HomeMy Public PortalAbout5218 FARAGO AVE_Electrical__ 76A663-CE606 10-59 APPLICATION FOR ELECTRIC PERMIT
1
COUNTY OF LOS ANGELES ELECTRIC
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER L�^+
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY Fl- IVI J-AI�-,t
FOR APPLICANT TO FILL IN CROSS ET. Cr
PERMIT FEES
ITEM NUMBER OWNER
EACH FEE MAIL
OUTLETS: $ ADDRESS
LIGHTS RECEPT. SW. .10 s<j
LIGHTING FIXTURES 10 CITYTEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN / sAlf
r 1 Al
WATER HEATERS .50 ADDRESS //.(/�„ D%, /'/f., [=.� G - [�¢•en R/"1�g4-Y/?`,�.('.+Ej'�,
ELEC.SPACE HTRS. DISHWASHERS TEL NO.
CITY
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS .25 LICENSE NO. �/ �',•F �%.0
hx,
MOTORS: OVER INC. H.P. DIST ICT NO. I GROUP I ZQ NE CESSED BY
O— 1/2
1/2- 2 .50 INSPECTION RECORID
2— 5 1.00
5— 15 1.50
is— 50 2.50
50-200 5.00
NO.TRANS.
SIGNS: NO.LAMPS �� �� �+•.' �C�
SERVICE 0-600V 1.00 a I
SERVICE OVER 600V 5.00
r
V WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT 50
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING '•��� �� G+ CI L•
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ,T
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL/VROPERTY. ti POWER
SIGNATUREs '`r yam _ , UTILITYCO.NOTIFIED
OF PERM I'
mmsessiffim FINA E l t_ F
OF A ATION ARTHUR C.VETT,
t, CK MO CASH SUPERVISING ELECTRICAL ENGINEER
3 8 8 w �-Q.7 8 � Fi 2 .8 0 C t7
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76A669-CE6O6 10-59 APPLICATION FOR ELECTRIC g E R I T
COUNTY OF LOS ANGELES 1■�[■ 9�i
DEPARTMENT OF COUNTY ENGINEER ADLD'DRESS
�i � �� ��n���
BUILDING AND SAFETY DIVISION ' ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY -
ILI
FOR APPLICANT TO FILL IN NEAREST r
PERMT FEES CROSS ST.
OWNER �CG7
I T E M NUMBER EACH FEE MAIL '
OUTLETS' $ $ ADDRESS "'-
1 LIGHTS RECEPT. W. .10
LIGHTING FIXTURES 10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAAN
WATER HEATERS .50 ADDRESS U'
ELEC.SPACE HTRS. DISHWASHERS CITY TEL.
GARBAGE DISPOSERS AUTO.- STATE-
WASHERS
I'
WASHERS STA.COOKING UNITS .25 LICENSE NO. GF O j
MOTORS: OVER INC. H.P. DISTRICT NO. GROUP I ZONE MPCESSED BY
0— 1/2 .2 5
1/2- 2 .50 INSPECTION RECORD
2— 5 1.00
5— 15 1.50
IS— 50 2.50
50-200 5.00
NO.TRANS.
SIGNS:
NO.LAMPS
SERVICEO-600V 1.00
=' SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER
9
SIGNATURE UTILITYCO.NOTIFIED
OF PERMITTEE 3
.: FINAL
®F. VALIDAT 33 ARTHUR C.VETT, r
(/ cK Mo cwsH SUPERVISING ELECTRICAL ENGINEER
kJC09400 ANPR1 2 A 2.9 -J
u
APPLICATION
�p@�R Rnry( ELECTRIC
(/�_ ® µg�gp�g T
DBS-53 APPLICATION F®R ELECTRIC ■ ER19� I ■ 1
DBS-5A 9.55
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDING --
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BUILDING
mvai LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES cRoss sr.
NUMBER EACH FEE
LIGHT OUTLETS OWNERMAIL
•sl 1
RECEPTACLES ADDRESS
WALL SW ITCHES
TOTALOUTLETS _ 5¢ $ _CITY TEL. NO.
ELEC. RANGES 25 ELECTRICIAN
ELEC. HEATERS 25 ADDRESS
KW EA CITY TEL.NO.
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS
- DISTRICT NO. I GROUP I ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER HORSEPOWERFEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH
I12&LESS $ .25 _
1/2 2 .50
2 5 1.00
5 - 15 1.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS .NO.TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT: '
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE I$ �� �5 DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE•THAT I.HAVE READ THIS APPLICATION CONDUIT _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING.
1HEREBY 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.
SIGNATUREUTILITY CO. NOTIFIED
OF PERMITTEE _ FINAL
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR
_ LC 0 5 3 1-SEP 2 4 2 2.3 5 °1
. o
Y�
76A663 CE 606R 10/77 APPLICATION FOR ELECTRICAL PERMIT A
COUNTY OF LOS ANGELES
DEPA"TMENT OF COUNTY ENGINEER JOB
r BUILDING AND SAFETY DIVISION ADDRESS
FOR APPLICANT TO FILL IN LOCALITY (11
7Residential
Bldgs.&Pools EACH NO. FEE NEAREST
$ .025 — $ CROSS ST.
Sq. Ft. OWNER OR
Sq. Ft. •02 — FIRM NAME (j
imming Pools 25.00 MAIL
ADDRESS
Outlets: Rec fi!7 Light_(_ Sw. CITY J Tel. No.
6,9
First 20 .50 r! ri PLAN CRECK
Total No. of <7 Additional .30 APPLICANT
ADDRESS
Lighting Fixtures First 20 .50 CITY Tel. No.
Additional .30 PERMIT
Total No. APPLICANT
Fixed Appliances Not Over 1 HP ADDRESS
Range_Heater_D.W._ CITY Tel. No.
Oven _Dryer,_W.M, LICENSE OR
Top —FAU•—W.H. REG. NUMBER Class.
Hood_Fan _Other_ - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Dlsp. _ Room Air Cond. 2.50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH 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 CALIFORNIA OR THAT I AM }}
Up to 1 Incl. 2.50 Q� THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. CD
Over 1 to 10 Incl. 5.00 v
Over 10 to 50 Incl. 12.50 PERMITTEE o
Over 50 to 100 Inc. 25.00 SIGNATURE 15
Over 100 40.00 DISTRICT NO. PROC D BY 0.
Services �
0- 200 Amp. Under 600 V 12.50 INSPECTOR'S
201-1000 Amp.Under 600 V 25.00 APPROVALS DATE SIGNATURE
Over 1000 Amp.or Over 600 V 50.00 TEMP. POWER POLE
UNDERSLAB WORK
Temp. Power Pole&Appurtenances 10.00
Sign with One Branch Circuit 10.00 ROUGH CONDUIT
Additional Sign Branch Circuits 2.00 WIRING
Misc.Conduits&Conductors 10.00 FIXTURES
Other(See Complete Fee Schedule) POWER AUTHORIZED
UTILITY CO.NOTIFIED
FINAL
PERMIT FEE (Sub-Total) r-I oo NOTES
PLAN CHECKING FEE (One-Fourth Permit Feel
PERMIT ISSUING FEE $7.00
1,T)P;—L
PkA+kkGe-V-Ad6MRd1L2F=l1 WA 9 MM CASH PERMIT VALIDATION M O CASH
9:7 8 JUN
i
COGACKQ'.S�-EQOCOMPLETE SCHEDULE;'.'
76A663A-Cg806A 4/72 APPLICATION F R ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
l DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
LOCALITY `
NEAREST �
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACHI FEE
OWNER ,
RECEPT.- 6 $ MAIL
LIGHTTOTAL FIRST 20 ADDRES
SA %
CITY TEL. NO
SWITCH _ OVER 20 PLAN CHECK
FIRST 20 /1 APPLICANT LIGHTING TOTAL
C��
FIXTURES2= OVER 20
f ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYERWTR. HTR. APPLICANT
STA. COOK DISP. F.A.U. ADDRESS
SPACE HTR. AIR COND. CITY TEL. NO.
CLOTHES WASH. DISHWASH. LICENSE NO. CLASS.
FAN OTHER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 0
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO G
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 — 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF W
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO a
1 — 10 RESIDE N, THE AB OV DES GRIPED RUE PROPERTY. N
�-.
SIGNATURE
10 — 50 OF PERMITTEE
50 - 100
DISTRICT NO. CLASS ZONE P CE D BY
100 — 500 4 —3
SIGN, GAS=AND ONE CIRCUIT NOTES:
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS
SERVICENOTOVER 600 VOLTS OR 200AMP
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVI CE OVER 600 VOLTS OR 200 AMP
TEMP.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE — ,,/I/
TOTAL FEE
d /
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION OcKM.O. CASH
1
9 6 :0;r"I"AUG 31 2 / 7.7 0 O
�
76A663-CE806'10/74 APPLICATIO FORECCTRIeAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER .JOB
BUILDING AND SAFETY DIVISION ADDRESS oJf
V.
7 LOCALIT ,��t
NEAREST i
FOR APPLICANT TO FILL IN CROSS ST, _
OUTLETS NO. EACH FEE OWNER OR
$ $ FIRM NAME
RECEPT._ MAIL r
FIRST 20 ADDRESS , ^c ''i•!
LIGHT TOTAL 25 n� -
CITY /., TEL. N0./
SWITCH OVER 20 10 �.
PLAN CHECK
LIGHTING 1 FIRST 20 25 APPLICANT
)} TOTAL ��O
ADDRESS
FIXTURES VER 20 10
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP. F.A.U.
ADDRESS
SPACE HTR, AIR CONO. CITY TEL. NO.
CLOTHES WASH. DISHWASH. LICENSE OR CLASS.
REG. NUMBER
FAN OTHER 1.00 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 PROPERLY REGISTERED AND/OR
0 — 1100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI' I AM THE LEGAL OWNER OF THE ABOVE c>_
1 — 10 3.00 DESCRIrED RESIDENTIAL PROPERTY,
U
PERMITEE (�
10 - 50 5.00 SIGNATURE �' �•''�`Jr� I/ �
O
1-
50 - 100 10.00 v
DISTRICT N0, P SSED BY N W
0-
1 00 - 500 15.00
SIGN, GAS_[SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTORS SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICENOTOVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK
S ERVI CE OVER 600 VOLTS OR 200 AM P 10.00 ROUGH CONDUIT // ..
TEMP SERVICE, POLE, &APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL 7 �.
PERMIT FEE (SUB TOTAL) NOTE . ;/��a� . ® ^(! �' GlGaceA
PLAN CHECK FEE
PERMIT ISSUING FEE
TOTAL FEE ,
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDA �ON ( CK. / M.O. CASH
8 '7 .4 SEP 26 2 � ;�r 9,C)
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE �/
76A663-CE806,10/74 APPLICATION FOR ELECTRICAL PERMIT
+ COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB �.
BUILDING AND SAFETY DIVISION ADDRESS �/
LOCA LI TY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
OUTLETS NO. EACHI FEE OWNER OR
$ $ FIRM NAME
RECEPT.L�L MAIL
LIGHT TOTAL
FIRST 20 25 Op ADDRES
SWITCH_ 10 OVER 20 10 CITY TEL. NO.
PLAN CHECK
FIRST 20 APPLICANT
LIGHTING TOTAL .25
OVER 20ADDRESS
FIXTURES .10
RESIDENTIAL APPLIANCES CITY TEL. N0.
PERMIT dit '
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP, F.A.U. ADDRESS
SPACE HTR, AIR COND. CITY TEL. NO.
CLOTHES WASH, 01SHWASH. LICENSE OR CLASS.
REG. NUMBER
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERSRATING 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 PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED A5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF a
CALIFORNIA OR THAI' I AM THE LEGAL OWNER OF THE ABOVE O
1 - 10 3.00 DESCRIPED RESIDE TIAL PROPERTY. U
PERMITEE cc
10 - 50 5.00 SIGNATURE �
V
50 - 100 10.00 LLS
DISTRICT NO. PRO ESSED Y CL
100 - 500 15.00 d CJ 1 =
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPE MTS SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE %
SERVICENOTOVER600VOLTS OR200AMP 3.00 UNDERSLAB WORK 1 6t
SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT pB o� r `
TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING z / Y A f
TEMP LIGHT OR RECEPT, SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATI CK. M.O. CASH
9 8 44 2 8.5 0 A
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORKERS'COMPENSATION DECLARATION CE 806G 10/81 APPLICATION FOR. ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN. JOB �� / `�
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO: FEE ADDRESS G
❑ 1 & 2-Fcimil S Ft. $ _ $ LOCALITY /
Certified copy is filed with the county building inspec- Y, q
tion department. Multi-family Sq. Ft. NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
Date ApplicantL
FIRM NAME O V4Ci
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL
COMPENSATION INSURANCE DRESS a/l�12
First 20
(This section need not be completed if the work involved by Total No. — Additional CITY ��(///(� 'Tel. No.
the permit is for one hundred dollars ($100)or less.) PLAN 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
. 7 Additional
Total No. ' , CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1.HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT 0
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 ''
with comply with such provisions or this permit shall be Top FAU —W.H. — c
deemed revoked. CITY T.I. No
Hood — Fan _Other—
LICENSED CONTRACTORS DECLARATION LICEN E O
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond., REG. NUMBER Class-d—/
(commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. ROC ED BY >_
and Professions Code,and my license is in full force and effect. @y
Size &Type HP, KW, KVA, or KVAR O
License Number Lic. Class Up to 1 Incl. FINAL
Contractor Date Over 1 to 10 Incl. DATE 2 "s?-/ VALIDATION
❑ Over 10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY 4U LUB.&P.C. for this reason Over 100
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
Exemption for Reg. Maint. Elect. F
SINGLE FAMILY Temp. Power Pole & Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2 ° - 20,25
1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o 0 0
Law for the following reason (Section 7031.5, Business and 2 0,2 5 c=i
Professions Code): Misc. Conduits& Conductors f 0,06-8 3
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_
7044, Business and Professions Code). ,
CONSTRUCTION LENDING AGENCY
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)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE LZI CE)
Lender's Address
I certify t I have rea a lication and state that the TOTAL FEE � ?—
above i orma ion is car ect. I gr e to comply with all County
ordina 9 d State I ws r gu ting Electrical wiring, and
here at/it orize repre ent ve of this Coun 1 to enter upon
th a v -menti n op ty or L
o urposes.
T3 SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign re
Nrr 'tt Date