SAFETY DI.I.V1810N ADDRISS
Ei
JOaZ
HN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPKMNrKNDKNT Of BUILDING LqcALITy
/
NEAREST
POR APPUCANT TO FILL IN C ST.
RECEPT. TOTAL N u'C14 rIQE
/ OUT-L" FIRST 20 1,20 MAIL
OWNER
LIGHT
SWITCH OAD 20 .10 AbDRESS
TOTAL FIRST 20 .10 CITY TEL Na
LIGHTING fi URGB
FIXTURES ADD'L CONT CTOR c/�7��n •��'��� cJ�� w
OVER 20 .10
NAND -UYV- WTR.HTptIL 1.00 ADDMMI ! �"I ✓ ��/��[�✓�/�
GARS.DI or. IrrA.DOOR I CITY e L 4d f� 4-TQ NO.`+/T 4,
DISHpAi*i. AUTO,-WASH. 'TATE
DACE HTR/, STA. AFFL. ,e0 LICENeS N0. 3
MOTORS. oma NOT Ova H.P. DIST CT GRO I ZQ 1111 1 r
p 1 1.00
1 a 1.e0 INSPECTION RECORD 7�7
a e 2.00
1. e 1e 2.e0
to e0 13.00
ISO lop 6.00 S
*IaNn NO. MMS.
L
oe
NO.LAID/
SERVICE 0.60OV-NOT ova 100A t.00 O.
wevICILO.9 OV-Ova loo A. 1.00
WKFtVICE OVER 600V 6.00
OTHER (SEE QOMFLZT[FE[SCH[DUL.E)
rERMtT ISSUING Fii 2.00
SU"LI MEMTARY Pff"FT ISSUING FEL 1.0-01 APPROVALS PATx
TOTAL FEE W
1 R111tSY ACIb10W LEY
DGE THAT I NAS READ THIS AF'FLICATIOM
UNDERSLA■ WORK
AND/TATS THA-r TH[ASOY[1/CORRkCT AND AGRSZ TO COMELY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STAT[ LAW REGULATING
ELECTRICAL WIRING. WIRING
I HERLY CERTIFY THAT 1 AM FROFSRLY RZGIfT[1[[D AHD/QR F1XTU
U CIN8ED M REQUIRkb SY LOS ANGELES GO NTY AND STAT[OF
GLIFO RNIA OR THAT I T}I Li GAL OF,AND INr[No TO =R
S I GNATU R E U T I L I TY CO.�iCM
OF PERMS
F I N.A.L.
71c-
Tt�� �i/ � K VIO TI SUFNI SIH C.NG ELECTRICAL ENCLIN IM
C7IC MO CASH wo /3� Y
? 680% WP-1 2D _ 3.00- Z
7bwd3 CE40-f i I'i 781VAPPL14CAT P, R1 CA
u. -
COUNTY OF LOS.ANGELES iU ING SAND SAF __- -.---- •.
•FOR IGANT Td Pel IN iARESS -
[Fm�&c�A�hapzmNof
sldentlal Bldgl:&Pools MACH Na. _. FEF
=Fomlly,Sq.Ft. S _0 5 S LOCALITY
i- gmllySq, -02 —entTal Swimming Pools. 25. 0CROSSSTOWNEROR-
�Rpc_Ligh1_' _.Syy•� 50 Ai71LRE5�1`Irst,20,l•No. 'Adoftbnal 300f Y__, _Ile_._NK_. P LI Fixtures First 20to 'ADDRESS
-Additionall No. � Tel.tJo_haaces.Nof Over 1 bP _. .. ie_l[eater_D.1fd. APPLI n'�_Dryer��W.ruL ..' A-0BR�S op _FAU CITY
Fioo�_dart Othdt LICENSE O
Disp._R6bm Ajr Cond. r� 2.50 RVS.NUMB R
1 HERBY,ACKNOWLEDGE THAT I HAVE READ THIS AP I
P.owor Appgrpti s 6 Large Appliances TION AND STATE THAT THE ABOVL 15RRE(_7 AND AGR�.TQ
�OMPLY WIPM' ALL WJNTY-ORD Iry ANQ--STAT-E
F{P, KW -CVA,or KVAR. 2.50 TING ELECTRICAL WIRING: •O
;lPio 1 Irc•._. ' tFiEREBY CERTIFYGT"T'I AMPROKWrRE,*MERED !OR p
QVer 1}o 10 Incl: 5'00 DCEN$ED AS RE{?<111REQ dY L05 AN E$aQUNTY AND ATE 0
Over.l0 to.50 Inal - 2. 0 �Cf�IFORNA OT2 THAP4 AMTHE _PV1 P SSE? :.
+ bES�RIBEDRETS L)MAG N00f,2
'Over.50 to-100 1n,- 25.00
Qvgr TOo-.. 4 .00 SERM1Lf�
Servicer - ; •.
12.50 DISTRICF NO.
D0
a-2Amp:Under 600 V-
201-'1000 Amp. Under 66Q V 25.00
Ovef 1000 Amp.or Over 600 V 50. ell
00
.1 .0.0
Temp.Power Pole b AppurteharlcAs �
Sign with One Branch CircuR' 10.00 F `
AddhlonaI Si n Brand,Circuits 2INSPK[ION
x' INFORMAnOW
Miss.Conduh S Conductor Oft REVERSE �� R
Other IS"Complefe Fee Sahedufe)" 1
SIDE: $ #'o.vio 0 0
• r
PERMIT FES (Sub-Totall v, 506
PLAN CHECKING FEE' (One-FourN 4rmjt Fgel- •�8
PERMIT ISSUING FEE - $7,00 -
TOTAL FEE >
INSPECTION FINALED/
dare �`�v• BY �j'aO '-r � �" '
76A6b3,CE,0611;70 - APPLICATION FOR ELECTRICAL ARM
COUNTY OF LAS -A"ELES
OIEFAItTMENT.OF COUNTY EN,OMIEER BUILDING
Mnt-DING AND SAFETY DIVISIQN ADDRESS
COLIK N W. JKNKINb r u LOCAI'ITY
NEAREST .
FOR APPLICANT TO FILL Ili CROSS ST,
0 TLETS OWNER
[RIEP
T. MAIL
T TOTAL
FIRST 20 25 ADDRESS oZ
OVIEk 20 - CI TEL. NO.
TCi},__ aD CHTINO FJR$T 20 2e APPLICANT
TOTALr ES OVER 20 .10 ADDRESS
APPLIANCES CI Ty TEL. N0.
PERMI
RANGE DRYER_WTR. HTR.— APPLICANT
STA. COOK DISP. -F.A.U. ADDRESS' Q
SPACE-ITR. AIR CON D'.— CI TEL. N0. `►
CLOTHES WAS-f.' DISHWASH. LICENSE NO. CLASS.
l
FAN OTHER 1.00 1 HEREBY ACKNDWLEDy[ THAT I -HAVE READ TMID APPLICATION
AND ,TAT[ THAT THE AEOVV IS CORRECT AND AGR[[ TO COMPLY
MOTOR,, TIIANS FOR1M ERB RATIN, WITH ALL COUNTY ORDINANCES AND ,TAT[ LAWS REGULATING
HMD:HEAT e, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE , TYPE OVER TO
IH[Rt EY-CERTIFY THAT I AM PROPERLY REGIS-TIERED AND/OR
D — 1 t� LIC[Nb Eb AD REQUIRED 6Y LOS ANGIELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM TH[ L GAL OWNER OF, ANO INTEND TO
' — 'o R[,IDE IN, THE D[ IE[ RESIDENTIAL PROPERTY. 0
SIGNATURE V
IQ 50 0.00 OF PERMI-ITE
o[
— 100 10
)DISTRICTNQ� S ZO R Y O
100 — 840 t e oo '� LUL
SIGN, GAt SIGN AND ONE CIRC1lT 0.00 NOTES; N
Z
TUBE, OR —
MARQUEE AQDITIDNAL CIRCUITS ,AO
SE-RVI CE-NOTOVER¢OOVOLTS-OR 200 AMP 3.00
APPROVALS DATE DW ECTOWS#ANATURE
SERVICEDIVER$DOVOLTS.01120QAMP ,0
TEMP-POWER POLE
TEMRSERVI CE,POLE, &APPU�RTENAN615S G80
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDIUT
WIRING
FIXTU-R
POWER AUTHORIZED
PERMIT FEE (SUB.—TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT 488UFNG FEE DAO
JQSP C. ROOHAN
TOTAL FEE SUPE VISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CR. M.O. CASH
, 578 2 - 2 D 7JDON
299 BACK OF APPLICATION FOR COMPLETE SPH96ULE
IL
WORKERS'C°"" A''°"DECLARATION '0'81 APPLICATION FOR ELECTRICAL PERMIT
J L ke{$by that I here a oerttfloate of cone, t to SWneub, 8080
of
Workers'Compensation h,eurance or a certftled: COUNTY OF LOS ANGELES. BUILDING AND SAFETY
copy thereof(Sea,3800 C.)
Pam ry � / FOR APPtr-%NT TO FILL IN ,oe SL2 Cil, Pr
C -Med copy b hereby funnlelled New Heetdential Bldgs S Pbde PEACHNO. FEE ADDRESS
W Certified copy Is fled with buldhip•nepecdon 1 d 2-Femlfy,84.Ft $ = $ NEAREST
nn%T Mu 1'tarrOy S4 Ft. C>1 m sr.
Dabj3 21 7 ,.�ml�&7it ReaborT� �p Pia OVJia R OFI
CERTFIQATE OF E)dDAPii M WORKERS'COMPEIJ8910N I RA1�ECutlets Reol-1-�t �3w. ADoftEss A/�
(Yids section r»ed not L2e completed fl the work trxo�ved by the Fkat Total No.QS Addhkxid. CRY. 7e1.Na S'
pert*Is-.for one hundr*d donera($100)or lees.) pl�rJc>�cx
I certify that,ta " performance (f;,the walk for which this permit
Is bail I shell not,errviay any parson In any manner so as to
beoome sub)ecf to(he Workem'.Compensatlon Laws. LlghtlugRrst 20 ADDRESS
Total No. Addnorral CITY 'rel.No.
Date Applicant F)xed App$enoee Not Over 1 HP
NQTICE TO.- APF�tfCA ; lf, after makk this Certfoate of �
ANT
Exemptbn,You afbuld becornb.su*d to the wodkers'Corrpeneation Reeser D.W.
prwleions of the Labor Co*'ypy must ic{thwtth.00mph with auoh Oven Dryer W.M ADDF;�SS3 q 0�.
provisions ar fhb perm t aha4 be deemed revoked Top FAU 'a— WJ-I, — My 8vmp- Tel Na
L r-�.CdNTF L ZTQ I$dE(YAAATION Food Fan Othe ,57745
I Nwaby'WF m that I am licensed under provbbrn or Chapter 9 Dbp, Roorn Air Cond O UCFN OR MBER ChmL
(comrnanoing with Section 7000),of DMIalon 3 ot the Busimms and
FlE{i MlU
Profesalcm Ooda,and my foense Is In U force and affect. Parer AppwiffiA d Large Appllancee DOTRICT NQ' PFK)CE88m BY
Stre S Type HP,KW,KVO or KW i CJ
Lberse �Q tJo C#aas Up bo 1 kv.- FIS
I I tTl til ��� 1!U 1 to 10 Yio1 DATE'
Cor�
OWK 10 to 60 ncL C/
I am exempt under Orec 60 to 100 tno
B. P.C.for this rdesen Over 100 LL
Services,Swbd,MCC S Pena baerde T��-
0-200 Amp.Under 600 V
Signature 201 1000 Amp.Under V
Over t000 Arte;or e00 V k 9i2t3ti"7;A
❑ Examption for Rag.Mahn E led # o o a?o!o f2;
SINGLE FAMILY �AZSign
p- S Appmtenances , .
HOME OWNER-BUILDER DECLARATION Brerioh Gnx1t • ° o:4G 6,2 5
I hbreby affirm that I am mwnm t from the Contractor's Lbnse Law
for the following reason(Section 7031.6,Badness end Protessone Brarah�Iroufte o o.o'4'&2 5 5
Code):' ,
El �.as orvPer of the PAY HAq do the work and the structure Mks Conduc]vra 0 4'�''8 8
le.not intended or offered for safe.(Section 7044, BLxWrKm Other Fee Sohockile)
and Profesabne Code).
CONSiRL CTIO►J LENDWG AGENCY.
I hereby ef[Yrh bnat there (a a corstrudon Ierding agency for the
periormanoe of the work fur which this permit l&haWd(Sec.3097, PERWfT FEE (Sub-Tobil) r ,
PLAN CHECKING FEE
Landaus me Na •
' PERMIT 13SUP!(3 FEE
Landers Addreea'
I m-d y that I have reed this aMfication and state that the above - TOL4L FEE
Inkffnaton is correct I agree 10 corq* vvRh all County ordnernee
and State taws regulating EJecfti wiring, and hereby authortre
repreeemtativee of th!e County to ember upon the above-•memtloned7
`
for �--� SEE REVERSE FOR EXPLANATORY LANGUAGE
GE
of Date
20-M 9
WOR}0U1ScoMPtoerdfi ate Df consent
to 7aAAM DPW°`� APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a oerUficete of consent to self Insure, 76ABR3
or a aertlncate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DN.
copy thereof(Seo.3`80010 Lab.C.)
Polky No.�.3 ° 7 company � r -TP G(r1Ir7 t Arai rcaxr To t�N -7 K'AfIELU
Cerdfled copy Is hereby furnished. New Residerrdal Bldg&S Pools EACH NO. FEE
LOCALITY
Certified copy is ftled with the oounty buikflng Inspectlon 1 8 2 funny,8q.Ft NST
dep)utme LMulti4arnly Sq.R 'T.
Applknrr—rom fp1�'j Rsekienflal Swlmmtrrg Pools AMMOR
MAP BCC K � pKiE �3 P-�Et
oo
CERTIFICATE OF EXEMPT}ON FROM WORK47T3' Outlets:Rea Llpht Sw. OWNER
OR r
COMPENSATION INSURANCE
(Thla sectlpn need not be oompkited If the work Involved bar U►e �/� f M&2 fQV
�� AMDoi1E88 �L) 14
pwmtf M for one hundred dollars(i100)or leas.) Total No.L�� A'ddIbonel
I certtty that In the performance of the work for which thta permit CITY--I-, L TOL No-
Is Issued, I shall not employ any person In kny manner to as toPLAIN Ct-ECK
become subject to the Workers' Compensation Laws. ung Tolal No. dN----s Ad t 20dRbnal - APPLICANT
ADDRESS
Dem AP 16 OR 2�120V BRANCH CIFIgJffB
NOTICE TO APPLICANT: It, after making this Certificate of CITY TOL No.
Exemption,you should become suNact to.the Workers'Compensatbn 1 TO 101NCLU&VE EACH
provlslona of the Labor Code, you must forthwtth comply wfth such 11 TO 40 INCLUSIVE EACH
provisions or this permit shall by deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH
LKCENSED CON fIACTOfiS DECLARATION - ADORES
I hereby affirm that I am licensed under provlelona of Chapter B 16 OR 20A,209V Tb 277V Llai-mw EACH
(commencing wkh Section 7000) of Dlvlelon 3 of the Business and _ CTTI' G� Tsu r+0.
Profeestons Code,and my license le In full force and effect pESI-DENTlAL APPLIANCES UP TO 3HP LICt�tBE oR �� Class.
O
/� PAppendus 8 Large Applancea
LJoenee Number Re[t Nl1MBFA
�O"l r Lk;.Ciase Size S Type HP,KW,KVA,or KVAR DtsTRCT NO. BY
Up to3Incl. �• �'(� W
--rel •t- ,1 Over 3 to 10 Ind. DATE FKAL ♦1
F-1Contractor Data OVx 10 ro 60 hroi �� `� r 7 g Z VAL1DATiOfi Z
I am exempt under Sec- Over 60 to 100 Ind.
FKAL
B.BP.C.for Ws resew Over 100 BY
Swvbw 8wbd.,MCC S-Pq*boardi- _ �!
Data 0-200 Amp.Under 000 V
83gnature 201-1000.Am p.Under 900 V-
Over 1000 Amp.or Over 900 V
E-1Exemptionfor Reg.Atatnt Beat
SINCaLE FAMILY
HOME OWNER-6UIO
ILDER DECLARATN with One grnuFt FrC•��.Ir
I hereby affirm that I am exempt from the Contractor's License Law `r1
for the following reason (Section 70316
. , Bualness and Profesatone AdditkxW Sjgn Branch Clroults 7K91760
�7 .4
Code): qtr
SO.Candults S Conductor T
r-11, erty
t Lt D
I, owner of the prop ,will do the work anMI
d the structure e--� }
Is not Intended or offered for sale (8ectlon 7044, Business Other(See Complete Fee Sohedrde) ' TOTAL AL 60 Y
- `5
and Profession Code). -
�:I-kEt� 60.4c;:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a conatructlon lending agency for the t�ril'�ts
performance of the work for which this permit Is Issued (Sec. 3087, PEAMrf FE (Sub-TotaD
Ctv.C.)
Name PLAN CHECKING FEE _ 0010 -OI �I 4/T2«fie PERMIT MUING FEE - L� 47631S 1 AM 9:09
Lenders Address
.I oertHy that I have read this applloatlon and state that the above TOTAL FEF
6b 4
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 - -
prw.%fpr Inspacftim Qu SEE REVERSE FOR EXPLANATORY LANGUAGE
�al Ax DATe