HomeMy Public PortalAbout9547 GARIBALDI AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER ELECTRIC 2
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, COUNTY ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN
ADDRESS
RECEIVED BY READY FOR DATE ISSUED
h� L
'H\ FIRST INSPECTION I 1���
CITY ,. - E '•-a �' r�
COUNTY LICENSE dO. IRES BUILDING
PERM FEES ADDRESS
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST.
WALL SWITCHES OWNER
TOTAL OUTLETS Sc- $ 1
MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
FIXTURES 5 CITY TEL. NO.
MISC. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER OF LIGHT CIRCUITS • APPLICATION AND STATE THAT THE ABOVE IS CORRECT
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 FEE ANGELES COUNTY LICENSE, OR F AM .THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESC IBED ABOVE.
1/2 R LESS $ .25 - i.�'7'. C�✓ ')r ,f/
SIGNATURE OF
V 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 15 1.50
is 50 2.50
50 200 5.00
200 500 10.00 W
500 1000 15.00 U
OVER 1000 20.00 J
M.G. SET/FREQ. CHANGER-HP IL
WELDERS: AC-KVA O
GENERATORS -KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO. - NO. TRANS. APPROVALSNO. N . LA
MPS FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 G CONDUIT
FIXTURES $1.00 G40 WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $ UTILITY CO. NOTIFIED
FINAL
75A 663 DBa# DA. 4-52
w q<ERs'cokiPE's"„°"DECLARAT1oN '"�83 '°'B' APPLICATION FOR ELECTRICAL PERMIT ''r
affhm that I have a ate of ooitaef�t 6o self heue C>-80eCi
« s oer of Y*xxtcera' C«mpansation trieurance.« a o«ttHed COUNTY OF LOS ANGELES BUILDING AND SAFETY
coopy3g" Corm�lgiry ''" �� FOH APPLx.WT TO RLL IN .f heretry famished. New Reefdentlal Bbg&&Pools EACH NO. FEE
LOCALITY
. CertHied copy Is filed with the ocunty, building Inepeotlon 1 S 2-Fan-&y,84 Ft lam— S — 5. 0
M ultl-famty 8¢-Ft NEAREST
S 87. ,
Date ��pAo l C4)6f Heelderrtlai Svvtnmrning Pools OWNER OR
FTW NAME
CERTFK.ATE OF EXEMPT16N.FROM WORKERS'M Outlets:Outlets:Roo�Light Sw. AML 1 -
G( ENSATION INSURANCE
(ThL9 wwWon nbed t be oornpl.bd If the work trrvotVid by the First 2d
mo :CITY V
permtt I.for ope hundred dollars($100) or."&)' Total No. Addb nel - TeL N, �
I owtify that In the perfonmence of the work for which'this permit PLAN
CHECK
Is issued, I'sW.not errpioy any person-In any Ynenryer so as to APPLIC
ANr
beoorne'eub)eot to the Workers'CortpersAYion Laws- Uult ng Ftxturee Fhet 20 ADDRESS
Date I , , - Total Na Additior� CITY ' TeL Na
Flxed.Appllencas Not OveS
r 1 HP PT �.0
NOTICE TO APPLICANT: tt, after makb-g this 'C ffkaW of APf�IOANT
EmTtp6cr*4 you gtmoufd b�a«ne amfb} to the Woriw&'Compensetion Range_ Heater D.W. — '
p6helons of the Labor Code,'you must•kxtth thwcon#yy 'wtth such Oven L dryer— WM.— ADDREss /i . C It V
prwidorre or this perrnR shall be deemed revoked- Top — FAU —• W.1-I- TeL
t UCEN44ED COIiACTORS WON DECTI4lHood — FQn Other—
. I hereby, dMmn Ciat I em rberreed under pmv6x q o(-ChaPPter B Dip•.— Acorn Air.Coed- OR
fps Care.�r/p
(c;c r end no'wtth'SQctbn 7060) of Division 3 of the&*naea sand
Prdeeslons bode,and'my Ibbnde Is In full force and effect Power APAP d L_amge Appikumoes QCT /.
w4o .C�/Q Size a Type HP,KW,KVO or KY4R J
Lberrse Number L kL C1eea Up to 1 InoL FINAL
Cont—!or-
9�f 6gK6 O�ef 1 to 10 hcol DATE ��y ALIDAM
L�
ole ¢�` 1` over i o to 60 o-ict
❑ I am wwnpt mnder Sea om�r 60 to 1.00 k-KL y�
t.Apz.for this reason over 100
3ervfcea Swbd,MCC S Panelboarde , Z
I D 0-200 Amp.Und«600 V
F SiQmfltmu@ 201 1000 Amp.,Under 800 V-
❑f T � oI%w 1000 Amp.«Over 800 V Exerrmption for Refl.Mafnt.Eleoi
BINDLE FAMILY Temp.Power Poie d Appurtenances /��vcc�v7
HOME OWNER-BUILDER DECLAAAIION g{� ith wOne Ranch Ciroutt 17 .Yt
I hereby affirm that I dm exempt from the Contracdor'a,License Law Gam. 1y
I for the foilowtrmp 4Ylon reason(Se7031.6,Business and Profeeslone Addttscnal�m prim ar�'� 5
. - �l .02
Code):
Ell as owner of the property,will do the work and the Istructure
Mtea Conduits a cormduaiore t I
Is trot Worded or offered for sale (Soc5on 7D44, Business Other(See Campl Fbe 8chedck) — , HITAL '95.02 '
and Pm%as orw Code).
95.02
�y
tiL4fi
CONSTRUCTION LENDING AGENCYMry
I hereby affirm thef there Is a construction ksnchp,agency f« the {rfrif7�, _ .UV
periormaroe pf the work for which thb permit itInsued(Sea 3087, PEFMT FFA (Sub-Total)
Civ.O.).
PLAN 1 iECK1NG FEE 000D-W01 V 9/84
L'ender's Name t��p
PERMIT ISSUING FEE T7(7 1 7f 11V W
L&xWa Addrbes 1
1 oertify that I have reed'this applloaticn and state that the above TOIAL FEE
hior-mation Is owact I agree to oompfy with eH Cammty «dkienoee
and Stats laws,regulating-EJectrioal wiring, and hereby auttiorte
reproeertlffi -ea pf this.County in eater upon the abbve-mentbned
property for Inspection purposes PEE FIED&RSE FOR EXPLANATORY LANGUAGE- ,
Sl naturd of Par mmfttee Dke
"' 'hat I have a oarii°"°E "'P°" � '0'B1 APPLICATION FOR ELECTRICAL PERMIT
• `.d hereby,m`n(m that I have a oerttl5oafe of•coneerrt to self insure,
I or a of Wbrkem' ^ Insurance, or a oerttned COUNTY OF LOS ANGELES BUILDING AND SAFETY
I COO (sea 3800,La>x c.) .
I '
Colby D Cornperry r-0a AaPtxwT To Fu IN JOB
ADDRE• �o • N"RaMdential Bilge.&Pools EACH NO. FEE S
I $ LOGALJIY t
❑ —.
Certified copy Is filed with tris county bu6dnp 1 d 2-Famty,Sq.Ft 21( $deparlpWrt Mute-farrgy t#Ft. — aTNEAREST T. P
C,4 Albl_
i Reefdentfal Swhnrnfng Poole
Del e Apj r t �
CE�AQF EXEf^P710N FROM WORKERS' 1h�
N Oirtleta Rea—Lfgt — ,—
$AVONINSURANCE 0 J
(Thk eocogi need not be oompImW if the 14m)rn trvolvrrd by the Ffrbt 20
Total Na Additbnel CRl Tel No.
prrrrprt:k for one t>tandrrrd dollen (f 100)or r+ ) ,
I . PLM GREK�K
I oertify that In the pedormerlce or the work for wttYGh thio pem�ft A
is iss r I shall rot employ ery person In--" manner so as to n tfGNr
b&oorne subject to the workers,ComPensatson Laws. [JghtInp Fbchues First 20. ADDRESS
Addrdonal
e Total Na brry TOL No,
Date 7' "" Rxaee ed.ApplienN&Over 1 HP.
1 NOTICE TO APPLICANT: M, after making.thk CortNicato of P—r
Emi nption,you should beoomb sub}ect to the Wxksrs'Compeneation Rem— Heater— D.W. APPUGANT
1
'prwleipne of the Labor Cox* ybv must forth%fth comply wlth euoh 0tiw — Dryer— W.M.— ADS
prd�or thta pertNt shell be deemed r yNmd. Top — FAU — WA TOL
LICENSILD COWrRACTORS DECLARATION Hood Food — Fan _ Other_ CITY s' Tel
1 hereby`affirm that I arh aceneed'under provhlone of Chapter 9 Dep• — Foon Air Crond. --. �OR
(comMencing WttH fieotion.7000) of DMaon•3 of the Busfnees and
Protesabrn Cote,and my fberrae is In furl force and effect Power ApAeratus.S Large APPiW"
C�/o Size&Type HP,KW,K1^or KVAR
Llcense Num bar1/03 c Up to I trxl FINAL
Contractor � 00? owr 1 to 10 Ind. DATE ✓
vier 10 to 60 Ihd, FINAL ]
❑ I am'e.mpt under Seo / Over 60 to 100{na BY iuL
B. P.C.for thie reason Over 100 N
Dix SwAces,Swbd,MCC&Panelboards , z
o-200 An-gx Under eco V
Slgnahue 201 - 1000 Amp-.Under 600 V
Over 1000 Amp.or Over 600 V z
❑ E ntptlon for.Reg'.Mdlrrt.Elect.
SINGLE FAMILY Temp,Power Poie& App.rrtenenoee
HOME OWNER BULDER DECLARATION Sion Wft One Br&rch Ctak
I hereby affirm that I am emrnpt fromowtti�ee Cneee and
License Law �� F1V41■t
for the foahig reason(Section 7W 1.t,Bueld Pro(essbrn ' _
dtB
Code): =7 .95.02
❑ 4 ae owner of the property,Wlll do the work and the eth,oture c cond<rotora. ITM
LB not tntended or offered for sale (Section 7044,Bushes Od*r(See Cornpiele Fee Saheduie) 02—
and Profeesbne Code). pop.
TOTAL W
CONSTAUGTK3NI.ENDM A0ENCY 1�f1�ytR ■tli
I hereby affirm that there Is a conahrt n lerxitrp eparxy fof'the
performance of the work for which the permit a lasued(Seo.3097, PERMIT FEE (Sub-Total) 4f1'Ri�. ■�.
Civ.C)•
PVN CHECKING FEE �yyy��yy� n
Lender's Nerne / UIDW'VtiV1+ Wyii M
PERMIT TSS JM FEE 49 � + 1711V=Q f
Lenders Adcteee
I certify that 1'have read thls appk4t1on and state that the above TOTAL FEE a
Information Is correct. I agree to comply wttrrall Ccurty ordirenoee
and State haws repuia ting �_:isctrical whW. and her wAhortre
repreaerttatfvee of this (, r to eoter upon tie above�mantbned
property foc Ins pePurPoeea SEE REVERSE FOR EXPLANArORY LANGUAGE
Sd
idture of Rsnhfttee Lfm
,. WORKERS'colvTldrrDECLARATION 7MO63
CE-8080 APPLICATION FOR ELECTRICAL PERMIT -
•I hareby a"iet I have a oernflcabe of coneord to serf halm
or a carftl ate of Workers Corr�on hiaurahcb;or a cerMled COUNTY OF LOS ANGELES BUILDING AND SAFETY
oopy tfrereof y �Lab C.> sw+ .
Pulldq (T �w FOn Apptw.AmT To FILL iN .roe t
®; copy444 famished. J V.
(D.• New Resldendaf Bldpn d Pude EACH No. FTS
s $ LOCALUTY
Certlf43d Copy b flied wfth the oouhty brlVdfng 4vpecgon' 1 d 2-Farrky,Sq-Ft- _ NEAFIE3T -
Maid-famRy Sq.Ft
D.te Appilan1 t"144f,4Reeidendal swimming pools 61
Qyyp�gq
FVA
CERTF"TE OF EXPMPTICN FROM WORK `• - MAL
COMPENSATION•INSUFWJO . Orrtiete Rec t lght Sw. ADDRE§9S
(ThLa eectlon'nOd riot be oompletedIr tho tlgo Irrvotvoc b*tike N0'
Bret 20
perrtitt It for or>Er hundred dollen(tiOO)or Mei.) Total No. Addttlonal CITY {
I oordfy that In the performance of the work. for WhfCYI lhb perrntt a PLANICM
Ip letlued � ar �
, I'°hall not ey y IarIn My mauler so ae m
beoome atAt act in the,Workam'Compeneadon Law&. Ughtfng Fbduee Fbst 20 ADDRESS
Total No. Addttiatal C" T(3l.No..
Date
NOTICE TO APPIJCkNT': If, -shor makdng this GertffYoebe of Fixed Appflanoee tJot Over i HP
ATLW
Exemption,You a,6 ld beoome")Bot to ifie Workers'6ompertiatbn Range— Heai?er— D.W. _
ovision of the Labor Code;-you Inlet fartf wkW corrr* wkfi 'Dryer_ SVM r ADDRE
pr
ptov14"or tie permit ehaJPbe deemed Yeybked. Top T'FAU •WI L —
CITY Tei Z— �
' . L�4ED CONTRl�fOR3 DEQ � Hood � Fen', Other�� - • '.
1 hereby'aWrn t#ra4.1 am Ilc,.ie,.n,,a,ed under provfeibrb d Chapter 9 I
(ogtnrnonolrp wtth.Soodon tdDO) of¢Melon 3 of lbe Budtn@de and n Air Cbnd. — RECI N(WER �'
ProfeeeloneCode,and rry Ilcerose le-In full force end-affect. Pourer App-eb-d Large Appliances Ivo.
,{_ Size h Type 4P,Kw,KA or KKR '
IJoerm.Number Lt t7 L3�C �, Up to 1 Ind.- FINAL- .
over 1 to 101ng1. DATE. YkUDKW
{ co,traotor �' tate -
Over 10 to b.o lnod. FINAL
' I am exempt under Sea ` O%W.60 to 1.00 kis gY. y
' B.BP.C.for this reason Over 100 . 0.
services,SWbd,MCO h Par,elbbards N.
Dew o- 200 Arrp.Under 00 y
Signature 201 - 1000 Amp Under 80P V
Piet ESect
Over 1000 Amp or Over 800 V
El
f STNGk�FAMILY Temp-Rorer Poe S Apputt9rianoee
J-IOME OWNER-BUILDER DEOLARATONr
IHereby afifrm that I am exempt from the Cbnga"a Uoenae Law s wtd,oneEcenon cFLYdt ACICT.0
for the follaWrip r'aa°orr(Section 7031.6, and Pruteeelbfm Addb-wJ Sign Bri}roh CfrWrca
Code): �7 95.02
jQ I,as owner of the'property,w1I do lila work.arld,6B ehucfue rude. cbrrduttri a Conductors +�
not
Ftot1 asebne coda� MAL'offered� � &
Is 1a (Section 7044, bi,eas Other(See(see CompleLaFee Schedule)
an — �CJ�7T,�.Ll.d
�+{/
CONSTRUCC)ON LENDING AGENCY 'M
/+��CK 95-0x�2
�I affl- that there r a Ich#da per it is Ise ed(Se for the PERMIT FEE (Sub-Tgta!)
oe of the work for wtYch.thb permit b beued(Sea 3097, •' .
cM.c,.
PLAN CHIrCKNG FEE 1 p
Lender'° Name _ 1 &I 9A9
PERI T ISSUING FEE Q
I-endWa Addrgea
I cw fy that I have read ribs app'Dation and-s ate that; the above TOTAL FEE
information Is oorregt I agree to cornpfy with afl County orditancQe-
and State laws regulating Eleotrbsl wirtgg, and hereby aWvrtLe
repraeenffitfveS of thle Courrty bo super LPW—de above-me(doned .
property for Inepecdon pu
SEE REVERSE FOR E)03, SfOR LANGUA13E
gig, u
&axture of ftbDe DaW
WOIlf(ER3 COMPEIJ8ASf(N DECLARATION 7eA.ae3 10/81 APPLICATION FOR ELECTRICAL PERMIT
alfam that I hatifi
ve a oercate d ooneerrt to self hraxe, CE_aoeCi 7�
of a pertlfic to of Workers' Con-psnaetlon IneurarK^ or a cwttfbd COUNTY OF LOS ANGELES BUILDING AND SAFETY Iul
.00py�.thereof( 3800,Leb.C.)
Kl�ll FOR ro�u w .roe
rix.
EACH NO. FEE ADDRESS
I h S_C O • New ReeldenUal f�Idge.8 Pods LOCALITY I
1 S 2-Family.34 FL�,-z,► 1 3 $ — &
4 Certffiad copy b flied with the camty tw Irrepectlon - � —
NEAREST I
CFK)88 8T.
Data Rf ok"l-tie!Swhnmkrg Pods
R
FIRM
E MAYG
iRfA NAMECEFM OF EXEMPT10fJ FRO Rea—Light — 8w+ 3AAL
COMPENSATION INSIJ ADDRESS O
(Thio section need not be completed It the work kmotved by the First 20 CITY Tel.No.
Pam-it in for one hundred dollars($100) or lees.) Total N0 Additional
I certify that In the.perfomrence of ttie work for which this perndt PLAN
APPILICANT
is Issued I shall riot ernploy arty peraon In any manner so as io
become subW to the Workers'Carnpgneetlon Laws, Lighting FbtuTvs First 20 ADDRESS
AddftbW
Total Nd . _ - CITY Tet.No.
Delle "bant Fbmd ApPIW-ices Not Offer 7 HP
NOTICE TO APPLIQANF: If,. aftEr making tufa Certlfbefe of pEFq(rAPPLr � C
xoneh
.you oulme d bec6m h act to the Vrbrk xV Compensation Range— Heater— D.W, T
Eempti
prwWons of the Labor Code, you-muni forthwith oompy with such Oven — Dryer= WAC ADDRESS CH t co If H
provisions or this ib rrnit shall be deemed revoked Top — FAU WI-L
LICENSED CONTRACTORS DECtJ1mnolsi Food — Fan Other— Cfry - FL 0 �. Tel.Na Z�Q
I Inaraby dfi in that 14m Ilosnsed under pr;N alons d Chapter a Dlep. Room Ak Coad �OR S
rrrCt�a ,� �.
(oorwdng.with Section 7000)of DNisbn,3 of the Business and
eeeiona Code,and my license is in furl forob and Watt Powe-r Apwatus& Large Appliances DLSTFOCT Na �Y` BY
Stre d Type HP,KW,K1^or KNAR �. O u
�{}� LJo.
Lbenee Number S��T L Claes O4 - up to 1 Ind. �. -- - '
64RL T Over 1 b:).10 Incl. DATE �l�[y �
cohtractci_ Mte. Over.1-0 to 60 Inot
FINAL iuLU
Lf I am ax9ro under Seo. Over 60 to 100 Inc. BY;
BAP._for ttrle meson Over 100 le
Servloes,Swbd,MCC ft Paneboerrfe_ , R
0-.200 Amp-Lkider 600 V
Signature 201 - 1000 Amp.Under 800 V
Over 1000 Amp_or Over 800 V
❑ Ex6mptbn for Rep.Maim Elect _
SINGLE FAMILY Temp.Power Pole d Appurtenances
HOME OWNER-BUILDE0 DECLARAFIDN $Iqn with One Branch Ciroult' -
I I hereby affirm,that I am exempt from the Contractors Lbanse Law 1•hirt.
for the fobowtrng reason (Section 7031.6,Bualrm=and Prdessions Additional�Branch Ctraulfa '
Code): X307 T 95.'02--
Ell,
5■02_-❑ I,as owner of the rrooppeerr-tt will do the'work anrdApe struct re Moa con ducts a corduotore �y 1 1 1 G1 k[7� ry
Is not tnbendQd orpot}eredy'tor sale (800tion 7044, Businees Other(Sas Complete Fee Schedule) 1�llrf. 7,.� V.i
and Prok sone Code). -
CONS RUCT)ON LENDING AGENCY CHECK 95.02
I hereby affirm that there Is a const.ruoiion brdtng agency for the 'OWE M
perfgrrrrence of the work for which thio permit b Issued(Seo.3087, PERMTr FEE (Sub-Total)
CN. C).
PLAN CHEC ING FEE0MxW1 8/ 9/89
i�
Lenders Nemo PERK rF ISSUING FEE 4980' 1 AM10=01
L.erdere Address
10Wtfy that I have reed thio appfbatlon and state that the above TOmI FEE
Information Is oorrect. I agree to comply with o➢Cormty Ordhnernoee
and State im" regulnting Electrical wiring, and hereby authortre
representatives Of this to enter,upon the above-merrtiorred
PmPertY for I SEE REVERSE FOR EXPLANATORY LANGUAGE,
LM 19f
r q
�. NOFZKE I hffveA�EN8AT10N of oonaAIIoN CE-WOO '0'B1 APPLICATION FOR- ELECTRICAL PERMIT '
I hereby afftrTt, that I r,a,,e (' oertfncsde o* o«,eent to self.Mire,
or a,oerNfioade of Workers' Conxweetion Ineurwpa, or a owtfW COUNTY OF LOS ANGELES BUILDING AND SAFETY
ccvytheme
z. ADCREM , ,•
cerdw ovy b.pergby furr,Ier,e� flew RBelder,eai Bfdge a Poole EACH.• NO. FEE
certtned coAY Aad wtrt;'the boUnfir 4tbdlnp InepbeSon 1 a 2-Fanty,sq.Ft — s bCJWTY
depar
Muttl-tamlly S4 Ft CFI098 NEARESTT. tfn ag
13�- ` ' gPd ,r,fa' .i✓t�v. iL_ Re der'tiel ewlrrrrino-Poo+e' . OWNER OR
FOA KkW
�E$ FROM EROuHets,Roc uQW Sk. X�MN �OrIJ8 89 Q
-(This eeotiort need not'be cbrft~tt"work kwN6,ed by the F1rAt 20
1:f'fY Na
losnit Ir.for-ono hundmd�ollsro.(*300)- r,low) �1 No. Addtdonel �
� • .. � �'
hr
r,cer f that tri,tbe p ? d to-work for whbh.tNe perfnft PLAN Cf
,w r
la baled, I of I nqt*rpbY any.-•pere0n In arty.manner eo ae•to '
become aubl .t0,the s L LjGhtlnp Ftxttuee First 2Q ADQF{ESS.
Total No. CITY V.No.
Date Appliodnt.• Fbed ApQitancea Not (Just 1 HP
NOTICE l771APPlJCAtfr::.11,. of ek- rtiafdnq'thb Car#kade'of hr n
Exqmp6o .YOT,a�bie6t'yO,#�6►Vtbrf®rs'Cortp@aestiorl Rar,ve—.1 laater_� P.W..T .
�roviebne<,f-ma Ireba;�ya �" �Y tivftt,a,ohi Oven . . Dryer'_ wx,!'T gDDREsd
provlebrre Qr"thiQ AerRJ6 shell be daerr,ed revoked .T?pL� FAU W.H.
LIGEIJ�E4,:CQNTHA((FORS DEC(AA,410Nf., Hood Fan, 0��--�--
l
I,hereby ta€nrm Mai j+aN�IIcenWl,wXier':pfwfai0ne of Chapter 8 DWp. LKENaE.QR . .
(oommenoing wftq.Sec�fbn.7o00).oT DNf4bn,a,.4F-the Buefneaa and Floom Air Cond. RE0L Cys
Proleeelorte Code,and my roar,&'Is in full force and effectPottier AAverafue.4 Large Ap{�Ilerroee .- USTACr do. _._: ENA
:.
?.
Stza!L Ty"HP,KW,K1At or KWR
Lloshee Number Lk:-Cla9ei1P
to t incl.' - - SINAL
Over 1,to.]0.00L _ iz
Contractor Date- over 10 to 60-Lnd. •.
Lgrtt eRarnpt'.urder Seo. r • -' ,�;� Gker 60grr 100 Y,o.,'-
�._
Aer'
BhP.C.Wlh3a reason 100 rA
,:... services, MCC Serielboerde �,
" Dede, - 0-200 Amp.0nder'800 V
hfe 201 - t000 Amp..)oder 800 1(
Q Emnpfibn for Reg rot-bedt Over 1OOq Amp.or Over e0p V
SINGLE FAMILY Temp Power Pole ApWIwat,cee / _ ;; _
HbME CNJfJ1 R-9 L DER 4ECL-4RAT10N Sign wIth One�Branoh Ctrcutt C• .r
I hereby etirm that t 4m Wvio Irom t-oe Contractors Ucense Lew Addflionel Slgo,Branch C#routts
for the fotlowing meson(Section 7031,6,'Bi)sJrx a arA Pro(waigrtb 1
7 .T t�C►. d).
I- ITEM
0 as Qwaer of the property,wif do the work&nd tha WTwt re
b not InWdad.or offered,f6r safe (Sectbh 7044,•g**m Otftef(See Complete Fee Sa dole) — - MAL
end P-(oAoons Code). r+r�-.�•r�
CON l3CTIbN LENDINQ AGENCY ` t;r` •r�
I herektY afflm that Niers le a conehuctlon lending agency for the
pegornWKt a of the work for which tt,fa pefrnit Is leased(Seo.2087, PEgjMIT FEE ($u Tdt91)
Ctv,C.) _
PLAN CHECKING FEE - - wuV+1"rtJt- � ary
a er4er'a Name �` o 1 . A�'I :0[71
..�' PENMIT 154UING FTE
Len s AddraM
I owIfPy that a hove reed t*'&*loarion 4^d eia3e that the above .TO-PL FEE ,
hfa'mation W oorroot I agree lo comply with ell County ora}xu,oee
and Stade laws reWletfnp E6obioal W drQ and heregy authortre'
npreeenta#tvea of ttao Canty to order upon the•above-mentioned
PrtiRertY for U,dpec3ia,'pa f SEE REVERSE FOkEXPLANMORY L,ANGOAOE
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