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HomeMy Public PortalAbout9508 LAS TUNAS DR_Electrical__ °B 8-A 4 .41 25M APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE Pj�ER'MIT NO. WIRING FIXTURES SERVICE • vim'- "' RE Q"'IVE _.BY READY FOR DATE ISSUED RANGE HEATER POWER FIRST,1NWCTION SIGNS MISCELLANEOUS C,(+���a'•h / APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB Q NAME 20th Century Lites ,Inc. ADDRESS 21062 E. Las Tunas, U ADDRESS 3200 Sol Grand Ave• LOCALITY Temple City, Calif. tr U NEAREST &5-rws�F- W CITY Los An eles TEL.NO. PR-3161 CROSS ST. PR1A„Ro6 `p' &,(d —COUNTY ,QYlS� 6. CERT.O.5$5.: ..L EXPIRES 1PI' "47 m NAME Bragg T s. DESCRIPTION OF WORK 3 MAIL ADDRESS 30-,Xest.9a.iy-S'treet NUMBER OF OUTLETS ON CIRCUITS Oy, _ AA LOCATION BY ROOMS CITY Alhambra,•_ TEL.NcAT.10762 LIGHT OUTLETS SW. PLUGS Flsr. I AM THE LEGAL PO ESSO THE A VE LOS CIRCUIT A B C D E F G H ---------= ANGELES COUNTY CERT I AT F UALIFI IN. LIVING ROOM ELECTRICIAN. ---------- 1 AM THE LEGAL OWNER OF E PROPERTY DESCRIBED DINING ROOM ABOVE. BRFST.RM. _________ OWNER. BATH ---------- CORRECTION'S ENT.HALL HALL NO. FRONT PORCH OUTSIDE . . KITCHEN SERV.PCH. -------_-- - "I BDRM.NO. Z CLOSET Q' BDRM.NO. CLOSET --------- .Tarr. TOTAL NO. OF OUTLETS b APPROVALS NO.�OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS 1 TRANS. 2 $ Q WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ ,►�1 POWER t� PERMIT FEE $ �o1 UTILITY CO.NOTIFIED I TOTAL FEE S y FINAL DBS-SA I1-55� APPLICATION! ION F®R ELECTRIC ■ ERMI E 1 DBS-5A DIVISION OF BUILDING AND SAFETY Department of County EngineerL4M C jCounty of Los Angeles �� �JOHN A. LAMBIE. COUNTY ENGINEECASSATT D. GRIFFIN, SUPT OF BUILDING 0FOR APPLICANT TO FILL IN PERMIT FEES NUMBER OWNER & Z�Z LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES FEE CITY 7: TEL.NO. TOTAL OUTLETS @ 5¢ $ ELEC R IIAN ° a EC. RANGES 25 ADDRESSZ 7� •�/'�'� ���/� / I�'/y EC. HEATERS 25 KW EA CITY ��z 4X04-" TEL. N9656-:S STATE ty FIXTURES 5 LICENSE NO. ��✓ MOTORS DISTRICT Ny GROUP ZONE4 READY FOR INSPECTION NUMBER HORSEPOWER FEE NEW MVD. HP OVER INC. EACH 1/2&LESS $ zs INSPECTION RECORD 1/z 2 .50 . Ej 4 1456 2 5 1.00 5 15 1.50 15 50 2.50 50 1 200 5.00 misc. NO. SIGNS NO.TRANS. NO.SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ `�� DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT+AND AGREE TO COMPLY CONDUIT 1 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1.HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL € UTILITY CO.NOTIFIED SIGNATURE �^ OF PERMITTEE FINAL 2s JOHN A.LAMBIE.COUNTY ENGINEERMO ATION ARTHUR C.VEIT.CHIEF ELECT.INSPECTOR CK CASH 4�_ACo 6 5. 1 5 RV 2 9 2 1 .0 0 >n r . 76A663-CE806•9-6Z APPLICATION FOR ELECTRIC L PERMIT r r r COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. i NO. EACH FEE $ $ OWNER RECEPT`_ MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS �} SWITCH_ OVER 20 .10 CITY TEL. NO. C LIGHTING �TOTAL FIRST 20 .20 CONTRACTOR FIXTURES OVER 20 .10 ADDRESS �d �O RANGEDRYER—WTR.HTR._ CITY ( ` III TEL. NO. ��''� / STA.COOK_DISP. F.A.U._ LICENSE NO. , 3_ fv SPACE*HTR. AIR COND. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CLOTHES WAS H._DISH WAS H._ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. FAN-OTHER 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF MOTORS,TRANSFORMERS RATING CALIFORNIA OR THAT I AM THE LEG OF, AND INTEND TO IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE ESC R ENTIAL PROPERTY. SIZE.& TYPE OVER TO - SIGNATURE O .1 7' 1.00 !ZO OF PERMITT d 1 - 103.00 - 00 DISTRICT N . GROUP ZONE P OE SED u 10 - 50 5.00 r © W O 50 - 100 10.00 NOTES: / V 100 - 500 15.00 1 a TUBE, A SIGN AND ONE CIRCUIT 3.00 MARQUEE ADDITIONAL CIRCUITS 1.00 I SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 2 D SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT ISSUING FEE 2.00 WIRING FIXTURES SUPPLEMENTARY ISSUING FEE 1.00 POWER AUTHORIZED PERMIT FEE UTILITYCO.NOTIFIED ®, PLAN CHECK FEE (50% PERMIT FEE) FINAL o TOTAL FEE 9 9 1 B O JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 3:6 0_� : ice. 2 p LAW Y� �� M 3EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE .. 76A663-CE806 3-64 APPLICATION FOR -ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING - BUILDING AND SAFETY DIVISION ADDRESS �J JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY NEAREST . FOR APPLICANT TO FILL IN CROSS ST.- RECEPT. TOTAL NO. EACH FEE ' OUTLETS FIRST 20 $20 $ OWNER . LIGHT MAIL y+ ADD'L .10 ADDRESS 'f' !� . SWITCH.. _. OVER 20 CITY, I TEL. NO. LIGHTING TOTAL 1 FIRST,20 .20 FIXTURES J( ADD'L1O ELECTRICIAN OVER 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK - s CITY -7y... TEL. NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(ys H.P.MAX.) -Sp LICENSE NO. /Z MOTORS: OVER NOT OVER H.P. DISTR_J.Cj IjLO. GROUP ZONE P ESSED B O 1 1.00 �/ 1 3 1.50 INSPEETION RECORD 3 8 2.00 0 8 15 2.50 dw O 15 50 3.00 V uj 50 100 5.00 0. SIGNS: J NO.TRANS -' _Z NO.LAMPS SERVICE 0.60OV-NOT OVER 200A 1.00 SERVICE 0.60OV-OVER 200 A. 2;00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTA@Y PERMIT ISSUING FEE 1.00 TOTAL FEE $ 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 - - ...y.Jl.— WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY',REG I STEREO AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALILOS OR THAT I AM TE LEGAL OWNER OF THE ABOVE - DESCRIBED RESIDENTIAL-PROPERTY. POWER SIGNATUREUTILITY CO.NOTIFIED �y/ � sL t✓ OF PERM ITT FINAL VA ATI ARTHUR C. VETT CK MO r2ASH SUPERVISING ELECTRICAL ENGINEER L;�o6 2 8 0-0 NOV 3Q . 2 D 3.5 Or, oB 5-A ,z-aa ssM 4 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC; COviJNTY OF L ,,S ANGELES y V1%M. J..FOX CHIEF ENGINEER/f Zx � DISTRICT NO. GROUP ZONE PERMIT NO. Q NAMEk K `/IB/// /,,'yj �i�I 9• / / j r v ADDR 8 /R �f Z't9✓%Fr9,9 .qtr' ��jj� �^� a� fA v a,/,/. RECEIVED BY READY FOR DATE ISSUED CITY Al/ R i Y,�J""�iF ;PTEL.NO. ry� FIRST INSPECTION WCOUNTY! 1 tJo-��y-rum CERT.NO. i EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTIONJOB �- DESCRIPTION OF WORK ADDRESS � �l NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST `f LIGHT OUTLETS SW. PLUGS FIZT CROSS ST. CIRCUIT A B C D E F G H m NAME ✓/9f11/Al+� �, //y9/ir : .� c�,- Z .MAIL Jt d1�'/l i SS ADDRE��.,f�J�,� qqR/IItt lA�//t 1 O CITY i�C✓P�/Vv&�i! / ZA`TEL.NO. 1 AM THE LEGAL POSSESSOR:70F THE AB0,VE., LOS ANGELES COUNTY CERTIFICAT�i�b���N.. ELECTRICIAN. 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE 1.0 / OWNER. CORRECTIONS Tiw&a 1 V 0 J Q _Z [7 . 0 r TOTAL _lg 6 NO. OF OUTLETS $ 00 APPROVALS � NO. OF FIXTURES ,f $ ' J DATE, INSPECTOR'S*NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS/ TRANS. $ WIRING /i✓fi`�/ // i NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE {�� P- �_� $ UTILITY CO.NOTIFIED TOTAL FEE /` 9V FINAL - ." "- WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate.pf Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy[hereof(Sec. 3800 Lab.C.) m. Policy No._� ��Company ye � FOR APPLICANT TO FILL IN JOB ADDRESS s !� ❑. Certified copy is hereby furnished. �� /7 New Residential Bldgs.&Pools NO. EACH FEE ^/ _ $ $ LOCALITY C ,�t✓� lyj Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. NEAREST department.. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESS K PAGE 1PARCEL CER IFICATE OF EXEMP ROM WORKERS' OWIIER oR COMPENSATI N SURANCE Outlets:Rec. Light Sw. n�1 FIRM NAME First 20 D'v MAIL (This section need not be com ted if the work involved by the f' ADDRESS permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY ` Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT y p p y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT c LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. J' Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICE } Over 50 to 100 InSE OR CI. REGNNU BER L Class. // a Lic.Class ��O OVP,r 100 DISTRICT NO. P C SED BY CS O License Number y�y Sery/�QQ / f. &Panelboards 2 Q Contractor�^_' y(C�L ate �l/b/�'U�39T'"mp.Under 600 V DATE FINAL O ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V 5- W Over 1000 Amp.or Over 600 V FINAL VALIDATION B'.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A, 120V,Lighting or Recept Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.CircuitsE ,r rr T 2 SINGLE FAMILY. Temp. Power Pole&Appurtenances ACCT.nIr HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ii�t 100o0�^ 0 I hereby affirm that I am exempt from the Contractor's License Law 3303 for the following reason (Section 7031.5,_Business and Professions Additional Sign Branch Circuits i ITU Code): 1 �-tpI d�-s�h ❑ I,as owner of the property, will do the work and the structure Misc.Conduits&Conductors TOTAL .JL 00 -00 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , r i j0l`st�! and Professions Code). CASH .00 CONSTRUCTION LENDING AGENCY CHANGE .00 I hereby affirm that there is a construction lending agency for the' performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) b% 3/96 PLAN CHECKING FEE � p 8:29 Lender's Name V PERMIT ISSUING FEE 50 Lender's Address �I` I certify that I have read this application and under penalty of purjury state TOTAL FEE / V, . that the 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 above-mentioned property for inspect purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE w SIG RE OF PERMITTEE TE ' . WORKERS' COMPENSATION DECLARATION 76A669oPw3ia7 APPLICATION FOR ELECTRICAL PERMIT O I hereby.:affirm that.I have a certificate of consent to self CEsoaG 'insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a Ice,rtifi6d copy thereof (Sec. 3800,,Lab. C. p�-�-.�� Polky,Na' Company :71l�� FOR APPLICANT TO FILL IN JOB El Certified copy is hereby,furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS / t LOCALITY h Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ } tion department. u ti-family Sq. Ft. NEAREST CROSS S Residential Swimming Pools O Date •�� Applicant �-'� OWNER OR FIRM NAME f1 .�'� .Ili CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLightSw._ MAIL �s� t COMPENSATION INSURANCE ADDRESS t V tThis section need not be completed if the work involved b First 20 CITY \ he permit is for one hundred dollar's ($100)or less.) . y Total No. Additional e Tel. No. I certify that in the performance of the work for which this PLAN CHECK r> 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 lLc Lf bFL Total No. Additional CITY 1a4�J�A,�1e R Tel. No �. Date ApplicanT Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT:'if, r making this Certificate, of Exemption, you sl o% eccme subject to the Workers' Range— Heater—D.W. APPLICATION /� �' z 4. Compensation pr ions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with com ith such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR p I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER / Class:C. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PRSED BY >_ and Professions Code,and my license is in full force and effect. �`-^ D_ `or` Size&Type HP, KW, KVA, or KVAR Q License Number Lir. Class Up to 1 Incl. FINAL Contractor' Date . (I'--� Over 1 to 10 Incl. DATE VALIDATION °C Over 10 to 50 Incl. FINAL O ❑ I am exempt under Sec. Over 50 to 100 Inc, BY r C) W B.BP.C. for this reason Over 100 O_ Services, Swbd., MCC 8 Panelboards 0Z Dat • 0-200 Amp. Under-600 V — . Signature 201 - 1000 Amp. Under 600 V F] Over 1000 Amp. or Over 600 V Exemption f eg. Maint. Elect. SINGLE FAMILY Tem Power Pole &Appurtenances i HOME OWNER-BUILDER DECLARATION p' PP �'r a I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ACCT Sign Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits ,97 25.Y Professions Code): ITEIM� ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— , TOTAL 25 ®.50 Business and Professions Code). 25.50 CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lend' gency for CHANGE .00 the performance of the work for which permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). - PLAN CHECKING FEE I I'f �l_I I 1 � /;:9 Lender's Name PERMIT ISSUING FEE 10. 6835 1 ASI 9:OF-; Lender's Ad s I certify at 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 abg -mentioned prop=forn purposes. .e f SEE REVERSE FOR EXPLANATORY LANGUAGE /tk . I '. Sig ure ofejefrmittje Date WORKERS' COMPENSATION DECLARATION76A6690PW3/87 APPLICATION FOR ELECTRICAL PERMIT. I hereby a5firm that I have a certificate of consent to self CE806G insure, or•a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) _ policy No. ompony ( f ' FOR APPLICANT TO FILL IN JOB --� ❑Certif ed copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS J LOCALITY r ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. _ $ /t/I .f tion department. Multi-family Sq. Ft. NEAREST O�1 ���"2 Residential Swimming Pools CROSS ST: Date �� �� d -Applicant efa_A2.A)C3 izr- OWNER OR FIRM NAM MEIV 41IM6 CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw.� ADDRESS (This section need not be completed if the work involved by / First 20 CITY Tel. No. Total No.-�-J- Additional -7.0 the permit is for one hundred dollars ($100)or less.) I certifythat in the.performance of the work for which this PLAN CHECK R 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 pAdditional Date 'l �j Applicant 64,0x9 '618626 1,6ZI Total No. V CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 'HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS ' with-comply with such provisions or this permit shall beTop , FAU —W.H. — deemed revoked. Hood — Fan —Other_ CITY 7 > Tel. No. 33� - LICENSED CONTRACTORS DECLARATION LICENSE OR J I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. _ REG. NUMBEROf E✓ P Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROC >- and Professions Code,and my license is in full force and effect. (J/1 a _ © Size &Type HP, KW, KVA, or KVAR Q License Number _SZ� 71 / Lic. Class f b V —� Up to 1 Incl.'- FINAL Contractor �' �CGl�d�tC bICP Date _l Over 1 to 10 Incl. DATE /�_��+_� VALIDATION Cr ❑ Over 10 to 50 Incl. FINAL !/" ~ I am exempt under Sec. Over 50 to 100 Inc. BY U B.&P.C. for this reason Over 100 �"� _� d Services, Swbd., MCC& Ponelboards Z Date: 0-200 Amp. Under 600 V - Signature G'l;� C ,M tfJly 201 - 1000 Amp. Under 600 V F]' Over 1.000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances ; HOME OWNER-BUILDER DECLARATION I herebyaffirm that I am exempt from the Contractor's License Sign with One Branch Circuit {,�.} -I P fi��v a Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits e Professions Code): Zi ° ❑ Misc. Conduits&Conductors �• T�•`I, as owner of the property, will do the work and the •T•- �M+� structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ )I poll { 5 Business and Professions Code). •lil '-a CONSTRUCTION LENDING AGENCY CHOCK 2 °f I hereby affirm that there is a construction lending agency for - a the performance of the work for which this permit is issued. PERMIT FEE (Sub-Total) � .00 (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name 0000-01001 11!15/39 PERMIT ISSUING FEE Lender's Address 817 1 F'M12. 3 I certify that I have read this application and state that the I TOTAL FEE f' 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 above-mentioned property for.inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee , "Date f ©s h