HomeMy Public PortalAbout4856 GOLDEN WEST AVE_Electrical__ (2) y
TeAeea-c[.oa a-ea+ APPLICATION FOR CTRICAL ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADD R=BB
JOHN A. LAMBIE. COUNTY ENGIN =
WILLIAM A..IQISIN, SUPT OF BUILDTNO iOCALlTY
N[AR=BT
R APPLICANT FILL Chop ST.
n[C[FT. TOTAL MO
oIITLt~re FIRST 20 S.1 f OWN"
LI@HT a MAIL
W
SWITCH. ov[R 20 .10 ADD
IU
FIXTURE 1—f—,
TOTAL FIRST L so D Cm N0.
FIXTURES v%R 2 1O EL • l
ov n 20
ll"Cc CLO.DRYLMI vfm urns. 1.00 ADDR= 814
uR0.DUl. ATA.COOK
CTTY T>a.N
DISHpA>FI. AUTO.-WASH. PATI
!AC=HTni. /TA.AR.(%H.P.MU17C.) .50
LIC[NB[ N0.
MOToR11h oven NOT Ovm H.P. DISTRICT NO. GUNE r ED
0 1 1.00
1 3 1.50 INSPECTION RECORD
s e 2.00
a 1a JL50 of
15 so 3.00
no 100 5.00
•IGwr Mo.TRANS-
M0.LAMPS
satVIC=0-a00V•NOT OvzR 200A 1.00
sotvlcz p-600v-0vm sOo A. x0o
ssnvlc=ovu eoov a.00
MIBC.
r[RMIT IMUING FQ 3.00 CIO
•UPFLAMXNTA0rY f MMIT IMUI40 F[= 1.00
TOTAL FEE
1 HAY AC]CMOMLXD= THAT"1 HAIR ISAD THIS T"IoN DATK
AHD,2TATX THAT THE. AAKM UI 9DMM= AND AO1Q TO COMPLY CONDUIT
WIrH ALL COUNTY ORPINANf=S AND ET4TK LAWS IMOULATING
KLXCXMDCAL WrtR1N4L JJJJJJ WIRING
1 MY"Y CQTIFY THAT I ASM FRorO[LY S=OU AND/OR
LICADMMM AS M=U® NY LOS ANS�� CDUIM'TY STAT[ OF FDrM
CA JYOpUA On THAT 1 TkR OTI1d1 OF TH= ASOY[
OdCR»�R!S POW= �.
•IGNATURII UTI --
OF�QtM ,
VALIDO ARTHUR C. VlaT
•UIRIJI I[ING ELicTRICAL a1G7lIlf�f
cK M CAB
X0 6 2 1 0';� OCT 6 2 D 720-
r
76Ae6 eoe .1 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LAS ANGELES
DEPARTMENT OF COUNTY ENGINEER
�� Cp�
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS FEE OWNER OR
$ FIRM NAME
RECEPT._ MAIL r/
LIOHT._�. TOTAL
FIRST 20 ADDRESS 7`
CITY TEL. NO.
-_
SWITCHOVER 20 1p
PLAN CHEGFR
LIGHTINGTOTAL FIRST 20 2:5APPLICANT
FIXTURES
—OV ER 20 .10 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYFA_WTR. HTR. APPLICANT
STA. COOK DISP. F.A.U. ADDRESS
SPACE HTR. AIR COND. Cl Ty TEL. NO.
CLOTHES WASH. DISHWASH. REO NUMBER CLASS.
FAN OTHER TDO I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STAT[ THAT THEABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING
IND. HEATERS, ETC. HP. KW. RVA. ELECTRICAL WIRING.
SIZE & TSP[ OVER To
I HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED ANb/OR
R1 Air C _ 1� LICENSED AS RED IR[D GY LOS ANGELES COUNTY AND STATE OF
�[ M CALIFORNIA OR THAT I AM THE LEGAL 0 R OF THE ABOVE
Ilk 3 71)pi
� j 1 _ 10 '� DESCRIBED RESIDENTIAL PROPERTY.
PERMITEE
10 — 50 600SIGNATURE C
1O.
60 — Soo IODO DISTRICT NO. PROCESSED BY U
LLL-
1 OO — b00 I e m Q I
SIGN, GAS SIGN AND ONE CIRCUIT 6.00 APPROVALS DAT[ DwECTowS SNSMTUlE ,
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1D0 TEMP. POWER POLE
SERVICENOTOVER$OOVOLTS OR200AMP am UNDERSLAB WORK
SERVICE OVER 600 VOLTS OR 200 AMP 10 ROUGH CONDUIT
TEMPSERVICE,POLE, &APPURTENANCE$ 6.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES: 0V Srr
PLAN CHECK FEE 1 — 6
PERMIT ISSUING FEE am 0 �
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
13 2r-`_' 21 2 Q 1 5.2 5
SE[ BACK OF APPLICATION FOR COMPLETE SCHEDULE '
{
T°A °'-`E p° 101 APPLICATION FOR ELECTRICAL PERMIT 779P,7
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER �s
BUILDING AND SAFETY DIVISION
LOCALITY L T
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NOw I1AC.HFE FIS NA E
S
RECEPT._ MAIL 10
LIGHT TOTAL
FIRST 20 23 ADDRESS OV
CITY TEL. NO.
SWITCH OVER 20 10
PLAN CHECK
LIGHTING
FIRST 20 APPLICANT
I 1 TOTAL �OVER 20 ADDRESS
FIXTURES .t0
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYEAWTR. HTR. APPLICANT O
STA. COOK DISP. F.A.U. ADDRESS
SPACE HTR. AIR GOND. Cl Ty �- TEL. N0. 777
CLOTHES WASH. DISHWASH. ��M ER CLASS.
FAN OTHER 1.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND [TATE THAT THE ABOVE IS CORRECT AND ASR[[ TO COMPLY
MOTORS, T1IANSFORM[Ra RATING WITH ALL COUNTY ORDIH.A NC ES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HR. KW. KVA. ELECTRICAL WIRING.
SIZE IN TYPE OVER TO
IHERESY CERTIFY THAT I AM PROPERLY REGIIT[R[D AND/OR
0 — 1 1D0 LICE Na ED AS R E 0 U
IRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE y,
1 — 10 3.001 DESCRIBED RESIDENTIAL PROPERTY Go..
PERMITEE
10 - 30 aA0 SIGNATURE j�'!` CId
IO-.
30 - 100 t0A0 DISTRICT N0. ED BY U
100 - 300 t e oo !��• g . Z'
SIGN, GAS SIGN AND ONE CIRCUIT 0.00 APPROVALS O DATE aaNWTUII
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1DO TEMP. POWER POLE
SERVICENOTOVER 600VOLTS OR200AMP 3,00 UNDERSLAB WORK
SERVICE OVER 600 VOLTSOR200AMP 10.00 ROUGH CONDUIT
TEMP SERVICE,POLE, h APPURTENANCES 0.00 WIRING
TEMP LIGHT OR RECEIPT. SYSTEM DAO FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL g �R( � 7 L ♦r 11,
PERMIT FEE (SUES TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE SAO (f
TOTAL FEE 0
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C M.O. CASH
3 5 4 1i3 OCT 1 1 2 D 6.0 0 e
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 1�
7OA962-CZ.WG-10-86 APPLICATION FOR ELECTRIC PERMIT 1
BURDOG AND SAFETY DMSION
Deparwmant of�7 ADDRI BUILDING
+'++M+7B AD DR Rda
JOHN A. L A IH. C30�IINGIN[ID!
CRAW TT D. GRIFFIN. SUPT OF■UILDINS LOCALITY
NEARUArr
FOR APF4_�CA�ITILL IN C*Qaa OT,
aT
pp� � OWN E
uGHTr
a�AamLxsrwrraHn y �
N LIY■
IT[Y LACH FAIL
ADDRESS
TOTAL OUTLETS = .10
■Li C. WG[l, rAT[l BYAT[■■, crry TRI_
CLOTHn D�TWA .. .50
KLKC. SPAO= Qurm, 6T4T•T. COO[- ELECTRICIAN
,90 U:L OARIAlr DI/ro"", ADDREAG
AUTO fAfGrR.r DI5"A". .R5
LIGHTING FIRTURES 10 Q C / T"L_ NO. b
MOTORS STATM
END NO.
HORSEPOWER
H.P. OVDVW I
R o. I GROU P I ZONZ I R[ADT FOR 125P[CT1011
va i LK" .25
2 .50 INSPECTION EDCOB,D
9 — 5 1.00
D 15 1.50
15 — 50 9..50
50 900 5.00
Y ISG.
DIONS NO.TRAMS
XO.LAYPr
arRvlcE 0.GoOv 1.00 B O
saRvlcs Ovne e0ov 5.00
WIRING PERMIT 1.00 d
FIXTURM PRRHIT 1.00
aUPPLDIEXTARY PERMIT .50 MMOVAM
TOTA,L,FEE DATE INSPECTOR S SIGKATURX
I HOMY ACKNOWLEDGE TEAT I RATE MEAD THIS APPLICATION
Allp STAT1Z THAT THE ABOVE IS CORRiCT AND AGREE TO COAPLY f.ONDUIT
WITH ALL COUNTY ORDINANCLSG. MD STAT[ LAWS REGULATING
M RACAL t¢YLNG. WIRING
I HERMIT CERTIFY THAT I AM PROPERLY RXGISTIRED AND/OR FIXTUIRE,G
LICZMDKN As RIQURID sT LOS AIIGE.RS COUNTY AND STATH OF
CALIFORNIA OR THAT 1 AN THM LILGAL OWrKN OF THE A" pOWER
DESCRIM MMIDENTIAL PERM I
�IGNATVRi LJTrL CO. NOTIFIED
I7TE[ 1
OF FINAL
�4OUN BIg, �ATION UR c IT.
LINTY GII1ml CJC YO UPM3tV1iING LGL BLiGIIVM7Qt
SA/H
_LAW 1 6 1 5V-, AM29 2 7ZO g
a� OOUIITY OF LOS ANGELES APPLICATION FOR PERBM
� ' ELECTRIC 1
' �-DZ`YISION OF BIIII�DINC & SAFETY
WILLIAM 1 FOX, OMaty EmoIm�
FOR APPLICANT TO FILL IN DIRTR10T NO. GROUP ZONE P[RMff NO.
Is gLEL"TRICIAN _3
R[O[IVKD SY READY FOR DAT[ I■OUm
ADDREJM FIRST IHJZP[OTIOH
CITY TIL NCL
OOU 10 N V d IRK4 k ■UILDIHG
Phi ADDRESS FJ
Per
NUM■[R [ADH LOOALITf
UGHT OUTLETO HEARmvT.
MKOK TALES S
O
WALL I WITOHd OWNER rAp X1
TOTAL OUTLETS ■D1p MAIL
[LEO. RANOd 9i ADDRti
[L[d HEATERS 9■ CITY T[L. NO.
F orru RID ■
I H[R[QY AOKHOWL[DG[ THAT I HAVE READ THIO
mim APPUCATION AND STATIC THAT THE A■OV[ 1■ OORREDT
NUMBER Or LIGHT CIROUITS AND A13F= TO COMPLY WITH ALL OOUNTY ORDINANCES
HUMBER OF RKOKPTA13LIE CIRCUITS AND STATIC LAWN REGULATING [L[OTRIOAL WIRING.
MOTORS I O[RTIrY THAT I POidN THE ABOVE VALID LOS
Hummm HORSEPOWERF[[ ANO[LL O
[S OOUHTY LIO[NBE, OR 1 AN THE LEGAL
HrW Mw. HP OVM I110. XA13H OF THE R[BID[HTIAL PROPERTY DIO CRI■[D ABOVE.
YX • PC" -SS SIGNATURE OF
2 .60 PERNITTIME
■ 1.0`131 INSPECTION RECORD
6 16 1.60
16 ■O 9-60
6o ZOO 6.00
am 600 10.DO J
6013 1000 16.00 j
oVrR IOM 90.00 p
M.O. ■ET FR 13HAN131ER-HP R'
W[LD[Rft AD-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS 76 or omm.
movirp MOTORS (76 or DRI■
MIND.
BIONS
NCL N O.TRAN■.
N APPROVALS
DATE INSJi[CTOR'■NAM[
FOR EACH PERMIT?
WIRING 1.Q0
CONDUIT
F l)CTU R d 1.00
WIRING
r IXTU R d
POWER
TOTAL FEC ■� UTILITY OD.NOTIrI[D
FINAL I
7LA&a Dea#ILA ■-aa
i
' „-°° - APPLICATION FOR PERMff
F-00 JoX?C 41,4
DEWAHTMESAFETY
NT OF BUrLDING AND
.,�. COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHIEF ENaIN[ER
FOR APPLICANT TO PILL IN DISTRICT NO. GROUP ZONE . PERMIT NO�
ELECTRICIAN uesper Islectria
ADDRESS rOZ et VED eY READY FOR TE UED
FIRST INSPECTION
CITY EJL Monte TIL NO. C .
IC 1854 C? 3 DUILDING
PERMIT FEES ADDRESS 4856 N Golden West
NUMBKR FEE —LOCALrrY Temple City
LIGHT OUTLdTB NEAR S'Irr. HallWOod
RECEPTACLES
WALL BWITCHp OWNER Ist Baptist Church
TOTAL OUTLETS be MAIL
tiLEC. RANGTf !D ADDRESS S+ ame ..
EU-&C. HEATYRS 25 CITY
TEL. NQ-
FIXTURES 5
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
misc.
APPLICATION AND STATE THAT THE MOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECSIPTACLE CIRCUIT'0 AND STATE LAWS REGULATING ELECTRICAL WIRIN0.
MOTORS I CERTIFY THAT I POOSESH THE ABOVE VALID LOS
Nu"Km- HORSANGELES COUNTY LICENSE, OR I AM THE LIMA OWNER
NCR PER
NrW MvD. HP ovu ,Nc. OF THE RESIDENTIAL PROPERTY [DIED ABOVE.
EAG+
a,rm R SIGNATURE OF
Y .60 PERMI
: 5 ,1.00 INSPECTION B&bRD
D 15 1.50
5 50 2.50
50 IoQ 0100
� a .00
1000 15.00
OVER 1000 10.00 _
M. G. SET FRE . CHANGER-HP
WELDERGi AC-KVA 0
GENERATORS-KW
TRANBFORMERS-•KVA
TRMP. MOTORS 75of o,na.
MOVED MOTORS 75 0pr olua.
IS '
SIGNS
NO. NO. TRANS. APPROVALS
NO. NO. LAMPS F
ATE SFQCTO •■ AMIK
FOR FACH PERMIT
WIRIN91 CONDUIT
FIXTURES 1.00 WIRING
SUPPLYMENT RY •50 FIXTUR69
POWER
TOTAL FEE S 6 UTILITY CO. NOTIFIED
FINAL 9111;rla I-,
1
APPLICATION FOR ELECTRIC PERMIT 1
y BUILDING ANIS SAFETY DIVISION
Deparimumt of co=ty Eughlow 15UILDiNG '
JbQ HN A. LAM61e, COUNTY Er�a1N[fll
TT D. 4R1FTIN. sur-T or nuu-DIN• I-OCALiTY
NL+.REST
FOR APPLI T ILL IN
WNER
LIGHT[ irwITQHKs
MUM■" XACMF[i MAIL
ADDRIS"
TaTAL OUTLETS • .10 • l _ p
[LKC- 1"OKI, VAt[K GYATkR/, C L-' /
CLOTHKK D.t"I -15O ELECTRICIA
[I,KC- $PACK H[ATKM 9TKVT. OOOR-
111[ 011Im GAK[A[[ gI�POn[., ADDRMW _
AUTO ■AIBn■ DIKHI1LKLn .Za
LIGHTING FrXTURE8 10 OITY TSL N
MOTORS BTATIK / d
END[ 4 7
HORSEPOWER
H.r. OVWA INC. READY FOR IIIPFCTIO■
Is,. —3
77
>t ASO. MOPE TION`EEMED
2 15 1.00
a — 115 1.50
115 150 2.150
150 !00 15.06
k lsa_
s14Np NO.ThwN+
No.LwrrPs '
ro[RV Cl O-CO-OV 1.00
BEISVIC[OVXR 600V 15.00 -
WIRING PKRMIrT 1.0017
FIX'TUR6 PRRMIT 1.00
aUPfiLmdaNTARY PKmmrr DQ AMOVAIB
TOTAL ME _ �I DA`f[ IISPECTO G
AND STAY ACU TH$ ABOTIC IS CO Y��T A�1V A0R TO �OYPL� CONDUIT
..WITH
CIXAT{II1T1' ORDISAACEG A11q STA
LAf6 REGULATING WIRING
1 ADS TH/►T LOS
PR6PIERLY RSGIDTI1FJO AAD/OR �r�UR"
LICSJIs® 2EO 'i 9Y LOS ANGIfl3i COUNTY A*D ETATE OF
DESCQIBmIAOR I All Pim�IDtAfIA1 -;GAL Opp OTHR AlOTSI pOyylR
r1ONATU" -UTILITY Co. NOTWISa.
OR P[RY FINAL, I
coHu>rNsurrqLN HIL VALIDATION AJITHURINa
cic Yo rA.H Rte• RIialNm!
655 vv
c.�. �� •• �o1 2 A 5.1 C3 �g
1 , -
IT T
hereby OR RS'thal hCOMPENSATION! D a oRATIQent to stiff ' 10/B1 APPLICATION FOR ELECTRICAL PERMIT
Lasur or a r�tlflcate of Workers' Compensatlon Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or �prtlfled`copy thereof (Sec. 3800, Lab. C.)
Po` No. � Company i'OR TO t7u. xDRE55
El Cejtffled copy Is herebyfurnlshed. New Resldentlal Bldgs. 8 Pools EACH NO. FEE
Certified copy Is filed with the county building Inspec- 1 8 2-FanSq. Ft. = f LOCALITY
tlon department. Multi-famlly Sq. Ft. 3T C�IPO4P, +g-
Date Applicant
Residential Swimng miPools
FIRM NAME
CERTIFICATE OF EXI=MPTION FROM WORKERS' Outlets: Rec_Llght Sw. sff[J
COMPENSATION INSURANCE
I 673,0
(Thh section need not be compF•+sd If the work Imrolwd by First 20
the p+rmlt Is for orse hundred dollars ($100)or less.) Fatal No T Additional TeF. No.a �s
HECK
I certify that In'the performance of the work for which this PLAN NIRKANT
permit Is Issued, I shall not employ any person in any or
to as to become subject to the Wor n Compensatlo Lighting Fixtures First 20 ADDRESS
Additional
Total No. CITY Tel. W.
Date ' pllcan. Fixed Appliances Not Over 1 HP =CANT ` `K — G
NOTICE TO APPLICANT: If, after -making this Certfflcate of
Exemption, you should become subject to the Workers' Range— Heater_D.W. —
Compensatlon provlslons of the Labor Code, you.must forth- Oven —Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top FAU —W.H.
deemed revoked. Hood Fan _Other rCITY ! V ?jZTel. No. j (1(�
LICENSED CONTRACTORS DECLARATION t— / LFC2,t5E OR /�
-D rap. Roo At r Cond. REG NUMBER 3grO CIau.0 10
I hereby off]rra that I am IIFensed under provisions of Chapter 4 �
(c6n1men,dN with Sectiorn7000) of Division 3 of the Business ^'�"T DISTRICT NO BY
and Professions Code,and my license is to full force and effect. Power Apparatus 8 Large Appliances LIV
Size 8 Type HP, KW, KVA, or KVAR J` (l
License Num �Z � _Llc. Clau I0 Up to l Incl. FINAL V
aarc4 el f ,�_ Over 1 To 10 Incl. DATE V w►noN .0
Contractor Date Over 10 to 50 Incl.
FINAL
I am exempt underW Sec. Over 50 to 100 Inc, BY "'
B.$P.C. for this reason Over 100
Se'rvloes, Swbd.,MCC 8 Paneiboards ,
0 -200 Amp. Under 600 V
Slgrxotur 201 - TOW Amp. Urxier 600 V
Over 1000 Amp. or Over 600 V
Exemption for Reg. Mainz. Elect.
;F-7263'A
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION
Signwith One Branch Circuit #•o 0 0 o,o 2
1 hereby affirm that I am exempt from the Contractor's License Addlttonal Sign stanch Circuits
Law for the following reason (Section 7031.5, Bwlneu and g •1 ° 0 29.00
Professions Code): e,o • 2 9.0 0�5
I, as owner of the property, will do the work and the Mlsc. Conduits 8 Conductors
(� � ��8'�
structure Is not rntencied or offered for sale (Section Other (See Complete Fee Schedule)_ , r
7044, Buslneu and profession&Code).
CONSTRUCTION LENDING AGENCY
F 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}
(Sea. 3097, Clv. c).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING-FEE
Lender's Address
I certify that I have read this application and state that the TOTAL FEE (1
above 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
th above-mention rty f Inspection purposes. SEE REVOSE FOR EXPLANATORY LANGUAGE
Signature of PermlttDate
'"°RKERs have
a certificate
Df consent
to �D DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certl}Icate of consent to self Ineuri,
or a cert1fin b-SfWorker's Compensation Insurance, or a certlfled COUNTY OF LOS ANGLES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Seo.3800 Lab.C.)
Policy No. Comperry FOR Aarucrxr TO KILL IN PRESS44� Y
❑ Ceriffled copy is hereby furnished. New Residential Bldgs.S Poole NO.1 EACH FEE LOCALITY
❑ — $ $
C&rtffled copy Is flied with the camty bufldlrtg inspection 1 8 2 family,Sq.Ft Muhi-famlfy Sq.Ft. C .
z
Date Applloant Residential Swimming Pool / ASSESSOR
BOOK PAGE
CERTIFICATE OF DEMPT10N FROM WORKERS' Outlet:Rec._Lw—t--Sw. OWNER OR 9,fan
J-- O FIRM INSURANCE t
(This section need not be completed If the work Involved by the First 20 MAIL
permit is for one hundred dollars($100)or lose.) Tonal No. Add ftlonEd AD 88
I certify that In the performance of the work for which this permit O
le Issued, I shall not employ any person Irl any manner so as to PLAN p¢pt
become subject to the Workers'Compenoatlon Laws. LigtTdng Future. Flat 20 APP UC -r
Totes No. Additional
ADDRESS
Data Applloent REBIDENTLAL APPLLANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY T'i Kb
-
NOTICE
YOU should become subject to the Workere'CompenmWon OTHER APPLIANCES NOT OVER 3 HP. PERM Fr
provisions of the Labor Code, you must forthwith comply with such APPUC
P y PIY Povy�Apparatus ��Appllanoee APPLJCIM
prrnlstoru or this permit shell be deemed revoked. -
LK EN.SED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter B Over 3 to 10 Ind.
(commencing with Section 7000) of Division 3 of the Business and CITY Tet No.
Profeaelons Code, and my license Is In full force and effect. Over 10 to 50 Ind. LK,p,78E OR Clow a
Over 50 to 100 Ind. RE&NUMBER
over 100 DISTRICT NO. P BY O 0
Llcense Number Uc.Clare n
Services,Swbd.,MCC d Panalboerds (/ is
Contreotor Date 0-399 Amp.Under 800 V DATE
EJ 400-1000 Amp.Under 600 V
I am exempt under Sec. r 1000 Amp.or Over 000 V VAUDAT ON LLJ
Ove
r1000 NAL d
B.SP.C.for this rsCIRCUIT F
BRANCH CIRCUEES av CO
Date: 16A,or 20A,120V,Lighting or Recvpt Z
1 To 10 Branch Clrcutts
Sigma 11 To 40 Branch Circuits
41 Or More Branch Clroults 7
❑ Exemption for Reg.MaInt.Elect 1514 MA,208V To 277V Br.araifs 2t+T
84NGLE FAMILY Temp.Power Poi S Appurtenance• ACC ■i
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exompt from the Contractor's License Law gign with One Branch Chcutt 3 31.30
for the following reason (Section 7031.6, Business and Professions AddIdonel Sign Brandy Circuits
Code): 1 ITEMS
�ss owner of the property,will do the work and the structure Misc.Conduhs 6 Conductors TUI , 31 -30
Is not Intended or offered for sale (Section 704-4, Buslneas Other(See Complete Fee Schedule) 010. CHE 31.30
and Professions Code). �►f� rymy
CONSTRUCTION LENDING AGENCY ltl�L .00
I hereby affirm that there Is a construction lending agency for the
pertormanoe of the work for which this permit Is Issued (Sec. 3097, PERMIT FEE (Sub-Total) co
Civ. C.) ODOR-"l 1/31/96
PLAN CHECKING FEE 4620 1 N12:17
Lender's Name
PEAMFr ISSUING FEE 2
Lenders Addrees
I certify that I have read this applloedlon and under penalty of purJury state TOTAL F>=E 7jO
the the above Information ts=foci. I agree to compty with all County
ordinances and State Ia"reg ubadN ElacVIcal wldng,and hereby authortze
repreeentelfvee of this County in enter upon the ebwe4randDned property
purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
for�5� E
1- :31- R 6
��OFDATE