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HomeMy Public PortalAbout6019 CLOVERLY AVE_Electrical__ r - 76A683CE 90oI6,78, APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB GJ /� New Residential Bldgs &Pools EACH NO FEE ADDRESS (J / (� IA IJO—f 1 &2 Family Sq Ft $ 025 — $ LOCALITY Multi family Sq Ft 02 — NEAREST 25 00 CROSS ST 0 Residential Swimming Pools OWNER OR FIRM NAME Outlets Rec13Lght Sw MAIL First 20 50 a/ / ADDRESS Total No Additional 30 CITY alai No PLAN CHECK APPLICANT Lighting Fixtures- First 20 50 ADDRESS Additional 30 Total No CITY Tel No Fixed Appliances Not Over 1 HP PERMIT �C Range_Heater_ D W APPLICANT �L Oven—Dryer— W M— ADDRESS t�,7, _ Top _FAU — W H CITY T No Hood_Fan _Other_ LICENSE OR —Y Disp —Room Air Cond 250 REG NUMBER 7 Class ' �0 1 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA Power Apparatus&Large Appl ionces TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS yp HP KW KVA or KVAR 4 2 50 REGULATING ELECTRICAL WIRING Up to 1 Incl 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STA E OF V Over 10 to 50 Incl 12 50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE OVE Over 50 to 100 Inc 25 00 DESCRIBED RESIDENTIAL PROPERTY 0 Over 100 - 40 00 PERMITEE SIGNATURE ServicesDISTRICT NO PROCE B 0 200 Amp Under 600 V 12 50 201 1000 Amp Under 600 V 25 00 Over 1000 Amp or Over 600 V 5000 Z Temp Power Pole&Appurtenances 1000 " Q Sign with One Branch Circuit 1000 Gt1 til 7,P-70 7 Additional Sign Branch Circuits 200 INSPECTION > 10 0o INFORMATION W Misc Conduits&Conductors ON REVERSE s Other(See Complete Fee Schedule l SIDE u Z 3 ;24Q16A #000002 PERMIT FEE (Sub Total) 0 o 0 PLAN CHECKING FEE (One Fourth Permit Fee) O a '0000a505 PERMIT ISSUING FEE $7 00 o TOTAL FEE SD Oil 26-79 r INSPECTION FINALED i W date /- 7 By �/ ©s 76A663^E 806(11 /78) APPLICATI' R.,ELE RICAL WIT _ COUNTY OF LOS ANGELES BUILDING AND SAFETY _ FOR APPLICANT TO FILL IN JOB } New Residential Bldgs &Pools EACH NO FEE ADDRESS-Z&,0 '1'&2 Family Scl Ft $ 025 — $ LOCALITY Multi family Scl Ft 02 — NEAREST Residential Swimmmg Pools. _ 25 00 CROSSST OWNER OR FIRM NAME Outlets Re[ fight Sw _ MAIL First 20 50 ADDR Total No Additional- 30 CIT _ _Tel PLAN CHECK APPLICANT _ Lighting Fixtures First 20 50 ADDRESS Additional 30_ - - Totol No s CITY Tel No Fixed Appliances Not Over-1.HP — r - PERMIT APPLICANT Range_Heater_ D W Oven_Dryer_W M— ADDRES Top _FAU — W H CITY , b r T N4 Hood_Fan _Other= IICENS OR _ 4 ' E isp _Room Air Cond 2 50, REG NUMBER 0 _Class I HEREBY ACKNOWLEDGE-THAI I HAVE READ THIS APPLICA Power Apparatus&Large Appliances TION AND STATE THAT THE ABO IS'CORRECT AND AGREE TO '-e HP KW, KVA or KVAR - COMPLY WITH ALL COUNTY-O DINANCES AND STATE LAWS S¢e&T Yp 2 50 - REGULATING ELECTRICAL WIRING 0 Up to„1 Incl V -, --^ - - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF IN Over.10 to 50 Incl 12 50, CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE, _0 25 00 DESCRIBED RESID AL� O ERT 9 p. Over 50 to 100 Inc 40 00 PERMITEE,f , -- -�Ove r-100 '- SIGNATURE ` y� Services- -- - - - - 'DISTRICT PR E BY " 0 200 Amp Under 600 V 12 50 201 1000 Amp Under 600 V z 25 00_ -- _,G D .- ,. . _ _ �, Over 1000 Amp"or Over 600 V 5000 C Temp Power Pole&Appurtenances +10 00 Sign with One Branch Circuit, _ 1000 } Additional Sign Branch Circuits rt 2 00 INSPECTION > ` INFORMATION � 9 1 3 A r Misc Conduits&Conductors Y 1,000--, +; ON REVERSE v Other(See Complete Fee Schedule) - r,SIDE _. ,. Z ' #A00002 g ' t 2 O o 1-1,00 " PERMIT FEE (SubTotal) 1 0 0 0 1 1 0 OX _ -- Z 0226-80 PLAN CHECKING FEE (One Fourth Permit Feel _ _ O ' ' PERMIT ISSUING FEE x$7.00 i J � TOTAL FEE �! INSPECTION FINALED W date Z 3. By �r' '�°�^��;,� ©s 76A663 CES06 468 APPLICATION FOR ELECTRICAL ERMIT 7 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS exi JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST / FOR APPLICANT TO FILL IN CROSS ST �1.,/-,I -'72, T NO EACH FEE RECEPT _ $ $ OWNER Q MAIL C LIGHT TOTAL FIRST 20 20 ADDRESS S.a SWITCH_ OVER 20 10 CITY TEL NO PLAN CHECK LIGHTING1 TOTAL FIRST 20 20 APPLICANT FIXTURES Jj 1 OVER 20 10 ADDRESS RANGE_DRYERJ—WTR HTR CITY TEL NO STA COOK_DISP F A U _ CONTRAC rOR m e e.-f-, SPACE HTR AIR CONO / 24�� /V ` ADDRESS G fT F! �/ �j CLOTHES WASH —DISHWASH CITY ..Se/YIP�1J TEL NOW3- _3'- O J FAN—OTHER l 1 00 LICENSE NO v 7 O, � CLASS U MOTORS TRANSFORMERS RATING IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGU LA7I NG ELECTRICAL WIRING ` 0 - 1 1 00 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 1 - 10 3 00 LICENSED AS REOUIRED BY LOS ANGELES COUNTY AHD STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO >_ 10 - 50 5 00 RESIDE SIN THE ABOVE DESCRIf ED RESIDE TIAL PROPERTY O U SIGNATURE K 50 - 100 10 00 OF PERMITTEE 100 - 500 15 00 F" SIGN GAS DIST ICT, G$Q.UP N,E PROCESSE BY TUBE OR SIGN AND ONE CIRCUIT 3 00 N MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES I oc SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 Q SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR S SIGNATURE TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2 009>1QV UTI LI TY CO NOT]FI ED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE V JOSEPH C ROOHXN SUPERVISING ELE CAL ENGINEER = - PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATIO cK M 0 CASH l nr- 3 z 4 51-0 FEB 3 2 0 5.0 O SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS'COMPENSATION DEC LARATION = 63 CE806G (2 80) APPLICATION FOR ELECTRICAL PERMIT - - -- CE 8 I hereby affirm that I have a certificate of consent to selfCOUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or e, a certified copy thereof(Sec 3800, Lab C) yv I b0 1 J—� ,,_ . FOR APPLICANT TO FILL IN JOB 0 -� C Policy No ompany �J ADDRESS New Residential Bldgs &Pools EACH NO FEE D / $ — $ LOCALITY Certified copy is hereby furnished 1 &2-Family,Sq Ft Multi family Sq Ft — NEAREST Certified copy is filed with the county budding inspection CROSS ST department I Residential Swimming Pools OWNER OR ��, FIRM NAME Date.SL��Apphcant D a t e j6 � — Outlets Rec_Light_Sw ADDRESS First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY ' ' T e I N5/d COMPENSATION INSURANCE d PLAN CHEC APPLICANT 0 (This section need not be completed if the work involved Lighting Fixtures First 20 ADDRESS by the permit is for one hundred-dollars ($100) or less) - Additional 3 I certify that in the performance of the work for which this Total No CITY Tel No Fixed Appliances Not Over 1 HP U permit is issued, I shall not employ'any person in any manner PERMIT g tL so as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT 4 C Oven _ Dryer_W M ADDRESS Z Top _ FAU W H Date Applicant CITY Tel No /- Hood Hood _ Fan _Other_ Q� G/ NOTICE TO APPLICANT If, after making this Certificate of Disp Room Air Cond_ LICE SE O _ �— Exemption, you should become subject to the Workers' REG NUMBER Class Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO r PROCES ED BY with comply with such provisions or this permit shall be Size&Type HP KW, KVA,or KVAR deemed revoked Up to 1 Incl 7 FINAL O Over 1 to 10 Incl \ DATE VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL / � � 9 (commencing with Section 7000) of Division 3 of the Busi Over 100 l °?O ness and Professions Code, and my license is in full force and 1 effect Services �-A 0 200 Amp Under 600 V 6 d License Number Lic Class s� �l /� G/Y 201 1000 Amp Under 600 V Contractor Date Over 1000 Amp or Over 600 V 6�2� HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for"the following reason (Section 7031 5, Busi Additional Sign Branch Circuits ness and Professions Code) Misc Conduits&Conductors ;90027A I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— - structure is not intended or offered for sale (Section 7044, Business and Professions Code) # o 0 0 0 0 2 CONSTRUCTION LENDING AGENCY 2 °,0 1 2 0 0i I hereby affirm that there is a construction lending agency for the performance of the work for which,this permit is PERMIT FEE (Sub Total) issued (Sec 3097,Civ C) 1 2 0 0 Lender's Name PLAN CHECKING FEE (One Fourth Permit Fee) .0622-81 Lender's Address PERMIT ISSUING FEE ! It I certify that I have read this application and state that the TOTAL FEE V �� above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and i hereby authorize representatives of this County to enter upon \ the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date r WERS'COMPENSATION-DECLARATIO—!76 66 (2 Bo, APPLICATION FOR ELECTRICAL PERMIT CE I hereby affirm that I have x4Fi� to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Worance,or a certified copy thereof(Sec 3 FOR APPLICANT TO FILL IN JOBPolicy No Compa EACH NO FEE ADDRESS New Residential Bldgs &Pools Certified copy is hereby furnished /��d"� 1 &2 Family,Sq Ft $ — $ LOCALITY -7—�r Multi family Sq Ft NEAREST Certified copy is filed with the county building inspection CROSS ST � l depar ent Residential Swimming Pools OWNER OR �G _ / Q FIRM NAME Date e� � ='APphcant Outlets Rec-&Ight-3—Sw �� ADDRESS First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No 111.4 Additional CIT!7: ' Tel'No COMPENSATION INSURANCE PLAN CHECKZ d APPLICANT O (This section need not be completed if the work involved by the permit is for one hundred dollars (5100) or less) Lighting Fixtures First 20 ADDRESS U Total No Additional I certify that in the performance of the work for which thisFixed Appliances Not Over 1 HP CITY Tel No 0 permit is issued, I shall not employ any person in any manner PERMIT— so U so as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT CC- aW Oven Dryer_W M ADDRESS57&11 � Z Date Applicant Top _ FAU _W H / Tel No Hood _ Fan —Other_ CITY // Z£7-Stb NOTICE TO APPLICANT If, after making this Certificate ofDisp _ Room Air Cond_ LICENSE OR �/g7 0^, Exemption, you should become subject to the Workers' REG NUMBER3637-7 Class / Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO PR E ED BY with comply with such provisions or this permit shall be Size&Type HP KW KVA,or KVAR deemed revoked _ Up to 1 Incl FINAL Over 1 to 10 Incl DATE _ Q _�-Z VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl T I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL ^ BYVI(/ 9 (commencing with Section 7000) of Division 3 of the Busi Over 100 �l ness and Professions Code, and my license is in full force and _ effect Servi may/ I License Number Lic Class 0 200 Under 600 V 201 1000 Amp Under 600 V Contractor Date Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances Sign with One Branch Circuit z:0 0 S 9 A I hereby affirm that I am exempt from the Contractor's Additional Sign Branch Circuits License Law for the following reason (Section 7031 5, Busi #10 0 0 0 0 2 ness and Professions Code) - I Misc Conduits&Conductors ' 2'0 - 2650 F1 I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section o oo 2 650 c=i 7044, Business and Professions Code) ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0624-81 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued(Sec 3097,Civ C) Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 1 Lender's Address PERMIT ISSUING FEE 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 Co ty to enter upon the a mentioned propLo� SEE REVERSE FOR EXPLANATORY LANGUAGE cr ignature of Permittee Date 76A663 77771---WORK-E—RS C NEPMO Aicate of CE-806 10/81 APPLICATION POR ELECTRICAL PERMIT CE-806G � 11 herPoq Wfu m that I have a certificate of consent to self insure 3 �ror,a ce-tAcate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY %, copy therepf(Sec 3800 Lab C) Policy No 1ArTT Company e FOR APPLICANT TO FILL IN JOB ❑ Certified copy is herWy furnished New Residential Bldgs & Pools EACH NO .FEE ADDRESS !� ❑ Certified copy is fried with the county building Inspection 1 & 2-Famil S Ft $ — $ LOCALITY y 4 NEAREST department Multi-family Sq Ft CROSS ST / (f�j/ �`C� Residential Swimming Pools ` =ER OR I Date / y l ?l13 Applicant , u ��- " `+� 1 w � FIRM NAME � CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Recce/Light —;?—'Sw- t w` (MAIL COMPENSATION INSURANCE t ADDRESS �j 0� G �/ / r/ (This section need not be completed First 20 ted If the work Involved by the Total No Add;ional: * CITY e Tel No permit Is for one hundred dollars($100)or less) I I certrf that in the performance of the work for which this permit+ PLAN CHECK F y P �` APPLICANT n 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 t � � ��� Additional +� Total No CITY Tel No _ Date Applicant Fixed Appliances Not Over 1 HP `244 1 r NOTICE TO APPLICANT if after making this Certificate of PERMIT 1 Exemption you should become subject to the Workers Compensation Range_ Heater�—T� D W APPLICANT provisions of the Labor Code you must forthwith comply with such Oven Dryer /'' W M ,r ADDRESS y G S y #{ Provisions or this permit shall be deemed revoked Top FAU WH CITY Tel No 1 LICENSED,CONTRACTORS DECLARATION, Hood Fan Other_ �� I hereby affirm that,I am licensed under provisions of-Chapter 9 t Disp Room Air Cond d LICENSE OR Class (commencing with Section 7000) of Division 3 of the Business and REG NUMBER Professions Code,and my license is in full force and effect power Apparatus& Large Appliances DISTRICT NO 5ED BY b r ! �= a n ' Size & Type HP,KW KVA or KVAR` O License Number Lic Class 6 Up to 1 Incl FINAL O Over 1 to 10 Incl DATE VALIDATION Contractory� / T Date Over 10 to'50 Incl FIN- O0 ❑ I am exempt under Sec Over 50 to 100 Inc gY ' LU B&P C for this reason Over 100 a Services Swbd MCC& Panelboards - < < N Date 0- 200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V - Over 1000 Amp or c Over 600 V r` Exemption for Reg Main; Elect SINGLE FAMILY 'Temp Power Pole & Appurtenances 1 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from'the Contractors License Law 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 - r ' is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) and Professions Code) I , -S9261:4A CONSTRUCTION LENDING AGENCY # o 0 0 0 0 2 , 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)' I' � o2350civ c) _ ' PLAN CHECKING FEE _ o„0 0 2 a5 0 1 Len der, Name 0 3 2 918 8 N PERMIT ISSUING FEE Lenders Address c I certify that I have read this application and state that the above' TOTAL FEE information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize repreeees���entatives of'this County to enter*upon the above-mentioned j pro ty for i pectiori p oses SEE REVERSE FOR EXPLANATORY LANGUAGE , ignature ermitte4 Date WORKERS COMPENSATION DECLARATION CE 806G ,D;6, I h�, gppLICATION FOR ELECTRICAL PERMIT • � by•affirm that I have a certificate of consent to self insure CE 8066 r a certificate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800 Lab C) gyp /©� I l C FOR APPLICANT TO FILL IN JOB 6.-Ale J' Policy No Company I g a [/ ❑ Certified coliy is hereby furnished I New Residential Bldgs & Pools EACH NO FEE ADDRESS { $ LOCALITY — $ F-1Certified copy is filed 1 wr; the county budding inspection 1,& 2-Family Sq Ft de art ent Multi-family Sq Ft t NEAREST ,n /l CROSS ST Date' Applicant` v r -,'Residential Swimming Pools y r, ORM NAME' :+1 CERTIFICATE OF EXEMPTION FROM WO ERS Outlets Rec Light -�— Sw ' q' `MAIL COMPENSATION INSURANCE First 20� ^ADDRESS (This section need not be completed if the work Involved by the r al �s� CITY Tel No permit is for one hundred dollars($100)or less) Total No Additiony w I certifythat in the performance of the work for which this permit, PLAN CHECK P ,P , 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 ADDRESS ' , I ' 11 AdditionalTotal No CITY- Tel No i Date ,Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO, APPLICANT If after making this,Certificate of f, Exemption yoshould become subject to the,Workers Compensation 4_,Range_ Heater_ D W'_ APPLICANT 1 provisions of the Labor Code,you must forthwith comply with such Oven Dryer _ W M ADDRESS jyy S provisions or this permit shall be deemed revoked 'Top — FAU WH _ LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY ` ir� I No 1 hereby affirm that I am licensed under provisions of Chapter 9LICE Disp —,Room Air Corid REGNNUMBER f Class (commencing with Section 7000) of Division 3 of'the Business and Professions Code and my license is in full force and effect power Apparatus& Large Appliances' DISTRICT NO PROCESSED BY - Size & Type HP KW KVA, or KVAR r License Number - Lic Class « Up'to 1 Incl - FINALO ��/o Over 1 to 10 Incl DATE VA DATION 'Contractor i /bate u r Over 10 to 50 Incl n 0' E] FINAL I am exempt un er Sec Over 50 to 100 Inc0^ BY { � B&PC for this reason Over 100 p 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 9,5 7 3 A ❑ Exemption for Reg Mamt Elect c _ SINGLE FAMILY Temp Power Pole& Appurtenances # o o i 0 0 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit0 0 1 hereby affirm that I am exempt from the Contractors License'Law Additional Sign Branch Circuits I 0 �5 0 for the following reasoni '(Section 7031 5 Business and Professions - Code) 0.1 3505 ❑ Misc Conduits & Conductors ' r I as owner of the property will do the work and the structure , Other(See Complete Fee Schedule) 0 0 8 8 is not intended or offered for sale (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a'construction lending agency for the r ' performance of the work for which this permit is issued(Sec 3097 a PERMIT FEE, '+» (Sub-Total). Civ C) a „ PLAN CHECKING FEE r 'Lenders Name x ' PERMIT ISSUING FEE10 S-6 ) Lenders Address L � I certify that I have read this application and state that the above y TOTAL FEE r 3is j information is correct I agree to comply with all County ordinances y and State laws regulating Electrical+wiring and hereby authorize representatives of this County to enter upon the above-mentioned r ` ` property f r inspection pur ses SEE REVERSE FOR EXPLANATORY LANGUAGE ure of erm a Date