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79AG" r APPLICATION FOR ELECTRIC PERMIT 1
DY-*A it-90
,61MON OF BUMDING AND SAFM
of Co® Eavla«x BUILI1Ina
ADDRiQs
JOHN A BIH, C+Du�E alN = Temple City Calif .
CAASATT D. GRIFFIN SuP"T OF BUILDING L LnY City,
FOR APPLICANT TO FILL IN NEAREST
PE UM FEF$ CROSS ST.
uRBEY Sha
OWNER
41 o LIaH r OUTLirs Y.AIL
RECEPTACLES ADD CSS
WALL SWITCHES FEE rry
TOTALOUTLITS 0 ISO ELECTRIcIAN a E COR 0.
[LEC RANGES II15 ADDRESS 1600 So. Curtis
[LSC. HEATERS 215 CrrY Alhambra Cali TEL.NO. C 6
EA STATE
FU(TUREs D LICHNSE NO. 113244 C 10
MOTORS D17TIO. IGF�Q P ZONE I-aK&vTFolttmrJT ioa
numaxit HO"M-OWER FIR
IRM I mvD. HP ovR I RIG. rAat1 INEPECON BECORD
•Lx" q .IID 150
it .150 fll G rr C
a a 1.0.0 --L. ! �/
D 115 1.150 1
15 150 x.150
150 II00 15400
M I6C.
NO.SIGNS NO.TRANS.
NO.SIGNS NO LAMPS
FOR EACH PERMIT;
WIRING $1.00
F DCTU RXS 1.00 1
8UPPLIMIENTARY .150
APPHOYAIS
TOTAL FEE 7 DATE. INVICCTPR'SPIRRATURN
I HEREBY ACICAOWLEDGE THAT 1 HAVE READ THIS APPLICATION Vazw
AND STATE THAT THY ABOVE Is'CORRECT AND AGRE1 TO COSPLY CONDUrr
WITH ALL COUATT OYDIAAACEB AAD STATS LAWS REGULATING
ELECTRICAL WISING. WIRING
I REAEBT CERTIFY THAT I AN P AAD/OR FIXTURES
LICENSED AS REQUIRED BT LO CO MD STATE OF
CAUFORAIA OR THAT I F ABOVE POWIR
DESCRIBED RESIDENTIAL
SIGNATURE UTiLITYCIO.NOTIF1sD
OR PERMI FINAL
JOHN A.LAMBIE,COUNTY ENaiNzxR RATION ARTHUR C.V)Zrr,CHIS lzLicr. IN rmaTOR
CK ri0 owaa
3907E'; ' JAW 4 I 2 4.75 n
WORKERS'COMPENSATIONDECLARATION CE 06 (2-80) APPLICATION FOR .ELECTRICAL PERMIT
I hereby affirm that I have a certificate of.consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certlfled copy thereof(Sec.3800,Lab.C.)
FOR APPLICANT TO FILL IN JOB
Policy No. Company ADDRESS 0�+ 0 Z,
New Residential Bldgs.&Pools EACH NO. FEE
E] CertifW copy Is hereby furnlahed. 1 &2-Famlly,Sq. Ft. _ — $ LOCALITY �le•rr 1
NEAREST
Certified copy is filed with the county building Insoection Multi-family Sq. Ft. CROSS ST
department. Residential SwAmming Pools OWNER OR
a �jo S O IRM NAME
Date Applicant Outlets: RoAd Light Sw. ADDRESS
—F i rat 20
CERTIFICATE OF IiXEMPTION FROM WORKERS' Total No. _ Additional CITY Tel N9.
COMPENSATION INSURANCE 0 sc-> PLAN CHECK
-APPLICANT Q
(This section need not be completed if the work invotved 2 U
by the. permit is for one hundred dollars ($100) or IML) Lighting Fixtures Firat 20 ADDRESS
Additional,
Total No.
I certify that in the performance of the work for wtor-h this Fixed Appliances Not Over 1 HP CITY Tel No.
permit is Issued, I shall not employ any person in any manner PERMIT lL
so as to become subject to the Work on Laws. Renee_ Hester D.W. APPLICANT lz
Oven _ Dryer W.M. 05
ADDRE88 3Q AI Z
Date Applicant Top FAU _W.H.
Hood Fan _Other_ CITY Tal -336-7
NOTICE TO APPLICANT: If, after making this Certificate of .Dlsp. Room Air CdndLICENSE OR'
Exemption, you, should become subject to the Workers' �'- REQ.N MBER Clw
Compensation provisions of the Labor Code, you must forth- Power Apparel;& Large Appliances DISTRICT N-O. PROCESSED BY
with comply with such provldons or this permit shaD be Size&Type HP,KW, KVA,or KVA �r Q�
deem /V`��
bd revoked. Up to 1 Incl. y 6
Over 1 to 10 Incl. FINAL
]
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION .
I hereby affirm that I am licensed under provisions of Chapter Over 60 ti? 100 Inc. FINAL
BY
9 (commencing with Section 7000) of Dtvfdon 3 of the Busi- Over 400
nen and Profeesions,Code, and my license Is in full force and
Services Z
effect. `/ 0-200 Amp. Under 800 V x l 'o / � ' 73�j 6
Co 201 N�u�m`bl �` -Llc Class p 201-1000 Amp. Under 800 V
ritt5f^tt Citi/mat• ( r Over 1000 Amp.or Over 800 V
HOME OWNER-BUILDER DECLARATION Tamp.Power Pole&Appurtpnences
t hereby affirm that I am exempt from-the Contractor's -Sign with One Branch Circuit
License Law for the following Tenon (Section 7031.5, Biw- Additional Sign Branch Circuits
nen and Professions Code):
13
Mfsc.Conduits&Conductors 0.0 7,8 A
I, u owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure L sale not intended or offered for le (Section # 0 0 0'0 0 2
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is ■ construction lending agency ,2 o o 2. Jr 0
for the performance of the work for which this permit Is PERMIT FEE (Sub-Total) .0 0 0 2 5 0
issued (Sec. 3097,Ctv.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 0 608-81
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE
above taformation is correct.I agree to comply with all County `•
ordinances and State laws regulating Electrical wiring, and C>
hereby authorise.representatfves of tills County to enter upon
the abovementloned property for ln.pectlon purposes. SEE'REVERSE FOR EXPLANATORY.LANGUAGE
Signature o ttee Data