HomeMy Public PortalAbout9629-9633 LAS TUNAS DR_Electrical__ 76A663 DBS 5A 11-0 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY g,E CT R I C 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP i ZONE PERMIT NO.
ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDRESS j O r FI T INSPECTION ' )
CITY \vy fit.- TEL. NO. t�t �J
COUNTY LICENSE NO. 7 EXPIRES BUILDING
PERMIT FEES ADDRESS _/ - OS
FEE /Av
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES
WALL SWITCHES OWNER
TOTAL OUTLETS Sc $ MAIL
ELEC. RANGES 25 ADDRESS �Q )-n A1
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES 5
- 1 HEREBY ACKNOWLEDGE THAT 1 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 I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. HP OVER INC.
EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I /
1/2 a LESS S .25 SIGNATURE OF 1,/
1/2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 15 1.50
15 50 2.50
50 200 5.00
200 500 10.00 -1
Soo 1000 15.00 a
Z
OVER 1000 20.00
M. G. SET/FREQ. CHANGER-HP
WELDERS: AC-KVA
GENERATORS-KW
TRANSFORMERS-KVA L,
TEMP. MOTORS (75%OF ORIG.)
MOVED MOTORS (75%OF ORIG.)
MISC.
SIGNS
NO. NO. TRANS. APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
CONDUIT
WIRING $1.00 I I��
FIXTURES $1.00 I d WIRING
SUPPLEMENTARY 550 FIXTURES
/^ �J POWER
TOTAL FEE $ (-0� UTILITY CO. NOTIFIED
O FINAL
76A663-CE806 10 72 APPLICATION -OOR ELECTRICAL PERMIT ILJI
COUNTY OF LOS ANGELES � (
RELTMENT DD COUNTY DIV DIVISION ADDRESS ER
JOB
BUILDING ANSAFETY rC:3 �l _ ` �/�,J I `A; a
ADl ` �--
LOCALITY E�_ N\
NEAREST r i
FOR APPLICANT TO FILL IN CROSS ST. l�
OUTLETS N0. EACH FEE OWNER OR (�1 t l �^ ` \Ica,
\ '
$ $ S L,
FIRM NAME L..1 N 1 ��r-�
RECEPT._ MAIL
FIRST 20 25 Z?}7 ADDRESS
LIGHT``_ TOTAL
SWITCH _l OVER 20 '^1 10 CITY TEL. N0
o�L� PLAN CHECK
LIGHTING TOTAL
FIRST 20 '25 APPLICANT
1 �
I
FIXTURES .10
OVER 20 ADDRESS
RESIDENTIAL APPLIANCES CITY y�TEL. NO. '
PERT
RANGE DRYERWTR. HTR._ APPLIICANT � PC L- �#kW (�'�`-,��- �} l--�-�`� (�'�ct
STA. COOK DISP. F.A.U. ADDRESSC,-30(1 `(
14-v { Jq 'LtqJ
SPACE HTR, AIR COND. CITY � �/"` TEL. NO�j�y1 J f`�
CLOTHES WASH. DISH WAS H. RLICENSE EGMBER
CLASS. Lr�
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING W ITH 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
A�� 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE r
I - 10 3.00 DES CRIfED RESIDENTIAL PROPERTY. p�
O
PERMITEE
10 - 50 5.00 SIGNATURE y
O
50 - 100 10.00 �
DISTRICT N SED BY W
100 - 500 15.00 ' �r 8 vim)
7
!J Z_
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'4651GNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICENOTOVER600VOLTS OR200AMP 3.00 UNDERSLAB WORK
SERVICEOVER600 VOLTS OR200AMP 10.00 ROUGH CONDUIT
TEMPSERVICE, POLE, &APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT, SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00
TOTAL FEE t� L
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION C M.O. CASH
6 7 1 c�r Eli l y 2 U 1 G.G 1 •• c
SEE BACK'OF APPLICATION FOR COMPLETE SCHEDULE
76A663-CE80611-71 APPLICATION F07t ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BDDREIN \
BUILDING AND SAFETY DIVISIONCWI
LOCALITY
NEAREST /17
FOR APPLICANT TO FILL IN CROSS T
OUTLETS N0. EACH FEE
$ $ OWNER ..�^
RECEPT 1 MAIL
LIGHT TOTAL
FIRST 20 25 lADDRESS
CITY TEL. N0.
SWITCH OVER 20 .10 60 PLAN CHECK
FIRST 2025 APPLICANT
LIGHTING TOTAL
OVER 20ADDRESS
FIXTURES .10
RESIDENTIAL PPLIANCES CITYPERMT
—TEL. No.
RANGE DRYER_WTR. HTR._ APPLIICANT
STA. COOK DISP. F.A.U. ADDRES
SPACE HTR. AIR COND. CITY Cf)C IV fA TEL. N
CLOTHES WASH. DISHWASH. LICENSE NO. CLASS. —I O
FAN OTHER 1.00 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
3I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LIC4 Y ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO Cl0
1 - 1O 3.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
V
SIGNATURE
10 — 50 5.00 OF PERMITTEE ImO
50 - 100 10.00G
DISTRICTNO. jCL.A<._) ZONE ROC SED BY W
100 - 500 15.00 G - —2_ ' a
N
SIGN, GASSIGN AND ONE CIRCUIT 5.00 NOTES: ?
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICENOTOVER 600 VOLTS OR 200 AMP 3.00 10 t.9
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVI CE OVER 600 VOLTS OR 200 AMP 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE, IN APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE j
FINAL ✓
An
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. ) M.O. CASH
7 4 S;.SEP 3 2 ® 2 7.7 0 •w
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
�76A883-C.806 4-68 APPLICATION FOR ELECTRICA PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS t!�
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY ^ R
Oil
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. fi
NO. AC FEE
RECEPT S $ OWNER
.��//�� MAIL
LIGHT/ TOTAL FIRST 20 OLD .20 ADDRESS
SWITCH-d OVER 20 11 .10 CITY TEL. NO.
^ PLAN CHECK
LIGHTING �TOTAL FIRST 20 .20 QV' APPLICANT
FIXTURES OVER 20 .10 3 ADDRESS
sp
RANGE—DRYERWTR.HTR.— CITY TEL.
STA.COOK DISP.1—F.A.U._ CONTRACTOR
SPACE HTR. AIR COND. ADDRESS J �q
CLOTHES WASH,_DISHWASH._ CITY
FANAOTHER 1.00 t AD LICENSE NO. CLASS. ^(
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
_ G - i t.00 J ELECTRICAL WIRING.o
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
G 1 - 10 3.00 OO LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OW R OF, AND INTEND TO -
10 - 50 5.00 RESIDE IN, THE ABOVE DES"",ED IDENT AL PROPERTY. O
U
SIGNATURE
50 - 100 10.00 OF PERMITTEE �
100 - 500 15.00 U
69
DISTRICT O GRO P Z�N P O
SIGN.GAS SIGN AND ONE CIRCUIT 3.00
TUBE, OR
Z_
MARQUEE [ADDITIONAL CIRCUITS 1.00
NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 �>t
SERVICE OVER 600 VOLTS OR 200 AMP 5.00 J d d 7-f I/=l N� rt v Soi✓_ p "-
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE)
POWER AUTHORIZED
PERMIT ISSUING FEE 2.00I ]FINAL
UTILITYCO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE JOSEPH C. ROOH N
SUPERVISING ELEC AL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK, M.O. CASH
oul7 ju�23 B 54.7
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
78A6 3-CE806 4-6
r8 APPLICATION FOR ELECTRICA PERMIT
CE
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING G
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER r
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCAL IT LZ5G�T
NEAREST 100,
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
RECEPT._ S s OWNER D0IN/Al J G M/1.. pf$
MAIL
LIGHT TOTAL FIRST 20 .20 ADDRESS 1 112-1 ,6 s
SWITCH_ OVER 20 .10 CITY G TEL. NO_ v
PLAN CHEC f
LIGHTING TOTAL FIRST 20' .20 APP.LICAN .
FIXTURES 1_1OVER 20 .10 ADDRE
RANGE—DRYER_WTR.HTR._ CITY 2_- 900 T L. N ^
STA.COOK_DISP._F.A.U._ CONTRACTO
FF
SPACE HTR. AIR COND. ADDRESS j
CLOTHES WASH._DISHWASH._ CITYT TEL---N
FAN—OTHER 1.00 LICENSE 1.10. PVACLASS
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
0 - 1 1.00 ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM P OPERLY REGISTERED AND/OR
1 - 10 3.00 LICENSED AS REQUIRED BY LOS A ELES COUNTY A TATE OF
CALIFORNIA ORTHAT I AM TH L AL OWNER OF, INTEND TO
10-- 50 5.001 RESIDE IN, THE ABOV ISED R ID L PROPERTY.
SIGNATURE a'
50 - 100 10.00 OF PERMITTEE CD
V
100 - 500 15.00
SIGN,GAS DIST ICT OUP ZONE PROCESSED•BY p
TUBE, OR SIGN AND ONE CIRCUIT 3.00 •
MARQUEE ADDITIONAL CIRCUITS i 1.00 NOT D_
C7
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
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
PERMIT FEE (
SUBTOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% POWER AUTHORIZED,PERMIT ISSUING FEE2.00 OD UTILITYCO.NOTIFIED
SUPPLEMENTARY PERM1.00 FINAL /
TOTAL FEE JO P C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
.PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION GK. M.O. CASH
Alas .b 59 TG HAY 1 2_1 0 14,00-
M
4.Q0wM BACK OFAPPLICATION FOR COMPLETE FEE SCHEDULE s�
i
78A663-CE806 468 APPLICATION FOR ELECTRICA PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING v
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
T�
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY /�
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
RECEPT._ S S OWNER p
MAIL
LIGHT TOTAL FIRST 20 .20 ADDRESS
SWITCH_ OVER 20 .10 CITY 7 C TEL. NO.
PLAN CHECK
LIGHTING TOTAL FIRST 20 .20 APPLICANTIL
FIXTURES OVER 20 .10 ADDRESS d v
RANGE_DRYER_WTR.HTR._ CITY. TEL. NO.
STA.COOK_DISP.-F.A.U._ CONTRACTORS a
SPACE HTR. AIR COND. ADDRESS
CLOTHES WASH._DISHWASH._ CITY TEL. N0.
FAN-OTHER 11.00
i�
MOTORS,TRANSFORMERS RATING LICENSE 1-40. CLASS.
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
0 - 1 1.00 ELECTRICAL WIRING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 - 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AVEM T LEGAL OWNER OF, AND INTEND TO
10 - 50 5.00 RESIDE IN, THE SCRIP.ED RESIDENTIAL PROPERTY.
50 - 100 10.00 SIGNATURE
V
OF TEE w
CD
100 - 500 15.00 8
SIGN, Is O. G ZONE OCE BY a
TUBE,GOR SAS IGN AND ONE CIRCUIT 3.00 N
MARQUEE
ADDITIONAL CIRCUITS 1.00 NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
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
PERMIT FEE (SUB TOTAL) WIRING
PLAN CHECK FEE (50% PERMIT FEE) FIXTURES
POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUI NG FEE 1.001 FINAL
TOTAL FEE S JOSEPH C. ROOHAN
SUPERVISING ELEC AL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH
L Af r 9 c 9 3%co"' APR 1 0 2 D 5.0.D
X BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE /
76A669-CEB064-68 ®PLICATION FOR ELECTRICAL &MY IT �P
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING A
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.
NO. EACH FEE y
$ $ OWNER
RECEPT._ MAIL
LIGHT TOTAL FIRST 20 .20 ADDRESS
SWITCH_ OVER 20 .10 CITY TEL. NO.
PLAN CHECK
LIGHTING TOTAL FIRST 20 .201 1 APPLICANT
FIXTURES OVER 20 .10 ADDRESS
RANGE_DRYER_WTR.HTR.— CITY TE
STA.COOK_DISP.—F.A.U._ CONTRACTOR Y
SPACE HTR. AIR COND. ADDRESS °
CLOTHES WASH._DISHWASH,_ CITY T L. NO.
FAN—OTHER 1.00 LICENSE IJO. CLASS.
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
0 - 1 1.00
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
I - 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THELEGAL ER OF, AND JNTEND TO
10 - 50 5.00 RESIDE IN, THE ABOVE DES CRIPRE SIDENT L ROPERTY.
SIGNATURE t a
50 - 100 10.00 ]TEMP.
F PERMITTEE CD
V100 - 500 15.00DISTRICT NO. GROUP Z NE P ES DBY cTUBE,A WSIGN AND ONE CIRCUIT 3.00 MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES•SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERV) E, POLE, &APPURTENANCES 9.00 APPROVALS DATE INSPECTOR'S SIGNATURE
Ovi
topw POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) I POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE ! JOSEPH C. ROOHAN
SUPERVISING ELEC CAL ENGINEER
PLAN CHECK VALIDATION CK._ M.O. CASH PERMIT VALIDATION CK, M.O. CASH
Ari 9 4 o 40%4 Dr% APR 17 221 0 3 9 N
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
76A669-CES067-58 APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FBUI
LD
SS BUILDING AND SAFETY DIVISIONJOHN A. LAMBIE, COUNTY ENGINEERCASSATT D. GRIFFIN, SUPT OF BUILDING TY Z,;;-:,A
7
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
I T E M NUMBERI EACH FEE OWNE /
OUTLETS: $ $ MAIL
LIGHTS RECEPT. SW. .10
LIGHTING FIXTURES .10 CI i TEL. N "OLS
ELEC. RANGES CLO. DRYERS ELECTRICIAN
WATER H EATERS .5Oh
ADDRESS ylh5- S (J S
ELEC.SPACE HTRS. DISHWASHERS
CITE /
GARBAGE DISPOSERS AUTO.-
TEL. NO
STATE
WASHERSSTA. COOKING UNITS .25 LICENSE NO.k26s1�/
__..
MOTORS: OVER INC. H.P. DISTR�. I GROUP ZONE I P OCES BY
O- 1/2 .25
1/2 2 '50 INSPECTION RECORD
2- 5 1.00
5- 15 1.50
�1 &IY- 50 2.50 Cj
50-200 5.00
SIGNS: NO. TRANS.
NO. LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 Ci
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE $ APPROVALS
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED B S ANGELE COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM -LEG OWNER OF THE ABOVE
DESCRIBED RESIDENTIA P POWER
SIGNATURE UTILITY CO. NOTIFIED
OF PERMITTEE 9 7_ S /
FINAL
ARTHUR C. VEIT,
SUPERVISING ELECTRICAL ENGINEER
M CASH
A;o2548v; "B 17 2 A 3.50
76A663 CE 6068 10,77 APPLICATION FOR ELECTRICAL PERMIT (�
/ COUNTY OF LOS ANGELES n�
DEPARTMENT OF COUNTY ENGINEER JOB
ADDRESS oV
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN LOCALITY ;;—An.Qe ef/ Y
New Residential Bldgs.&Pools EACH NO. FEE NEAREST
1 &2-Fomily,Sq. Ft. CROSS .$ '025 — $ OWNER T. '
Multifamily Sq. Ft. 02 — FIRM NAME
Residential Swimming Pools 25.00 MAIL
Outlets: Rec v Light_Sw. CITY Tel. No.
First 20 .50 1 PLAN CHECK
Total No. Additional .30 APPLICANT
ADDRESS
Lighting Fixtures First 20 .50 CITY Tel. No. /
Total No. Additional 30 PERIT APPLICANT � -L l `
Fixed Appliances Not Over 1 HP ADDRESS 3103
Range—Heater_D.W.— CITY ( / Tel.No. 5
OfWj
Oven_Dryer_W.M. LICENSE OR
Top —FAU —W.H._ REG.NUMBER 5&Z-7534, Closs.c= v
Hood_Fan _Other_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp. _ Room Air Cond. 2.50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN
ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING.
Power Apparatus&Large Appliances
Size&Type HP, KW, KVA,or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELE UNTY AND STA CALIFORNIA OR THAT I AM
Up to 1 Incl. 2.50 THE LEGAL OWNER OF i A VE DESCRIBE E$ ENTIAI PROPERTY.
Over 1 to 10 Incl. 5.00 v
Over 10 to 50 Incl. 12.50 2 PERMITTEE
Over 50 to 100 Inc. 25.00 SIGNATURE o
v
Over 100 40.00 DISTRICT NO. PROCESSED BY-a
.r cn
Services I I I &/
0-200 Amp. Under 600 V 12.50 .� INSPECTOR'S
201-1000 Amp.Under 600 V 25.00 APPROVALS DATE SIGNATURE
Over 1000 Amp.or Over 600 V 50.00 TEMP. POWER POLE
UNDERSLAB WORK
Temp. Power Pole&Appurtenances
10.00
Sign with One Branch Circuit 10.00 ROUGH CONDUIT
Additional Sign Branch Circuits 2.00 WIRING
Misc.Conduits&Conductors 10.00 FIXTURES
Other(See Complete Fee Schedulei POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL
PERMIT FEE (Sub-Total) Z7 C NOTES
PLAN CHECKING FEE (One-Fourth Permit Feel
PERMIT ISSUING FEE $7.00
TOTAL FEE
PLAN CHECK VALIDATION CK, M O. CASH PERMIT VALIDATION CK M.0. CASH
9 4 l�'tl i 2 l)
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORKERS'COMPENSATION DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-8066
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
PolNO
icy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH . FEE ADDRESS
S —
Certified copy is filed with the county building inspec- 1 & 2-Family, q� Ft. $ $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST t
CROSS ST. _
Residential Swimming Pools OWNER OR
Date Applicant
44 FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec' '" Light t Sw. MAIL
COMPENSATION INSURANCE First 20 f ADDRESS
(This section need not be completed if the work involved by Total No. Additional CITY Tel. No.
the permit is for one hundred dollars($100)or less.)
1
I certify that in the performance of the work for which this PLAN CHECKAPPLICANT
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
?'..,
Total No. = Additional CITY Tel. No.
Date' 7y Applicant ter' - 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
with comply with such provisions' or this permit shall be Top _ FAU —W.H. —
deemed revoked. CITY Tel. No.
Hood _ Fan _Other_ r`
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. Room Air Cond. REG. NUMBER -��i Class.
I hereby affirm that I am licensed under provisions of Chapter 9 ti
(commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY a
and Professions Code,and my license is in full force and effect. O
( Size &Type HP, KW, KVA, or KVAR U
License Number (' # Lic. Class Up to 1 Incl. FINAL LU
O ( C Over 1 to 10 Incl. DATE VALIDATION LL
Contractor ° i '*-Y V ,((Date ' i }
❑ Over 10 to 50 Incl. FINAL oe
I am exempt under Sec. Over 50 to 100 Inc. BY Q
B.&P.C. for this reason Over 100
O
Date:
Services, Swbd., MCC& Panelboards ► n
0 -200 Amp. Under 600 V W
Signature 201 - 1000 Amp. Under 600 V
❑ /'
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r
I hereby affirm that I am exempt from the Contractor's License Additional Sign Brunch Circuits
Law for the following reason (Section 7031.5, Business and
e a s w p �•
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors
i Y A • '
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ►
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 t
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 above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
4. `{
id
ignature of Permittee Date
WORKERS'COMPENSATION DECLARATION CE-806 10181 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806G
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB e
ADDRESS •�' j
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE
❑ $ _ g LOCALITY !
Certified copy is filed with the county building inspec- 1 &2-family, Sq. Ft.
tion department. Multi-family Sq. Ft. — NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
Date Applicant
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE Outlets: Rec� Light '"!� Sw. ADDRESS /
s seccompleted if the work involved b First 20
(Thition need not be com p y Total No. Additional CITY Tel. No.;' '
the permit is for one hundred dollars($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this 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
In Total No. j CITY Tel No.
Date ' Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after mok`i�ng this Certificate–of APPLICANT – "kExemption, 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 4,\ p C
with comply with such provisions or this permit shall be Top — FAUW.H. —
'— CITY :;C,..
deemed revoked. Tel,.
Hood Fan Other—
LICENSED CONTRACTORS DECLARATION LICENSE OR "j 1 Y l
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER f Cass. }
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY p,
Power Apparatus 8 Large Appliances
and Professions Code,and my license is in full force and effect. O
t+ Size &Type HP, KW, KVA, or KVAR V
License Number 1 _Lic. Class— LUUp to 1 Incl. FINAL
Over 1 to 10 Incl. DATE VALIDATION LL
Contractor ' '' -� Date !fin❑ Over 10 to 50 Incl. FINAL C}C
I am exempt under Sec. Over 50 to 100 Inc. BY �
B.&P.C. for this reason Over 100
Services, Swbd., MCC& Panelboards rZ
Date: 0 -200 Amp. Under 600 V ► u�i
Signature 201 - 1000 Amp. Under 600 V ~
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
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):
ElI, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► r u (�!``
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY a ` r
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
the above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
WORKER'S COMPENSATION DECLARATION DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
76A663
I hereby affirm that I have a certificate of consent to self76A663. Insure, I
or&:certificate of Worker's Compensagon Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Policy No. Company I FOR APPLICANT TO FILL IN AOB DDRESS u Tq , \ 1 ��
Certified copy is hereby furnished. New Residential Bidgs.&Pools NO. EACH FEE, ,�
CA
❑ _ $
1 &2-Family,Sq.Ft. $ LOCALITY• `�
Certified copy is filed with the county building inspection
department. (Multi-family Sq.Ft. — NEARS ST..
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK I PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER R +
COMPENSATION INSURANCE FIRM NAOME
First 20 � r
(This section need not be completed If the work Involved by the Total No. Additional ADDRESS �� a 1P.Nw Y a G t
permit is for one hundred dollars($100)or less.)
,l I certify that in the performance of the work for which this permit cireX q. el.Na.
I Is issued, I shall not employ any person in any-manner so as to PLAN CHECK
become subject to the Workers'Co pensation Laws. Lighting Fixtures First 20 APPLICANT
Y i i 1 �d _� ;Total No. Additional
J� Wi �8\� ADDRESS
Date Applican 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. Q
IT
provisions of the Labor Code,you must forthwith comply with'such power Apparatus&Large Appliances APRPLICANrJ
provisions or this permit shall be deemed revoked. �t
LICENSED CONTRACTORS DECLARATION Size&Type HP;KW,KVA,or KVAR ADDRES
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. p
(commencing with Section 7000)of Division 3 of the Business and CITY `1ti Q_ Tel.No.�ap 63
Professions Code,and my license'is in full force and effect. Over 10 to 50 Incl. Q�c
i Over 50 to 100 Incl. LICENSE OR 0 –1 Class'
:1 Over 100
License Numberb% k� DISTRICT NO. PROCESSED BY Lic.Class � C)
( (� \+ !A Services,0-399 AmUndere600 V s ATE O
Contractor D
l, p. +
❑ I am exempt under Sec. 400-1000 Amp.Under 600 V W
VALIDATION
Over 1000 Amp.or Over 600 V FINAL' (1
B.&P.C.for this reason BRANCH CIRCUIT FEES BY CD
Z
Date: 16A,or 20A,120V,Lighting or Recept. ;� _
t 1 To 10 Branch Circuits I ANT.
_
Signature 11 To 40 Branch Circuits 'f�'�') 'a
❑ 41 Or More Branch Circuits I �� frl
Exemption for Reg.Maint.Elect. 15A,.20A,208V To 277V Lighting Sr.Circuits 3-120-1
SINGLE FAMILY Temp.Power Pole&Appurtenances fl
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit TOTAL 5101 ® `o"
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits N
H
I�HS
50.70
❑ I,as owner of the property,will do the work and the structure Mis I.Conduits&Conductors CHANGLE G)
Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code).
CONSTRUCTION LENDING AGENCY U( lia 3(-1(-(1 41/ 5/95
I hereby affirm that there is a construction lending agency for the } A f.;,
Performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) � r Vie26
Civ.C,)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE Q
Lender's Address I
I certify that I have read this application and under penalty of purjury state TOTAL FEE t1
that the above information Is correct. I agree to comply with all County
ordinance and State laws regulating Electrical wiring,and hereby authorize
r ent Ives of this County to enter upon the above-mentioned property
ppect n �IE
6SEE REVERSE FOR EXPLANATORY LANGUAGE
UBE OF S DA4T;E
WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-8066
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES "y— BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.) /
i
Policy No. Company FOR APPLICANT TO FILL IN JOBif�
Certified co is hereby furnished. ADDRESS � to
PY Y New Residential Bldgs. & Pools EACH NO. FEE �
❑ —
Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY
e
tion department. Multi-family Sq. Ft. NEAREST Jj
Residential Swimming Pools CROSS SL ,SLC Z�
Date Applicant OWNER OR ° /
FIRM NAME0JK.IC-4-N /
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec //,,���Light Sw.,O / MAIL
COMPENSATION INSURANCE 1 (' ADDRESS
This section need not be completed if the work involved b First 20 '
( P Y Total No. ' Additional i CITY — Tel. No �—
the permit is for one hundred dollars ($100)or less.)
I certify that in the performance of the work for which this APPLICANTK
permit is issued, I shall not employ ny person in any manner
so as to become subject to the W _kers'person
Laws. Lighting Fixtures First 20 ADDRESS
%I Q Additional t
Total No. .7 Y CITY Tel. No.
Date Applica Fixed Appliances Not Over 1 HP PERMIT wS
NOTICE TO APPLICANT: If, of r a ng this ertific f
APPLICANT
Exemption, you should beco a bject to the Workers' Range— Heater—D.W. _
Compensation provisions of the ab F Code, you must forth- Oven — Dryer W.M.— ADDRESS
with comply with such provision r this permit shall be Top _ FAU W.H. —
deemed revoked. CITY C7S._ Tel.
LICENSED CONTRACTORS DECLARATION Hood — Fan Other— r7.
Disp. _ Room Air Cond. v O LICENSE Class r
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROC SED BY_
Power Apparatus& Large Appliances �
and Professions Code, d m license is in full force and effect. (/ d
`l C-cam Size &Type HP, KW, KVA, or KVAR O
License Number. v'�t Lic. Class Up to 1 InclV
FINAL
fNter(=�� Over 1 to 10 Incl. DATE VALIDATION 0
Contractor to `O❑ Over 10 to 50 Incl. V FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY YJfL
B.&P.C. for this reason Over 100 N
Services, Swbd., MCC& Ponelboards ► �� Z
Date: 0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole &Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
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)_ ►
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) j
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name PERMIT ISSUING FEE U S
Lender's Address
I certify that I have read this application and state that the TOTAL FEE &-3
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
abov m�tionedperty for inspection�urpMA SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of Permittee Date
4
WORKERS'COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereb�TCE-806G 2bat I have a certificate of consent to self CE'8�G
insure, or a cern{'icate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES (_- i BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.) /
Policy No. Company FOR APPLICANT TO FILL IN SOBr- �J
CAT J
Certified copy is hereby 4urnished. New Residential Bldgs. & Pools EACH ADDRESS lCl 7- r`
NO. FEE v J
❑ 1 8 2-Family, S Ft. $ — $ LOCALITY t Q,
Certified copy is filed with the county building inspec- Y- q
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST. �lvU ��
LJ
Date Applicant OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_&Light_LSw.�First 20 MAIL
COMPENSATION INSURANCE ADDRESS b Z E. CR uV JX.S,
(This section need not be completed if the work involved by Total No. Additional CITY` 'eG Tel. No.
the permit is for one hundred dollars ($100)or less.)
I certify that in the performance of the work for which this PLAN
CHE K
permit is issued, I shall not employ any person in any manner
so as to become subject to th ers'Co anon Laws. Lighting Fixtures— First 20 ADDRESS
` Total No. S Additional CITY Tel. No.
Datil 2Applica Fixed Appliances Not Over 1 HP PERMIT �A \
NOTICE TO APPLICANT: If, of r aking this Certificate of APPLICANT `vim. e'r �C,
Exemption, you should beco a bject to the Workers' Range_ Heater—D.W. —
Compensation provisions of the ob r Code, you must forth- Oven — Dryer — W.M.— ADDRESS \�
with comply with such provision or this permit shall be Top FAU —W.H. —
deemed revoked. CITY �C2_ _G__ Tel. No 4 -0 2S
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
Disp. _ Room Air Cond. LICENSE M -7Class`a
MBER J
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCE ED BY
and Professions Code,qnd my license is in full force and effect. Power Apparatus& Large Appliances -�— >.
Size 8 Type HP, KW, KVA, or KVAR �Q .��✓�- 0
License N`�miler. tJ"CC Lic. Class Up to 1 Incl. FINAL V
l�� ��// Over 1 to 10 Incl. DATE -j VALIDATION 0
Contractor wDate ` ���PPP l!
F-1 Over 10 to 50 Incl. �
FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY t d
B.BP.C. for this reason Over 100 f h
Date:
Services, Swbd., MCC 6 Panelboards ► ,/��' Z
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY temp. Power Pole 6 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
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):
❑ 1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ,
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 O
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
theabove- a boned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
`t11jAbU
gnature of Permittee Dote