HomeMy Public PortalAbout9162 LA ROSA DR_Electrical__ 76A663-CE606 6/63 APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER 44
WILLIAM A.JENSEN, SUP'T'OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
iA,-Z"�a2z"e-c
RECEPT, TOTALNO. EACH FEE __ r
OUTLETS FIRST 20 - $20 $ OWNER /
LIGHT MAIL
a ADD'L D
10 ADRESS C�
SWITCH. _ OVER 20
TOTAL
.LIGHTING T
FIRST 20 .20 CITY TEL. NO.
FIX,TURES• ADD'L 10 ELECTRICIANELECTRIC
OV R 20 LT
RANGES, ` CLO.DRYERS WTR.HTRS. 1.00 ,ADDRESS 10124 ,E..-. R H_-S
GARB.DISP. BTA.COOK _ A ,
CITY TEL. NO. 8-8911
DISHWASH. AUTO.-WASH. STATE G
SPACE HTRS. BTA.APP.($/a H.P.MAX.) .50
.LICENSE NO. 137586 C-10
MOTORS: OVER NOT OVER H.P. DIST R CT NO. GROUP ZONE PR CES D BY
O 1 1.00
1 3 1.50 / INSPECTION RECORD
_ _ 6 2.00 J lJ0166 3 0 -AA fw
6 15 2.50 ( ` ,I a • �/ O
i
1s so 3.00 O
SO 100 5.00 r
SIGNS, NO.TRANS d
NO.LAMPS
SERVICE 0.60OV-Nor OVER 200A. 1.00
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00 '
MISC. -
PERMIT ISSUING FEE 2:00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00__
TOTAL FEE ffi Q
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT I I_6 .i�vl
WITH ALL COUNTY ORDINANCES,,AND, STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING A•1 4 ♦` �_
I HEREBY CERTIFY THAT 1 AM PROPERLY, REGISTEREO.AND/OR ��
LICENSED AS REQUIRED BY LOS,ANGELES COUNT AND STATE OF FIXTURES "'I V,i kb
- CALIFORNIA OR THAT PAM THE LEGAL OW OF THE ABOVE + - G
DESCRIBED RESIDEN ROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED //,z
OF PERMITTEE g. FINAL I /7 4 kA AI/ie
CKoSUIDATION ARTHUR C. VEIT �f
MO CASH
PERVISING ELECTRICAL ENGINEER
;8; 6 3 Z"o JIAN 7 2 D . 1 0.0 0- �
76A663-CE806 8/63 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT
BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 9/ld Z )v- er
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST {
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. f TOTAL NO. EACH FEE
LIGHT OUTLETS FIRST 2O 20 $ �j �G OWNER 1(tick / rt -
J MAIL
ADD'L .1O ADDRESS
SWITCH. OVER 20
ql� Ao CITY TEL. NO.
LIGHTING I
�TOTAL F7 OV R 2DDRST 20
L 20
FIXTURES A .10 ELECTRICIAN RUSH ELECTRIC
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS • 10124 E., RUSH• ST.
GARB.DISP. STA.COOK O
CITY TEL:N 8-8911
DISHWASH. AUTO.-WASH. - STATE
SPACE HTRS. STA.APP.(1/1 H.P.MAX.) .50 LICENSE NO._ - 137586
586 C-10
MOTORS: OVER NOT OVER H.P. DISTRIC N G UP E P E B
O 1 1.00
1 3 1.50 INSPECTION RECORD
3 a 2.00 C'
CL
8 15 2.50 O
15 50 3.00
O
50 100 5.00 ~
V
LU
SIGNS: NO.TRANS- N
CL
NO.LAMPS
Z
SERVICE 0-600V-Nor OVER 200A 1.00
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00 ±�
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE Is lo �U
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING /n {
ELECTRICAL WIRING. WIRING 1, Q✓ l/JU
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR /G �'
LICENSED,A8 REQUIRED BY LOB ANGELEff
S COON Y AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 M THE LEGAL OWN OP THE ABOVE
DESCRIBED RESIDE OPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED / ,f
OF PERMITTEE FINAL I15d /"-VA ✓Sl l
C�LIDATION ARTHUR C. VETT
o
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
X8;',3 6
6
8"7L DEC 29 . 2 .D . .��Q�
- .
76A663-CE806 8/63 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS,ANGELES,
DEPARTMENT 00 OF COUNTY ENGINEER BUILDING �A
BUILDING AND SAFETY DIVISION ADDRESS / 2-
JOHN A.-LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY /�it. ;./,r �I '
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. / T
RECEPT. ,° TOTAL NO. EACH FEE _
(-- OWNER FIRST 20 � $.20 $ �/7 MWNER
LIGHT s ti �,, . y`� 1 'a, �
ADD'L r ., ADDRESS
SWITCH. /� __ /"7_� OVER 20 s.U 10 -
TOTAL ZCITY TEL. NO.
LIGHTING J FIRST 201"-)v .20 _ /J�.
FIXTURES } (� Dv R 20 / .10 / li G ELECTRICIAN �; f �fr a -yf%L t'
RANGES, CLO.DRYERS WTR.HTRS. 1.00 ADDRESS 0 / z_ � Ir J Nj p4.
GARB.Of SP. ,STA.COOK I
CITY S ( b;z�*� "'-/"� TEL.NO.
DISHWASH. AUTO.-WASH. STATE -
SPACE HTRS., STA.APP.(yj,H.P.MAX.) .50LICENSE NO. 1 ;? .a' C l U
MOTORS: OVER NOT OVER H.P. 'DISTRICT NO. GROUP ZONE PR CESSED BY
O 1 1.00
'1 3 i /. 1.50 / s ! IN�,jSIPECTION� RECORD
3 8 2:00 ? P-/�6/[� VW O/o" .lx
B Is 2.50
.r 15 80 8.00 Ar
50 100 5.00
SIGNS: NO.TRANS v ' �� J��i l�C .✓®""•uFP I a
NO.LAMPS
SERVICE 0.600V-Nor OVER 200A 1.00 a ,W ss��r� � •t I�Ad�
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 15.00 1 .
" a ti47 a`fb
MISC.
v
PERMIT ISSUING FEE 2.00 ��U
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE l
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS vDATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT. ,1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING 4'i•` ,y ,�T'3
I'NEREBY-CERTIFY THAT 1 AM PROPERLY-REGISTERED AND/OR p ����a -•
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF7 ABOVE _ -
,.DESCRIBED REBIpE ROPERTY. POWER �.e;�•-
SIGNATURE UTILITY CO..NOTIFIED � d i
OF PERMITTEE FINAL p 114 7T-
IDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
JAN 2 9
76A663-CE806 8/63 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS . �v 4 r
JOHN A. LAMBIE, COUNTY ENGINEER I t
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST I�
FOR APPLICANT TO FILL IN CROSS ST. iI e ; 1, _f
RECEPT. TOTAL' +20
EACH FEE 1 {/ /
OUTLETS FIRS $20 $ OWNER ' �l/ Gil l
LIGHT MAIL
�i AOf0 ADDRESS 1( 1 Z. (C,Lt• Lt i
SWITCH. OVE
TOTALCITY � J u r f TEL. NO.
LIGHTING FIRST 20 .20 ' c�++
FIXTURESADD'L f0 ELECTRICIAN �u �. G If -- Cf� �-
OV R 20 j I `;J /
RANGES CLO.DRYERS WTR.HTRS. 1.00 'ADDRESS ` ` ' 1`.Q L'L J-1
GARB.DISP. STA.COOK
CITY S-J �;�11.,.e,.,Y-� TEL. NO.
DISHWASH. AUTO.-WASH. STATE �7
SPACE NTRS. BTA.APP.(+y H.P.MAX.) ,50 LICENSE NO.
MOTORS. OVER NOT OVER H.P. DISTR 7 N GUP ZONE P ESSED PY
0 t 1.00 f /4
1 3 1.50 fINSPECTION RECORD
S 8 2.00 A/
O
B 15 2.50
15 50 3.00 O
50 100 5.00 I`_
U
W
SIGNS: NO.TRANS d
NO.LAMPS NZ
SERVICE 0-600V-NOT OVER 200A 1.00
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC. /
11
PERMITlSSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 1J
LBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - APPROVALS DATE INSPECTOR'S SIGNATURE
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
LL COUNTY ORDINANCES AND STATE LAWS REGULATING
CAL WIRING. WIRING
EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES If
NIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
ED RESIDE ROPERTY. / POWER - n
URE UTILITY CO.NOTIFIEDMITTEE FINAL f•/�-�
/'VALIDATION ARTHUR C. VEIT '
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
WORKERS'COMPENSATION DECLARATION 76-663 10,61 gPPLICi4Tl®Ii1" FOR ELECTRICAL PERMIT. r•
CE-806G
I hereby,affirm that I have a certificate of consent to self insure, _ � PERMIT, , ,.,i.
'or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING_`AND SAFETY
_ t .
copy thereof(Sec.3800,Laabb/pC.)
POliby N0�7 apmpany" � � FOR APPLICANT TO-FILL IN- '' '"JO
y ADB
-JOB' 47/� fp
❑ Certified copy is herebyfurnished. " EACH' NO. FEE ADDRESS L 5
New Residential Bldgs.& Pools
1 &2-Family,Sq.Ft
❑,�;Certified 'copy is filed with the county building inspection LOCALITY `
. $ — $
,
department :.L �� Multi-,family Sq Ft. — NEAREST
ti CROSS S7
Residential Swimming Pools , '
Date Applicant - OWNER OR F '
CERTIFICATE OF EXEMPTION FROM WORKERS' � : L FIRM NAME G.
Outlets.Re Light gw MAIL n
COMPENSATION INSURANCE '• O �� 6O ADDRESS '1 - .• .• ,
(This sectlon need.not be completed if.the work involved by the / First 20" ti
Total,No 1 Additional• ClTY., e No
• •.,permit,is-for<one;hundred dollars,($100)or less.)r•, .. � � � .•�C' Z
I'certify that"in the performa rice of,the work for which-this permit .. PLAN CHECK
-is.issued,'Iem to•shall-notany -' APPLICANT
� p y person,in•any manner so as to ,
'become subject to.the Workers:Compensation Laws Lighting Fixtures, ' First 20 ADDRESS
Additional; �' )
/ a Total No__ CITY Tel.No' "
Date. Applicant,, -,, Fixed Appliances"Not Over 1 HP r _
^NOTICE. TO APPLICANT.•If,'_after, making this' Certificate of- PERMIT
APPLICANT e 1
Exemption,you;should become subject to the Workers"Compensation Range Heater_ D.W. t/
•provisions of the.Labor.Code, you must forthwith,comply with•such, Oven'— Dryer = W.M ADDRESS -a
provisions or this permit shall be deemed revoked. :Top. FAU WH
CITY No "�
LICENSED CONTRACTORS DECLARATION Hood Fan Other'
4A,fin
I hereby-affirm that.I am.licensed-under.,provisions±of,Chapter 9 LICE E R
— REG NUMBER
(commencing wdh Section,7000) of Division 3 oftthe Business;and Disp:•, Room Air Cond. Class
Professions Code,'and my license.is in full force'and'effectDISTRICT NO P C SED BY
Power Apparatus&•Large Appliances w
e ' Size&Type.HP,KW,KVA,or KVAR „�Qr�
ZL
License Number 7 Lic Class Up to 1 Incl FINAL - V
�.- c• Over 1 to 10 Incl DATE 7 d -
.Contractor !1 Date - -t!'v v- VALIDATION'.° 0
❑ f! , TOver 10 to 50 Incl. FINAL M U
I am exempt under Sec.. Over.50,to 100 Inc. BY• W .
B&P.C.for this reasoh ' Over 1,00 N
,.: Services,Swbd,MCC"& Panelboards_ oil, Z
Date 0: 200 Amp.Under 600 V
Signature �y 201'- 1000 Amp Under 600`V
❑ . Over 1000 Amp or-Over 600 V' y
Exemption for Reg.Mairit,Elect
SINGLE FAMILY Temp. Power Pole,8R,Appurtenances
HOME OWNER-BUILDER DECLARATION Sign.with One Branch Circuit n K
I hereby affirm that I am exempt from the Contractor's License Law f , 1, I� .•
for the following.reason(Section 7031 5,Business and Professions Additional Sign Branch"Circuits _ r
Code) t T I_;#HEL 62-' '15
1
❑ Misc.Conducts &Conductors` s ' °• " 1-7, F
I,as owner of the property,will do the work and the structure C.H-E�A• D•'=°i'
is not intended or offered for'sale (Section 7044, Business Other (See Complete Fee Schedule) ►
,and Professions Code) -
CONSTRUCTION LENDING-AGENCY . --
I hereby affirm that there is a-construction lending agency for the % i ift^f!i t?1] i v / _`
:.,p'erformance of'the'work for which this permit is.issued(Sec 3097, PERMIT FEE (Sub-Total),
Civ C)
). 5t �
'PLAN CHECKING FEE-
Lender's
EE Lender's Name`
PERMIT ISSUING FEE a,
Lender's Address s '7
I dertify that I have read this application and state that the above TOTAL FEE
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 the above-mentioned
property for nsp tion purposes
SEE,REVERSE FOR EXPLANATORY LANGUAGE
Signature -Permittee Date
WORKERS'COMPENSATION DECLARATION 76A663 10/81
J hereby-affjrm that I have;a certificate of consent"to,self insure, CE-Bose APPLICATION FOR E LE CTR I CAL PERMIT
or,a certificate of Workers' Compensation Insurance, or a certified_ COUNTY OF LOS ANGELES BUILDING AND SAFETY ''•
copy thereof(Sec 800,LabC.) C/� ��/��' 1 + 4• y! y IN c,,,• i
Policy No. lCbmpany.? t'C+�I V �/• . FOR APPLICANT,TO FILL IN . _ JOB /'t/ �' V•f (//7 J '� r
Certified copy is hereby furnished New Residential Bldgs & Pools
EACH' NO' . FEE ADDRESS'.
:u $ — $ LOCALITY,_ .
Certified copy„is, filed with, the county budding inspection 1 & 2-Family;'Sq.Ft
a^'
department'., 4•'. Multi-family Sq Ft., — NEAREST
CROSS ST
Date v Residential Swimming Pools -
OWNER OR
APPIiCarit •3i .., t S°w FIRM NAME
C RTIF-CATE OF EXEMPTIONfF.ROM WORKERS' Lig
.' Outlets Rec hw. MAIL
'�i 1� •' �COMPENSATIOWINSURANCE. .;"i., ,p ADDRESS. 0S
„(This section need not be completed If the work involved by the First 20
permit is for one hundred'dollars($100j or less.)• ,
Total No ', '.Additional, S O CITY ' G j — Tel.No.Z�
I, PLAN CHECK
certify that in the,performance of the;work.for which,this,permit '
.is issued, I'.shall not"employany person.m any manner so,as to • - APPLICANT
become subject,to the Workers'"Compensation Laws Lighting Fixtures First 20 - ADDRESS +•-
d
Total No. Additional �,' CITY Tel NO•`,.-
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO ,APPLICANT. If,, after.,:making-this Certificate of
Exemption,you should become subject to.the,Work'ers'Compensation Range_ Heater_ DW APPLICANT
provisions of the Labor Code, you.must-forthwith comply with such Oven _ Dryer _ -W M ADDRESS
provisions or this'permit shall lie deemed revoked Top,. '— FAU W H-'
,,LICENSED CONTRACTORS DECLARATION'i Hood Fan Other_ CITY No
I hereby affirm that I arn,licensed under•provisions,'of Chapter 9 LICEN EOR /
Disp Room Air Cond S < Class.��
(commencing with Section 7000)`of Division 3 of the Business and REG NUMBER
Professions Code,and my liberiS in full force and effect \ DISTRICT NO PROCESSED BY
Power Apparatus& Large Appliances O�
'�/ Size & Type,HP,KW;KVA,or KVAR
License Number 599yI�� Y/p� LiC.Class -Up to 1 Incl' FINAL U
�-Over 1 to 10 Incl. DATE VALIDATION
Contractor Date
Over 10 to 50 Incl ,'•• FINAL V
I am exempt under Sec. Over 50 to 100 Inc BY W
B&P.C,for this reason Over 100 N'
Services, Swbd, MCC'& Panelboards , Z
Date: 0- 200 Amp Under 600 V
Signature• 201-'- 1000 Amp Under 600 V. -
' P Over 1000 Amp or Over 600 V
'Exemption for Reg'Maint Elect '
SINGLE FAMILY Temp.Power Pole& Appurtenan_ces "
`HOME OWNER-BUILDER DECLARATION
Sign with One Branch Circuit i;..,.;,• _ -
I hereby affirm that I am exempt from th-e'Contractor's License,Law F, ¢•i?_� p,
for the,following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 4
Code) . ?y.3 i:•:a "�
- Misc Conduits&Conductors
�E
0 I,as owner,of the property,wll do,the work and the structure _ t i
is not intended or offered for sale"(Section 7044, Business Other(See Complete Fee Schedule) + w
and Professions Code) HL
.\ - f•.f«e••..r�J: may' ":.•.
CONSTRUCTION LENDING AGENCY '••'�i.�="•
i
,I-hereby affirm that there is a constructiori lending agency'for the
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) - D
Civ.,c'> �"
PLAN CHECKING FEE .
Lender's Name qq
PERMIT ISSUING.FEE ¢, �_ f i, O+ tNl f.�
Lender's Address a. — 3; -'s s f sib
I 'ertify that I have read this appiication,and state that the above TOTALFEE
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 en upon the above-mentioned
property f inspects n purposes SEE REVERSE FOR,EXPLANATORY LANGUAGE'
wv0 ;
,Signa ure of Permittee Date
WORKERS'COMPENSATIONDECLARATION 76A663 APPLICATION FOR ELECTRICAL PERMIT'
CE-806G (2-80)
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 certified copy thereof(Sec. 3800, Lab. C.)
FOR APPLICANT TO FILL' IN SOB
Policy No. Company EACH NO. FEEADDRESS
New Residential Bldgs.&Pools
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. — NEAREST
Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST -NC I A117A
department OWNER OR
FIRM NAME
Date Applicant Outlets 'Rec.—Light— Sw • ADDR
First 20 ESS al Ror4, 2
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional
COMPENSATION INSURANCE CITY CMPLO Tel No. 5 3/05-
PLAN CHECK O
,(This section need'not be completed if the work involved Lighting Fixtures' First 20 APPLICANT U
by ,the permit is for one'hundred 'dollars ($100) or less.) Additional .ADDRESS
Total No. O
I certify that in the performance of the work for which thisFCITY Tel No. U
ixed Appliances Not Over 1 HP
permit is issuedr - ,s–
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT
Oven Dryer_W.M._ CI
Date Applicant s Top FAU —W.H. — ADDRESS ��O a / Z
Hood _.Fan _Other_ CITY GJ��f�� Tel No
-NOTICE TO APPLICANT: , aft akmg is Certificate of Disp. _ Room Air Cond LICENSE OR
Exemption,' you should become subject to the Workers' REG.NUMBER Class 6-1 O
'Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW, KVA,or'KVAR i 7
Up to 1 Incl. FINAL
Over 1 to 1 0 Incl. DATE
LICENSED CONTRACTORS DECLARATION �J r VALI DATION
Over 10 to 50 Iricl. / '
I hereby,affirm that I am licensed under.provisions of Chapter Over 50.to 100 Inc. FINAL
BY rV//
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100
ness and Professions Code, and my license is in full force and
effect. - Services
License Number Lic.Class G� 0-200 Amp. Under 600 V
201-1000 Amp. Under 600 V y t ^� R q
Contractor%�� Date 6 �� Over 1000 Amp.or Over 600 V. ;�, 't 9��,�
HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances (S
I hereby affirm that I am exempt from the Contractor's Sign with One Branch CircuitAdditional.Sign Branch Circuits �'•
License Law for the following reason (Section 7031.5, Busi- ,
ness and Professions Code):
Misc.Conduits&Conductors
I, as owner of the property, will do the work and,theOther (See,Complete Fee Schedule)= –Z�
'structure is not intended or•offered for sale (Section Comp ,
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm tFiat there is a construction lending agency
for ,the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued (Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit'Fee)
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE
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
the ab e-mentione property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
gnat e o Per t o e