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76A663-CE;B06 '10/72 APPMCQMN F ° f L EC TR AL PERNU
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ADDRESS LLQ
BUILDING AND SAFETY DIVISION /
LOCALITY _ fJ'� L 0L
NEAREST FOR APPLICANT TO FILL IN CROSS ST
L"! 0'
OUTLETS NO EACH FEE OWNER OR
$ $ FIRM.NAME 19 CIA O
RECEPT MAIL ••
ogy
LIGHT� TOTAL
FIRST 20 �2� ADDRESS Z V` !4
CITY i TEL NO
SWITCHOVER 20_ 10 PLAN CHECK _
LIGHTING TOTAL FIRST 20 25 !? APPLICANT
(• _
FIXTURES Lo
10
VER 20 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL NO
PERMIT /
RANGE DRYER_WTR HTR APPLICANT
STA 'COOK DISP F A U ADDRESS Z �jPJ,�JQ�Q
SPACE HTR AIR COND _CITY * TEL NO �7�YrLrI
CLOTHES WASH DISHWASH LICENSE OR
REG. NUMBER CLASS.
FAN OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE'ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS, ETC HP KW KVA ELECTRICAL WIRING
SIZE & TYPE OVER TO
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 •1 00 LICENSED AS REQUIRED BY'LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I 'AM THE LEGAL OWNER OF THE ABOVE r
1 - 10 300 PESrRIf,ED RESIDENTIAL PROPERTY d
O
V
10 — 50 500 PERMITEE SIGNATURE, R__VrLI=
O
50 — 100 1000
DISTRICT NO J OCE ED BY ,W
100 — 500 1500
� N
Z_
SIGN, GAS SIGN AND ONE CIRCUIT 500 APPROVALS DA INSPECTOR'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE
SERVICENOTOVER600VOLTS OR200AMP 300 UNDERSLAS WORK
SERVICEOVER 600 VOLTS OR 200AMP 1000 ROUGH CONDUIT _
TEMPSERVICE,POLE, &APPURTENANCES 500 WIRING -Z3-���
TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES ,
POWER AUTHORIZED
UTILITY,CO. NOTIFIED
FINAL
PERMIT FEE. (SUB TOTAL) NOTES
PLAN CHECK FEE
I I I
PERMIT ISSUING FEE 300 ms 0
TOTAL FEE 10
PLAN CHECK VALIDATION CK M 0 CASH 'PERMIT VALIDATION CK M 0 CASH
80AR 19 6.10
U
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE V
76A6g3=CE806 11170 APPMCAMW FOR ELECTUC AL pC QlMl�4
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
COLEMAN W. JENKINS SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL,IN CROSS ST
OUTLETS NO EACH FEE
OWNER
RECEPT.7 MAIL '
FIRST 20 ADDRESS
LIGHT TOTAL ` 25
A.
�j OVER 20 CITY TEL NO
SWITCH-3/ 4 10 PLANC HECK
LIGHTING TOTAL ��O
,
FIRST 20 25 7 APPLICANT
FIXTURES
VER 20 10 ADDRESS
,
APPLIANCES CITY TEL NO.
PERMIT
RANGE DRYER WTR. HTR, APPLICANT '
STA COOK DISP F A.U. ADDRESS
SPACE HTR. AIR COND - - CITY -C _TEL NO. '���-,�pll)
CLOTHES WASH DISHWASH. LICENSE NO_26 �_ CLASS. C-/(�)
FAN OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE 'READ THIS APPLICATION
AND STATE THAT THE IABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS, ETC HP KW KVA ELECTRICAL WIRING'
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO }
1 - 10 300 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL P OPE TY d
10 - 50 500 SIGNATURE V
OF PERMITTEE
50 - 100 1000 DISTRICT NO CLASS ZONE ,P 2 36 Y 0
100 - 500 1500 0 a
SIGN', GAS SIGN AND ONE CIRCUIT 500 NOTES: N
Z
TUBE, OR -
MARQUEE ADDITIONAL CIRCUITS 100
SERVICENOTOVER600VOLTS OR200AMP 300 3
APPROVALS DATE INSPECTOR'S SIGNATURE
S ERVI CE OVER 600 VOLTS OR 200 AM P 1000
TEMP POWER POLE
TEMPSERVICE,POLE, &APPURTENANCES 500
UNDERSLAB WORK
TEMP LIGHT OR RECEPT SYSTEM 300
ROUGH CONDIUT
WIRING
FIXTUREIS
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL) _
UTILITY CO NOTIFIED
PLAN CHECK FEE
FI NAL 8
PERMIT ISSUING FEE 300
J091EPIA C. ROO
TOTAL FEE SUPERVISING ELE T•RICAL ENGINEER,
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION cK M o CASH
Lial,o `= 8 1 5 DEC 31 2 D 10.00-
SEE
0.0ONSEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
76AIS63 DBS 5A 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ApagmEM&I AMA
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRIC O. GROUP ZONE PERMIT NO.
FOR APPLICANT T FILL IN Gq
ELECTRICIAN RECEIVED BY READY FOR DATED ISSUED
ADDRESS. fz FIRST INBPECTION
CITY / TEL N0:
COUNTY LICENSE NO. E X P I R E B / �-^ BUILDING -
PERMIT FEES ADDRESS
FEE LDcnuTY ��'1
NUMBER EACH
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES f
WALL SWITCHES OWNER
TOTAL OUTLETS 5c $ J MAIL -
ELEC. RANGES' 25 ADDREB8
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES 6 I HEREBY ACKNOWLEDG THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LE AL OWNER
NEw MVD. HP OVER INC. EACH J QF THE RESIDENTI V
RTY ESC fBEP BOVE.
I/ a LESS $ .25 SIGNATURE OF '
I/2 2 .50 PERMITTEE -
2 s 1.00 INSPECTION RECORD
5 is l.so
15 50 2.50
50 200 5.00
200 500 10.00 J
500 1000 15.00 Z
NEI I OVER 1000 20.00 0
M.G. SET/FREQ. CHANGER-HP R'
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS- KVA
TEMP. MOTORS (75% OF ORIG•)
MOVED MOTORS (75% OF ORIG.) -
MISC.
SIGNS
NO. NO.TRANS.
' APPROVALS
NO. NO. LAMPS I d
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.130 0"0 CONDUIT /
FIXTURES $1.00 (� WIRING t� i
SUPPLEMENTARY ,50 FIXTURES
h POWER
TOTAL FEE $ v UTILITY CO.NOTIFIED
FINAL
76A663-CE806 8-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER fNEA
UILDING r,
BUILDING AND SAFETY DIVISION DDRESS C e U /4
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING OCALITY
REST
FOR APPLICANT TO FILL IN ROSS ST. Cg W
RECEPT TOTAL NO. EACH FEE r [ )
OUTLETS FIRST 20 $20 $ r OWNER i l r` N
LIGHT MAIL
p ADD'L ADDRESS /`\ L r `��J
SWITCH / OVER 20 .10
47 11
LIGHTING )Ij TOTAL FIRST 20 20 CITY ~LPI C TEL NO. l ZCJ�
FIXTURES I ADD'L 10 ELECTRIC)
111 O V R 20
RANGES CLO DRYERS ' WTR HTRS 1.00 ADDRESS
GARB DISP. STA COOK
CITY
DISHWASH AUTO-WASH STATE
SPACE HTRS - STA.APP.('/x H.P.MAX ) 50 LICENSE NO.
MOTORS --OVER NOTOVER H P. - - - -DISTRjr-T NO, GROUP ZONE PR BY
0 1 1.00 rNF
1 s 150 INSPECTION RECORD
s 6 200
8 Is 2.50
15 50 3 00
D_
50• '100 500 0
SIGNS- NO TRANS
NO LAMPS 0
O
SERVICE 0.60OV-NOT OVER 200A 1.00 ri
SERVICE 0.60OV-OVER 200 A. 2.00 D'
t�
SERVICE OVER 600V 5.00 ?
MISC.
PERMIT ISSUING FEE 200 "
SUPPLEMENTAgY PERMIT ISSUING FEE 100
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE - INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING /�Q 1
1 HEREBY CERTIFY THAT t AM PROPERLY REGISTERED AND/OR
LCA
ED A9 REQUIRED BY L09 ANGELES COUNTY AND STATE OF FIXTURES
RNIA OR THAT 1 AM LEGAL OWNER OF THE ABOVE ,
BED RESIDENTIAL PP Y POWER
TUREUTILITY CO NOTIFIEDRMITTEE ,p,
FINAL ✓[3 -
VALIDATIQN--)// ARTHUR C. VEIT
CK MO I(CASH
SUPERVISING ELECTRICAL ENGINEER
� y 0 7.4 31121 SEP 26 2 Q 2.20- cc
U wla
` O
WORKERS' COMPENSATION DECLARATION 76A66310/81
CE-806G n PP CnMN FOR E 5CTMICAL P2Rr
kl hereby'affirm that I have a certificate of consent to self
insure!or'a cgrtificate of Norkers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
r a- tified copy thereof (Sec 3800, Lab C ) -
Pol� No[,IFIL—Company �f`f/� ,V F,OR APPLICANT TO FILL IN IOB l �e � 11CCertified copy is hereby furnishesNew Residential Bldgs & Pools EACH NO FEE ADDRESS A4
—
Certified copy is filed with the county building4nspec- 1 $ 2-Family, Sq Ft $ $ LOCALITY— ,
tion department Multi-family Sci Ft NEAREST
a �l Residential Swimming Pools CROSSST
OWNER OR
Date- Applicant -e
FIRM FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light I Sw Z MAIL
COMPENSATION'INSU RANCE First 20 ADDRESS
(This section need not be completed if the work Involved by Total NoAdditional CITY r Tel No
the permit is for one hundred dollars($100)or less.)
that in the performance of the work for which this PLAN CHECK
I certify p APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS
Additional
Applicant Total No CITY i, %, Tel No-
Date Fixed Applionces'Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, after making this,Certificate of APPLICANT
Exemption, you should become-subject to the Workers' Range_ Heater_D W —
Compensation provisions of the Labor.Code, y'ou must fortK- Oven = Dryer W M - ADDRESS eli., ,�d^/ i✓c,ivi')`�
with comply with such provisions or this permit shall be Top FAU W H 9
deemed revoked Hood Fan _Other,_ CITY 7'—�7 .. Tel No j�f
LICENSED CONTRACTORS DECLARATION, LICENSE OR �+
I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond REG NUMBER d 3 7 ,] Class C 3
(commencing with Section 7000) of Division 3,of the Business DISTRICT NO PR OC SSED,BY
and Professions Code,and my license is in full force and effect Power-Apparatus& Large Appliances Ste` & 9L
Size &Type HP, KW, KVA, or KVAR °i O
License Number 0137315- Lic Class 3 Up to 1 InclFINALE ti
Over 1 to 10 Incl DAT
Contractor �Qr�Q� Date
❑ Over 10 to 50 Incl FINAVirr�� LUV
I am exempt under Sec Over 50 to 100 Inc BY �1/
CL
B &P C for this reason Over 100
Services, Swbd , MCC & Panelboards
91 #
^ 7 87A Date 0 -200 Amp Under 600 V � ,` 0 0 0 0 0 21
Signature 201 - 1000 Amp Under.600 V
aOver 1000 Amp of Over 600 V 1 -o - 23,25
Exemption for Reg Maint,Elect
SINGLE FAMILY Temp .Power Pole&Appurtenances o,o,0 2 3.2 5 6
HOME OWNER-BUILDER`DECLARATION, Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License '0�Q 0 0 8 8
Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits
Professions Code)
I, as owner of the property, will do the work and the Misc Conduits &Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— D
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 permit is issued PERMIT FEE (Sub-Total) 2 ,
(Sec 3097, Civ 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
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 bove-mentioned property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE _
Akwzor� X 7
Signature of Permittee Date
' o t
TION
76A66
CVOrr ERiv I have a certificate
of corse CE-806 10/81 APPUC AMN FOR ELEC�UMC AL PERMU
y,ffrcm feat I have a certificate of consent to self CE-8066
c� or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING ARID SAFETY
or a certified copy thereof (Sec 3800, Lob C ) 111
Policy No S�C ompany 'V V0FOR APPLICANT TO FILL IN JOB
Certified copy,is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS
❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq Ft $ — E LOCALITY
do/department Multi-family Sq Ft — 'NEAREST
/�.- CROSS ST
!� Residential Swimming Pools OWNER OR
Date Applicant FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL.
Outlets Rec Light Sw_
COMPENSATION INSURANCE ADDRESS I/Z E- ac- d4/r
s section neenot completed if the work involved b First 20
(Thitid t b
p Y Total No Additional CIT Tel No'
the permit is for one hundred dollars ($100)or less.)
I certifythat in the erformance of the work for which this PLAN CHECK
P APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 - ADDRESS
Additional i
Total No CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, after making this Certificate of APPLICANT
Exemption, you should become subject to the' Workers' Range_ Heater_D W _
Compensation provisions of the Labor Code,you must forth- Oven' _ Dryer — W M _ ADDRESS w,7 So, 04
with comply with such provisions or this permit shall be Top — FAU —W H —
deemed revoked CITY Tel NO
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other—
Disp _ Room Air Cond LICENSE NU R EPs�q• Class
j hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER r,(
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCESSED BY
and Professions Code,and my license is in full force and effect Power Apparatus& Large Appliances , >_Size&Type HP, KW, KVA, or KVAR �� �(� 0.
License Number Lic Class Up to 1 Incl — FINAL FINAL
Over 1 to 10 Incl DATE �, Im
VALIDA Id
Contactor Date ~
Over 10 to 50 Incl
FIN
A
❑ I am exempt under Sec Over 50 to 100 Inc BY LU
Over 100
B&P C for this reason 7 of
Services, Swbd , MCC& Panelboards D rL� a� Z
Date 0 -200 Amp Under 600 V `
Signature 1201 - 1000 Amp Under 600-V t ,
❑
Exemption for Reg Mamt Elect Over 1000 Amp or Over 600 V o 0 0j {
=• `
U
SINGLE FAMILY Temp Power Pole &Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0 4, O 9—8 5
I hereby affirm-that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for;the following reason (Section 7031 5, Business and
Professions Code)
❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors
structure is not intended or offered for sale (Section Other (See•Complete Fee Schedule)— D
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 permit is issued PERMIT FEE (Sub-Total)
(Sec 3097, Civ 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
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-mentioned property for inspects n purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee <1 Date
WORKERS'COMPENSATION DECLARATION 76A663 nfl%
CE 806G (2-80) Ar HICAT�WON FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of~consent'10 self COUNTY OF LOS•ANGELES G 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 AD " z— /
Policy No V .Company EACH NO FEE ADDRES � „�1� [� •
❑ New Residential.Bldgs &Pools
Certified copy is hereby furnished. 1 &2-Family+Sq Ft $ — $ LOCALITY
❑ Multi-family Sq Ft. NEAREST �9
Certified copy is filed with the county building inspectionCROSS ST t0
department7 �(✓t
Residential Swimming'Pools
OWNER } y1� w7
FIRM NAME
Date Applicant Outlets RecZ—Light2ZSw A-1 ,6o v MAIL �]!)
First 20 "ADDRESS v/v
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No �� Additional CITY C Tel No
COMPENSATION INSURANCE
PLAN CHECK O.
(This section need not be completed if the work involved APPLICANT O
Lighting Fixtures First 20 ; ,
by the permit is for one hundred dollars ($100) or less.) ADDRESS
Additional Cr
Total No CITY Tel No O
I certify that in the performance of the work for which this
Fixed Appliances Not Over 1 HP I'
permit is issued, I shall not employ any person in any manner PERMITU
so as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT W
• a
Oven _ Dryer_W M ADDRESS U!° Z
Date Applicant Top _ FAU _W H
Hood Fan _Other CITY Tel No 7
NOTICE TO APPLICANT. If, after making this Certificate of -Disp.-� Room Air Cond-�G 2-n° ENSE OR
Exemption, you should- become subject to the Workers' REG NUMBER Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PRO SSED B.l
with comply with such provisions or this permit shall be
deemed rbvoked Size&Type HP, KW, KVA,or KVAR
Up to 1 Incl
Over 1 to 10 Incl FINAL
•LICENSED CONTRACTORS DECLARATION DATE VALIDATION
• Over 10 to 50 Incl
I hereby affirm that I am licensed undei provisions of Chapter Over 50 to'100 Inc FINAL
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 0-200 Amp Under 600 V-
201-1000 Amp Under 600 V
Contractor Date Over,1000 Amp or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code).
Misc.Conduits&Conductors 9 3 8 319 A
as owner of the property, will do the work and the Other (See Complete Fee Schedule)— -
structure is not intended or offered for sale (Section #.010'0 0 0 2
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY 2+0 0
33,
1.0
I hereby,affirm that there is a construction lending agency .
for the performance of the work for which this permit is PERMIT FEE (Sub-Total) o!0`0 3 11 Q v
issued'(Sec 3097,Civ C) S� , -
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) l) 3 O—8 2
Lender's Address PERMIT ISSUING FEE lJ
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
t ove-m on G proper for inspection pur=os SEE REVERSE FOR EXPLANATORY LANGUAGE
1 � �
Signature of Permittee Date