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7gAl6e3-CID0410-61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOB ANGELEB
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRifi
JOHN A. LAMBIE, CouNTY�NGINialt
WII "M A.Jam.6UrT Of 19UU-DING LOC.JLUTY
NEAREST
CROSS
o FnbT 10) NO, uai ; OWNER
umiiti 111[caT. ow. MAIL
OLFrL3Tl, (ADD•L UNITS) to wDDm"
UGHTs RiCaT. Tw.
UGH•(•ING FOCiUR)a. (FIisT10) 10 CITYTim-140.
W04-rnNG F1xruIW. (AmrnoNw1) t LLECTRIC1AN
RANaii cLXL gRYges wTR.HTR/, 1.00 ADDRESS
aAIR DIl. STA.cogK SIT. TEL NO.
DISHWASH. ALITb,-WAS;i. STATE
MACK KnM STA.A".I%H.P.MAX.) 6P + LICSI ISK Nd.
MOTQRI, ovM NOT VVKPt Hs. DIST fjl,%2TGRG3LLP Z NF P EBBED Y
o
t 1.50 INSPE t!ON RKORD
a a 2.00 a�
e to Leo
is ISO 3.60j
50 -100 415.00 14i¢Y.i;
•IbT11� NO.TRANL
No,LAMrR
SERVICfi10-E0OV-NoT Ovnt 200A lAm
SKRVICE 0-6OOV-0nM 100 A. 2.00
6113tVICI OVKR 600V 5.00
MIaC.
PERMIT ISSUING P71X 2.00
SUPPLEMINTARY PQtMIT[ISSUING FSS 1.00
TOTAL FEE
I HrtnoY AC D 05►LIDUZ THAT I HAVi RSD THIS APrLICATLON 13ATIC
AND XTATZ-ITIAT TkM AMOyi is CdRNiCT Arm Aaltti To COMPLY CONDUIT
wTTH ALL COUNTY ORDQiA*=X AND UTATi LAWS Ria ULAT1N6
a[arnlcAL wRtiNd' WIRING
1 HAY CAET4PY TkAT L AM FRO�[LY RialiTgtm AND/OR '
uCatlm Al Riq{1DtID MY Lgi ANnrn r. COUNTY AND STAY% OP P XTURE/
Cly..(PORNIA OR THAT 7 All THI L XSA O OR THK AIOVi
0-CAMEP PMWll bIT1AL F*OriJrrY. POWER
O NATURE LITY co NOTIPt `
F I NAL
VALI O A >#R
ARTHUR C. V
CK MO SuPERvu1Na ELJ<CTRICAL ENaINgR
{ACj�2 7 6 2% AUG 9 2 D 320-
71lA aZ 01111111 IIA 11-AD APPLICATION FOR PER3GT
,DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENOIN[IR
I TO FILL IN DISTRICT NO. GROUP ZONE P fT ND.
FOR A�FL
ELECTRICS
REO[IVED MY READY FOR DATE ISSUM
ADDRESS FIRST IN![OTIOM
CITY eX TIL. NO
COUNTY LICENSE N0. EXPIREING
PERMIT /NUI DRIy
PERT FEES
F[[ LOCALITY
NUMBER EACH
LIGHT OUTL[TENEARERT
ST.
RECEPTACLES ORCUSS
WALL BWITCHEB OWNER
TOTAL 0LrrLrro Bo If MAIL
ELEO. RANGES 1 98 ADDRQS
ELEC. HEATERS 28 OTT' TIL NO.
FIXTURES S I HEREBY AOKNOWLEDOE THAT I HAVE READ THIS
MIB0. APPLICATION AND STATE THAT THE ABOVE IN CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL OOUNTY ORDINANOEB
NUMBER OF RECEPTACLE CIROUITIS AND STATE LAWS REDULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I FCLMt THE ABOVE VALID LOS
Nummrm H [POWERANG [
ANGELES COUNTY UDNB[. OR AM THE LEVAL OWNER
�[ CF Twit RJ BIDENT DEI4ORJSED ASOVE.
r
NW Mw. HP IND. r�nH
• Era. .26 BIDNATURE OF
a .BO PERMS
a —j
B 1.00 INSPECTION RECORD
6 16 1.60
15 SC 9.60
i0 2010 9.00
900 BOC 10.00 aJ
■OD 1000 16.00 Z
wER 1000 90.010 p
M.D. ECT/FR OHANG[R-HP
WELDERSI AC-KVA
GENERATORS - KW
TRANSFORMERIi - KVA
TEMP. MOTORM (715DF CATs..
MOVED MOTOR■ (71 of 13RINJ
Mina.
9113NS
Na NO.TRANS. APPROVALS
NO. N0. PS
DATE INBrEOTDR'■NAAI[
FOR EACH PERMITS
WIRING 1.00 CONDUIT
FIXTURES 111111.033 WIRING
WUPPI.KMENTARY .513 FIXTURE B
yj� pOWER
TOTAL FEE •� AS UTILITY OO.NOTIFIED
FINAL
1 .
7aA"M DOM ILA tSX3 APPLICATION FOR PEHVUT
DEPARTMENT OF BIIII.DING AND SAFETY ELECTRIC i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF QNOIN[ER
FOR APPLICANT TO FILL IN DISTRIOT�N13. G`ROOUP NE P[RMTT N3.
pg I I,rl 7
ELECTRICIANrte✓ 1 L
RECEIVED NY READY FOR DAT[ INNLItD
ADDREM —Z;pri"I IMBPKIMOM
CITY TEL H0.
COUNTY L PEKIM ME36M,3 gxpigp:md CUILDINCI
PEEMIT FEES ADOR[NN
Y1�HUNGER EACH rim
LI11HT OUTL[TI! MEAR[NT
GROWN WT.
R[C[PTAOLd
WALL SWITCH® OWNER
TOTAL OUTLET? 6o MAIL
ELED. RAMSES 7e ADD RIM
[LID. HEATERS 78 D TEL. NO.
FIXTURIO! S 1 H Rltill ADKNOWLEDVE THAT I HAVE READ THI■
Mina, APPLICATION AND NTATE THAT THE ABOVE '1■ CORRECT
NUMBER OF LIIIHT CIRCUIT13 AND AGREE TO COMPLY WITH ALL COUNTY ORDJMAMO[0
NUMDER OF RECEPTACLE 13IR13UITM AND NTATE LAWN RIOULATIMD ELECTRICAL WIRIMO.
MO7IOR8 I CIUMFY THAT I r0!•[NN THE ABOVE VALID LOW
NIJMm[n HDRNKPCWERANO � OIn rCOUNTY LIOEREK, R I AM THE KnAL UWN[R
FEE OF THE RINIDQfT or DENORINED ABOVE.
NEW Mw. HF win IN0. [MN
Ya a .an WIONATUR[
f .6O P[RMI
s s 1.00 INSPECTION RECORD
a lls l.sD
16 60 7.60
W 7CD 0.00
YDO ■o0 10.W
NCO 1000 I&.DO Z
WLR 1000 70.00 C
M.O. DET FR OHAND[R-Hr rz
WELD[RNIAC-KVA O
DEN[RATORN - KW
T'RANEFORMERN - KVA -
T1CMr. MOTOR!! (76 of aRla•
MOVEP MOTORS (76 of opus.)
MIN0.
BIONS
MEL M O.TRAM.) APPROVALS
N C. MO. LAMPIS
DAT'[ INNr[DTCR'■NAM[
FOR [ADH PERMITI
WIRING 1,D0 CONDUIT
FIXTUREN 1111.00 WIRING
so F IXTU R"
POWER
TETTAL FEB * UTILITY Da NOTIFIED
FINAL
WORKERS'CO^""T'ION DECLARA11ON 76AW 10'8' APPLICATION FOR ELECTRICAL PERMIT
hefeby trffirm fiat I have p certificate of consent to self CE-806G
Ic
Insure, ora C,�r�l�flccrlesof Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
dr a,cirifled copy thereof (Sec. 3800, Lab. C.)
Policy No. Company POR APPLXA7fr To Flu LN �Q
Certified c Is her furnished. EACH NO. FEE ADDRESS
copy eby New Re•Identlal Bldgs. 8 Pools _
❑ — s
Certffied copy 4 filed with the county building Irupec- 1 8 2-Family, Sq. Ft. LOCALI`Y
tion department. Multl-family$q. Ft. NEAREST
CROSS ST. 4?'--
ResidentialSwimming Pools OWN19?OR
Date Applicant J
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Llght Sw:_ - ADDRESS' L G M
COMPENSATION INSURANCE First 20
(This section reed not be completed if the wodk Involved by Total No Additional CITY "ry Tel. No. -7 7
er
the pmM is for one hundred dollars ($100)•or fees.) PLAN
CHECK Jy
I certify that in the performance of the work for which this " APPLX
permit Is Issued,1 shall not empfoy'anj person y manner
so as to befome rblod to the Work Com Ion Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel. No.
Date Ilcdrit Fixed Appliances Not Over 1 HP
NOTI CANT: ff, after making this Certificate of =C
Exemption, you should become. suble 'to the Workers' -Range. Heater_D.W. — s���
ct t
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. —
deemed revoked. CITY N�¢ Tel. 1Jo.
Hood — Fan Other—
LICENSED CONTRACTORS Dk—LARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Dlap. — Room-Air Cond. REG NUMBER (j Com• C-1f
(commencing with Section 7000)of Division 3 of the Business Apparatus �APp DISTRICT NO. BY
and Professions Code,and my II nse b Irl-full force and effect. Power 8 La Appliances
_ll/� Size 8 Type HP, Kite, KVA, or KVAR'
Licen*e Num Ic. Class I V Up to 1 Incl. j
FINAL V
Over 1 to 10 Incl. DATE — VAI N
Contractors; Over 10 to 50 Incl. FINAL Q
G
❑ I am exempt under Sec. Over 50 to 100 Inc. BY �t+
Over 100' 6n
B.&P.C. for this reason
Date: Z -
Servlcea, Swbd., MCC 3 Panelboards z
0 -2 00 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Req. Malnt. Elect.
SINGLE FAMILY Temp. power Pole 8 Appurtenances 3 % 1 .9.4 2
HOME OWNER-BUILDER DEaARATK>NSlgn with One Branch Circuit
# o 0 o o 'o 2
I hereby affirm that I am exempt from the Contractor's Ucense
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circults ) o - 2S50
Profe4slons Code):
Eli, as owner of the property, will do the work and the' Mlsc Conduits b Conductors o o •
structure Is not Intended or offered for.saie (Sectlon Other (See Complete Fee Schedulq)— O Q 2 O
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 permlt Is Issued PERM IT FEE (Sub-Total)
(Sec 3097, Clv. C).
PLAN CHECKING FEE
Lender's Name -
PERMrf ISSUING FEE
_Lenders Address �7
I cerltfy that I.have rood this appllcatlon and state ihpt the TOTAL FEE (�S!
above Information Is correct. I agree to comply with all County
ordinances and Sfate laws regulating Electrical wiring, and
hereby authorlxe niatives of this County to enter upo�
the abo e-men n property for Inspection u SEE REVERSE FOR,EXPLANATORY LANGUAGE
S-nature of Permittee Dat