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76Ab63 CE-806(71 /78) APPLICATION FOR ELECTRICAL PERMIT
5.
COUNTY OF LOS ANGELES `•' BUILDING AND SAFETY
FOR APPLICANTTO FILL IN JOB �' ... -
New Residential Bldgs.&Pools - EACH NQ FEE ADDRESS r�: ! ' I>'/rr / �. J'' :ta N
1 &2 Family,Sq. Ft. $ .025 — S LOCALITY
Multi family Sq. Ft. .02= — NEAREST.
ResidentialSwimming Pools
25.00 CROSS ST. C' !(e f i`!
OWNII/
. . . FIRM NAMNAM E I-\ �r{.��
Outlets: Ree_LigFt_Sw. MAIL / / 1
First 20 _50 ADDRESS 1+"�`T t f J.`f,`.,�'s, JJ/-T` Tri
TotalNo. .30 CITY r ' ; f Tel. No...
Additional f •. "_ f 1a, /
PLAN CHECK '
APPLICANT
Lighting Fixtures First 20 - .50 ADDRESS ""� •.a '
Total No. Additional .30
Tel.Na.
FixedAppliances Not Over l H.P PERMIT f
APPLICANT
Range—Heater— D.W,
'Oven'_Dryer'_W.M._ ADDRESS
Top _FAU W.H. CITY r, c;.� 04- Tel.
Hood--Fan Other_ LICE
' `
Dis Room Air Cond: 2'50 - REGNNUMBER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA: _r
Power Apparatus&Large Appliances. TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO d
h COMPLY WITH ALL COUNTY ORDINANCES AND.STATE LAWS O
-Size-&.yType HP,-p W, KVd. KVAR 2,50 REGULATING ELECTRICAL WIRING. - {J
'- Up ro 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR W
'Over 1 to 10 Incl. 5'00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF J
Over 70 to 50 Ind.
12.50 CALIFORNIA OR THAT(I AM THE LEGAL OWNER OF THE ABOVE' }
f
25.00
Inc. 40.00 DESCRIBED RESIDENTIAL�ROPERTY, _
Over 50 to 100 f PERMITEE j !
-
Over 100
SIGNATURE ._.O
Services. _ G
F ' DISTRICT NO: PROCESSED BY, rg
0 200 Amp Under 600 V 12.50 rte•. w + l/�
.201. 1000 Amp. Under,600 V _ 25.00t,: J .,J.✓r -,,,cJ
Over 1000 Amp.or Over 600 V 50.00 fi`.:? �"-" ;;;rf Z
Temp. Power Pale&Appurtenances 10.00 Wyk' /'�''i•! Q k.
. - '• �"' g
Sign with One Branch Circuit 1000� � �
Additional Sign Branch Circuits t. 2'00 INSPECTION _>
• INFORMATION C p
Misc.Conduits BCondudI D oo _�ors ONREVERSE •= t �'� � '
Other(See Complete Fee Schedule) SIDE_ Z
PERMIT FEE (Sub Tamp --i: e•�e1e,.�ii4' •
~ 'J '
PLAN CHECKING FEE (One Fourth Permit Fee, O ` Yt to J_ +r!
PERMIT ISSUING FEE $7.00- `✓%'
TOTAL FEE ! Y"-�.. ;
t
'INSPECTION FINALED �
M?.
d
date: By
I II
WORKENS'COMPENSATIONDECLAk7GA66 ,
(2-80)
ATION 86B APPLICATION FOR ELECTRICAL PERMIT
-Cr
I hereby affirm, that I have certificate of consent to ;elf 'COUNTY OF'LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab. C.)
Policy No. Company _ FOR APPLICANT TO FILL IN JOB
ADDRESS
New Residential Bldgs. &P ols EACH NO. FEE
Certified copy is hereby furnished. 1 & 2-Family Sq. Ft. $ — $ LOCALITY "��•yl r
r] Certified
Sq. Ft. — NEAREST _
Certified copy is filed with the county buildinginspection ROSS ST
departm t. Residential Swimming Pools OWNER OR
e� / ( QQ FIRM NAME
Date Applicant —�/% Outlets: Rec.�Light�5w.� ADDRESS
- q / First 20
CER IFICATF OF EXEMPTION FROM WORKERS• Total No. 'L Additional CITY Tel No. ®6 R6�
COMPENSATION INSURANCE v }
' P AN CHECK y
(This section need not be completed if the work involved t APPLICANT 0
U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20Additional ADDRESS
Total No. It
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 as to become subject to the Workers' Compensation Laws. Range__ Heater D.W. APPLICANT W
Oven _ Dryer _W.M. a
ADDRESS to
Date Applicant Top _ FAD W.H. Z
Hood _ Fan —Other / CITV Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.� ICENSE OR
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. PROCESSED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP, KW, KVA,or KVAR
Up to 1 Incl. '
FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE Y��//— VALI DATION
Over 10 to 50 Incl. GJ
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FIN' L
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force and
effect. Services
License Number Lic. Class 0-200 Amp. 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 _
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit '
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code): - g'6 2$3 A
Misc.Conduits& Conductors
}f) I, as owner of theproperty, will do the work and the Other (See Complete Fee Schedule)— ee•o,o e,2
Tstructure is not intended or offered for sale (Section
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY0,29'9 0
I hereby affirm that there is a construction lending agency 0�0 e 29, 90
for the performance of the work for which this permit is PERMIT FEE (Sub-Total) t
issued (Sec. 3097.Civ.C.). - '
Lender's Name9' '6—8 2
PLAN CHECKING FEE (One-Fourth Permit Fee)
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 a d Stat law �s - ula[ing Electrical wiring and '
hereb uth ize re r 'e tiv of this County to enter upon -
the e- tion d erty or in
p•,urr�pose . SEE REVERSE FOR EXPLANATORY LANGUAGE t
ture of. ermittee Dal -