Loading...
HomeMy Public PortalAbout5000 ENCINITA AVE_Electrical__ 76A663-CEB06 10,74 APPLICATION R ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADORESS._.'�_Oee • LOCALITY FOR APPLICANT TO FILL IN NEAREST i CROSS ST el OUTLETS NO EACH FEE OWNER OR {`�/ FIRM NAME RECEPTAJ $ $ MAIL LIGHT TOTAL FIRST 20 25 OD ADDRESS i SWITCH �� OVER 20 tp CITY TEL NO PLAN CHECK LIGHTINGTOTAL FIRST 20 25 00 APPLICANT FIXTURES OVER 20 10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL,NO RANGE DRYER_WTR HTR PERMIT,APPLICANT STA COOK DISP F A U ADDRESS SPACE HTR ` AIR COND CITY TEL NO CLOTHES WASH DISHWASH LICENSE OR REG NUMBER CLASS FAN OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS, ETC HP KW KVA ELECTRICAL WIRING SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPEXNEIR EGIS7ERED AND/OR 0 - 1 100 LICENSED AS REQUIRED BY LOS AN LESTY AND STATE OF CALIFORNIA OR HAI I AM THE GAL OF HE ABOVE 1 - 10 300 DE S CR I PED RE E IAL PRO _V PERMITEE 10 - 50 500 SIGNATUR O� U 50 - 100 1000 LLI DISTRICT NOESSED Y 0- 100 - 500 1500 -f-` Z SIGN, GAS SIGN AND ONE CIRCUIT 500 APPROVALS DATE INSPE OR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE SERVI CENOT OVER 600 VOLTS OR 200 AMP 300 UNDERSLAB WORK SERVICEOVER 600 VOLTS OR200AMP 1000 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 500 WIRING TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES POWER AUTHORIZED UTILITY CO NOTIFIED FINAL O� PERMIT FEE (SUB TOTAL) NOTES PLAN CHECK FEE PERMIT ISSUING FEE 300 TOTAL FEE Q PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK Q CASH 2 1 4 n,., 9 2 D 2 0.0 0 ,&% SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CE806 I2-65 APPLICATION FOR ELECTRICAL RMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING A BUILDING AND SAFETY DIVISION ADDRESS - Q JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST RECEPT TOTAL NO EACH FEE OUTLETS1 FIRST 20 $20 $ OWNER LIGHT MAIL SWITCH ADD L 10 ADDRESS-30 OVER 20 TOTAL FIRST 201 20 CITY L NO r `SPO L LIGHTING I FIXTURES i FIXTURES ADD L 1O CONTRACTOR OVER 20 RANGES DRYERS WTR HTRS 1 OO ADDRESS GARB DISP STA COOK CITY TEL NO DISHWASH AUTO WASH STATE SPACE HTRS STA APPL 50 LICENSE NO -2 / J MOTORS OVER NOT OVER HP DIST�gLCT N I GROUP ON PROCE E/D Y O 1 100 d 1 3 150 INSPECTION RECORD 0 3 8 200 U 8 15 250 O 15 50 300 r) W 50 100 500 N Z SIGNS NO TRANS NO LAMPS SERVICE 0-600V NOT OVER 200A 100 SERVICE O 600V OVER 200 A 200 SERVICE OVER 600V 500 OTHER ��(SEE ®®COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2 00 SUPPLEMENTARY PERMIT ISSUING FEE 1 00 APPROVALS DATE INSPECTOR'S SIGNATURE TOTAL FEE UNDERSLAB WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO POWER RESIDE IN THE ABOVE CRIB D ESI DE T L PROPERT^ SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE FINAL (LK MCI T,ON JOSEPH S ROOAAN LEC CK MO CASH SUPERVISING ELECTRICAL ENGINEER LM.;O 3, 2 1 91 JUL 1 2 D 3.40- 7GA663 CE806 ID 56 APPLICATION FOR ELECTRIC PERMIT BUILDING AND SAFETY DMSION Department of County Engineer BUILDING County of Los Angeles ADDRESS C7.-� JOHN A. LAMBIE. COUNTY ENGINEER CASSATT D GRIFFIN SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN q.RCSS PERMIT FEES OWNER � LIGHTS RECEPTACLES SWITCHES NUMBER ITEM EACH I FEE MAIL ADDRESS67VZ ow L TOTAL OUTLETS $ 10 $ J �°�''/� (j' ELEC RANGES WATER HEATERS, CITY ' TEL NO (- / c� CLOTHES DRYERS k 50 ELECTRICIAN ELEC SPACE HEATERS, STAT Y COOK ING UNITS, GARBAGE DISPOSERS, AU70 WASHERS DISHWASHER 25 ADDRESS LIGHTING FIXTURES 10 CITY _ : �.� TEL NO �} /+� ' MOTORS STATELICENSE NO Z- HORSEPOWER H P OVER INC DISTRICT NO GROUP I ZONE I READY FOR INSPECTION 1/2 B LESS 25 1/2 - 2 50 INSPECTION RECORD 2 5 1 00 5 15 1 50 15 50 250 50 200 500 MISC SIGNSI NO TRANS / ....� NO LAMPS SERVICE 0-600V 1 00 SERVICE OVER 600V 5 00 WIRING PERMIT 100 FIXTURE PERMIT 1 00 SUPPLEMENTARY PERMIT 50 APPROVALS TOTAL FEE DATE INSPECTOR S 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 WIRING IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PROPERTY SIGNATURE LL UTILITY CO NOTIFIED OF PERMITTEE "=jjg¢¢�}j Lai FINAL ,n JOHN A LAMBIE VALIDATION ART UR C.VEIT, COUNTY ENGINEER Lc�� Mo CASH SUPERVISING ELECTRICAL ENGINEER ILACO2 4 8 2ru-1 SEP 2O 2 2.00 0 v r 76AG63 DBS 5A 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC COUNTY OF LOS ANGELES � WILLIAM J FOX, CHIEF ENGINEER FOR APPLICANT TO A ILL IN DISTRICT NO GROUP ZONE PERMIT NO ELECTRICIAN RECEIVED BY READY FOR DATE ISSUED ADDRESS FIRST INSPECTION CITY TEL NO 9 �� ��� COUNTY LICENSE NO 4 EXPIRES 3o BUILDING - PERMIT FEEV ADDRESS FEE 77: e17 NUMBER EACH LOCALITY � LIGHT OUTLETS NEAREST CROSS ST RECEPTACLES WALL SWITCHES OWNER ♦ „�/-,%9: TOTAL OUTLETS Sc $ ® MAIL ELEC RANGES P5 ADDRESS ELEC HEATERS 25 CITY TEL NO FIXTURES ' 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 11 h NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS 1 CERTIFY THAT 1 POSSESS THE,ABOVE VALID LOS ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER / NUMBER HORSEPOWER FEE l S NEw MVD HP OVER INC EACH OF THE RESIDENTIALZOPE TY CRIBED ABOVE l 1/2 a LESS $ 25 SIGNATURE OF 1/2 2 50 PERMITTE .� z 5 1 00 INSPECTION RECORD 5 Is 1 50 1 15 50 2 50 � So 1 200 1 5,00-- 200 00200 50070 00 /�y/sz ;z.[I 5 Q a....rc,n.0 500 1000 15 00 � Z 1 OVER 1000 20 00 M G SET/FREQ CHANGER-HP WELDERS AC-KVA GENERATORS-KW TRANSFORMERS-KVA TEMP MOTORS (75%OF ORIG ) MOVED MOTORS (75%OF ORIG ) MISC SIGNS NO NO TRANS APPROVALS NO NO LAMPS DATE INSPECTOR S NAME FOR EACH PERMIT ^ WIRING $1 00 CONDUIT 1 FIXTURES $1 00 WIRING C/ f SUPPLEMENTARY S0 FIXTURES , POWER TOTAL FEE $ UTILITY CO NOTIFIED / (G 1<2-D © FINAL 7SA663 DBS SA 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN / S.1��� RECEIVED BY READY FOR DATE ISSUED ADDRES 1Y FIRST INSPECTION / CITY TEL NO COUNTY LICENSE NO. EXPIRE BUILDING nn PERMIT FE S ADDRESS NUMBER EACH FEE LOCALITY LIGHT OUTLETS NEAREST RCROSS HT. RECEPTACLES m WALL SWITCHES OWNER �.� AP TOTAL OUTLETS 5c $ © MAIL ELEC^RANGES 25 ADDRESS ELEC HEATERS 25 CITY TEL. NO FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT I POSSESS THE ABOVE' VALID,,LOS NUMBER HORSEPOWER ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER FEE OF THE RESIDENTIAL f2OPE TY SCRIBED ABOVE. NEW MVD HP OVER INC EAC N V 6 LEHB $ 25le SIGNATURE OF I/2 2 .50 PERMITTE - rlf'� 2 5 1.00 INSPECTION RECORD / 5 15 1.50 15 50 250----- 50 200 Soo 200 600 1000 Q 500 1000 1500 Z OVER 1000 20.00 M G BET/FREQ CHANGER-HP R' WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIS) MOVED MOTORS (75% 0R19) MISC BIONS NO NO TRANS APPROVALS NO NO LAMPS DATE INSPECTOR18 NAME FOR EACH PERMIT: WIRING $1.00 CONDUIT FIXTURES $1.00 WIRING SUPPLEMENTARY 50 FIXTURES �j POWER TOTAL FEE $/ 4/ UTILITY CO.NOTIFIED., FINAL V APPLICATION pp�p■y ELECTRIC PERMIT 7ES 5A TIE C L (CATION FOR ELECTRIC ■ ERY IT ri `DBS 5A 3 55 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING r WM J FOX, COUNTY ENGINEER ADDRESS U Oo _ �✓G�I✓Y �� CASSATT D GRIFFIN SUP T Of BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST NUMBER EACH FEE OWNER LIGHT OUTLETS MAIL RECEPTACLES Q _ADDRESS WALL SWITCHES TOTAL OUTLETS _ S¢ $ CITY TEL NO ELEC RANGES 25 ELECTRICIAN CC _ELEC HEATERS 25 ADDRESS KW EA CITY ��t/ TEL NO FIXTURES ZZ 1 5 LICENSE NO .h J NUMBER OF LIGHT CIRCUITS - DISTRIC�OI G / P I �N% I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS MOTORS NUMBER HORSEPOWERFEE INSPECTION RECORD NEW MVD HP OVER I INC EACH 11&LESS $ 25 _ 1/2 2 50 2 5 1 00 5 15 ISO 15 50 250 50 200 500 MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING $1 00 I'0 v FIXTURES $1 00 4O SUPPLEMENTARY 50 APPROVALS TOTAL FEE g I Q� DATE INSPECTOR S SIGNATUPE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAT IONCONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO ' • WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULAWIRING ELECTRICAL WIRING I HEREBY CERTIFY THAT 1 AM PROPEPLY REGISTERED ANFIXTURES LICENSED PS REQUIRED BY LOS ANGELES COUNTY AND STATCALIFORNIA OR THAT I AM E GAL WNER OF THE APOWER DESCRIBED RESIDENTIAL PR ER Y. SIGNATURE UTILITY CO NOTIFIED 1i OF PERMITTEE FINAL WILLIAM J FOX, COUNTY ENGINEER VALIDATION A C.VEIT,CHIEF ELECT INSPECTOR '_ACO 8 5 1 S SEP 30 2 400 v 76,11663 CE 606R 10/77 �• © � APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 1 ` ' JOB ADDRESS BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN,, _ '. LOCALITY , r ".� A � New Residential Bldgs &Pools EACH NO FEE NEAREST 1 &2 Family Sq Ft $ 025 — $ CROSS ST OWNER OR t Multi family Sq Ft 02 — FIRM NAME Residential Swimming Pools 2500 MAIL \ ADDRESS > "� Y► � . Outlets Rec Light_Sw CITY P Tel No First 20 50' 1 i i PLAN CHECK+`1 'A.Ie�-NkN ' V, Total No Additional 30 APPLICANT ADDRESS Lighting Fixtures First 20 50 CITY Tel No Additional 30 PERMIT Total No APPLICANT Zi4f 1./ '4's a� Fixed Appliances Not Over 1 HP ADDRESS d _ r '%Z ,A/ J )� Range—Heater—D W CITY Cb £ ( G Tel No .44yeq q.,,, Oven —Dryer—W M— LICENSE OR ,a Top —FAU —W H REG NUMBER f 2, fo Class . 0 Hood—Fan _Other 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp — Room Air Cond 2 50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY G'/ITH ALL COUNTY ORDIN ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING Power Apparatus&Large Appliances Size&Type HP KW, KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED By LOS ANGELES COUNTY AND STATE OF ALIFORNIA OR THAT I AM io �w.rUp to 1 Incl 250 THE LEGAL OWN THE ABOVE DESCRIBED RES! TIAL PROPERTY C Over 1 to 10 Incl 500 p v •�Y✓ 1 2 50 PERMITTEE ver 10 to 50 Incl o Over 50 to 100 Inc 2500 SIGNATURE K5 Over 100 4000 tROUGH O PR ESSED ti JJ J GGT • `– Z Services 0 200 Amp Under 600 V -1250 �' OVALS DA�� INSPECTOURE201 1000Amp Under600V 2500Over 1000 Amp or Over 600 V 5000 ER POLE WORK Temp Power Pole&Appurtenorces 1000Sign with One Branch Circuit 1000 NDUIT Additional Sign Branch Circuits 2 00 WIRING Misc Conduits&Conductors 10.00 FIXTURES Other(See Complete Fee Schedules POWER AUTHORIZED UTILITY CO NOTIFIED ` FINAL U >b PERMIT FEE (Sub Total) NOTES PLAN CHECKING FEE (One Fourth Permit Feel PERMIT ISSUING FEE $700 __7 OFq TOTAL FEE SP:�� PLAN CHECK VALIDATION CK M O CASH PERMIT VALID TIO CK M 0 CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CE80612-65 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS OD JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST L OcvF! ZU .e P RECEPT Z TOTAL NO EACH FEE LIGHT OUTLETS I FIRST 20 $ 20 $ O OWNER �D G�PGv/eC I ADD L 10 ADDRESS HO SWITCH S �" OVER 20 TOTAL FIRST 20 20 O CITY TEL NO LIGHTING 1 FIXTURES FIXTURES J( ADD L fo OVER 20 CONTRACTOR T LCT RANGES DRYERS WTR HTRS 100 ADDRESS GARB DISP STA COOK CITY TEL NO 3 DISHWASH AUTO-WASH STATE SPACE HTRS STA APPL 50 LICENSE NO V�+tlZD Morons OVER NOT OVER HP DISTRICT NO GRjQUP ZM PROCESSED BY 100- _l't 1 3 150 INSPECTION RECORD 0 3 8 200 �.� C.�(� t A (J 8 15 250 ® � 15 50 300 V / W D. 50 100 500 to Z SIGNS NO TRANS NO LAMPS SERVICE O 600V NOT OVER 200A 100 00 SERVICE 0-600V OVER 200 A 200 SERVICE OVER 600V 500 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 200 2 CX SUPPLEMENTARY PERMIT ISSUING FEE 100 APPROVALS DATE INSPECTOR'S SIGNATURE TOTAL FEE Sd UNDERS LAB WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT L` LC ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ECTRICAL WIRING WIRING �� ,.�'" 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES ALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO POWERSIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY IGNATURE UTILITY CO NOTIFIED F PERMITTEE E FINAL 0 ALIDAT!ON JOSEPH C ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER L�i'�� 4 2 1 7:° AUG 1 8 2 D 8.80- rt` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ti-ECECTRICAL PERMIT', DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS `EL_0508_9707229051 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDIN-G ADDRESS TR: 1098 LT: 5 BL: .001 �1-5000"ENCINITA AV I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: =TEMP-CA=917803707 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8590-031-028 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 1.00 BR 17.40 TENANT: J5 OTHER PWR APP LT 3HP 2.00 PWR 30.90 ISSUED 0 PROCESSED B S ON: SEAFOODS R US, INC. TOTAL FEES 76.05 07/22/97 TC 07/22/98 OWNER- TEL. NA PAJE FIN CODE: INTERNATIONAL BUSINESS TRADING CORP - MTPK 917540293 DESCR lPTrI ON OF - ELECIRICAL FRO NEW WALK IN FREEZER APPLICANT: TEL. NO: G W AIR-CONDITIONING, INC. (818) 572-9338- SPECIAL CONDITIONS: CO AC OR: TEL. 0: APPROVALS INSPECTOR SIGNATURE G W AIR CONDITIONING, INC. (818) 572-9338- 1544 GLADES AVE. LIC. NO Gl%� TEMPORARY POWER POLE SAN GABRIEL CA 91776 505565 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. . UFw GROUND LIC. N0: J �J CONDUROUGH IT ,, �c ���00ll MAIN ER LIN PLASTIC Y/N METAL Y/N , UTILITY COMPANY NOTIF15D REPORT ID: DPR265 ROUTE TO BS0508 I hereby WORKERS'have a NSAcate DECLARATION - CE-806G '0'81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, U or a cert¢icate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy }Hereof(Sec 3800 Lab C) yn�`) Policy No Company FOR APPLICANT TO FILL IN - �0� f ( ❑ Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE Y ADDRESS A /'S V $ $ LOCALITY ❑ 1 & 2-Family,Sq Ft _ Certified copy is filed with the county building inspection department Multi-family Sq Ft NEAREST •CROSS ST ' Date` Applicant Reside4al'Swimming Pools A`, OWNER OR FIRM NAME vj, CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec` Light L3 Sv (L ' MAIL COMPENSATION INSURANCE /4 ADDRESS ��// °First 20� (This section need not be completed If the work involved by the 41CITY Tel No permit Is for one hundred dollars ($100)or less) Total No —1-III Additional + PLAN CHECK 1 ' I certify,that in the performance of the work for which this permit APPLICANT is issued I shall not employ any person in any manner so as to become subject to the Workers'Compensatio aws Lighting Fixtures First 20 ADDRESS- ' Total No Additional CITY- Tel No DateApplicant 11 - . Fixed Appliances Not Over,1 HP r, NOTICE TO APPLICANT If, after making this Certificate of PER _Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D W APPLICANT provisions of the Labor Code, you must forthwith comply w(th such Oven _ Dryer ` W M ADDRESS 300 L• S ` provisions or this permit shall be deemed revoked Top — FAU WH CITYNTLfCTs rA(t Tel No Z` DiSp Room Air COnd 40b LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I,hereby affirm that'I am licerised `under provisions of Chapter 9 LICENSE OR - Class Cil / t '(commencing with Section 700 0) 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 PROCESSED BY (1 t Size& Type HP,KW,KVA,or KVAR License Number 414 14 ( Lic Class O411 Up to 1 Incl /.d 0 f/ FINAL (� //�� r-W / ? Over 1 t.,10 Incl DATE —� VALIDATION 0 Contractor.,q ITgV CH0 f *� 60 Date Ir 30- Over 10 to 50 Incl FIN IV 4 CCC/// _ U ❑ I am exempt under Sec Over 50 to 100 Inc B f s LJ.I B&P C for this reason Over 100 / N Services,Swbd,MCC &Panelboards, o Z Date 0- 200 Amp Under 600 V + t' Signature 201 - 1000 Amp Under 600,V - - a Over 1000 Amp or Over 600 V t " ❑, Exemption for Reg Maint Elect 2 SINGLE HOME OWNER-BUILDER IDECLARATION Temp Power Pole& Appurtenances ACCT.T t Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractors License Law Additional Sign Branch Circuits t r1�f for the following reason (Section 7031 5, Business and Professions r - - �7 - 65.40 Code) r ^ + �p� ❑ Misc Conduits & Conductors ` - - i T 1�.11J r • I,as owner of the property,will do the work and the structure Toys is not intended or offered for sale (Section 704,4, Business Other(See Complete Fee Schedule)'_ TOTAL 1 Q� and Professions Code) _ 65.00 CONSTRUCTION LENDING AGENCY C` 00 1 hereby affirm that there is a construction lending agency for the i VLl performance of the work for,which this permit isissued(Sec 3097, _ PERMIT FEE . (Sub-Total) Civ C') r ' 4LR W-4igJ1 PLAN CHECKING FEE 6/30/89 JU/G7 Lender's Name 4277 ASI $��$ PERMIT ISSUING FEE Lender's Address o I certify that I have read this application and state that the above TOTAL FEE J 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 prope y A mspect,on r oses SEE REVERSE FOR EXPLANATORY LANGUAGE Si ture oT Permittee } Date`