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HomeMy Public PortalAbout9663-9665 LAS TUNAS DR_Electrical__ S-A 12-43 2SM DBDAPPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC M. J. FOX CHIEF ENGINEER Q NAME DISTRICT NO. GROUP ZONE PERMIT]NO. U ADDRESS 7 '7 f RECEIVED BY READY FOR DATE ISSUED wU CITY TEL.NO. FIRST!NSPECTION J COUNTY W I CERT.NO. EXPIRES APPLICANT FILL IN HEAVILY OUTLINEhD PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS / 74, 5 y l y NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS Y� NEAREST LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. CIRCUIT A B C D E F G I H W NAME w - Z MAIL ADDRESS / O �> CITY TEL.NO. j 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION., Z.. z /'� •� ELECTRICIAN. 4- I AM THE]LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER. ' -�- CORRECTIONS u.. - Q Z C7 D TOTAL �1-- NO. OF OUTLETS $ Z APPROVALS NO. OF FIXTURES $ ' DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ ^ POWER PERMIT FEE $ <� UTILITYCO.NOTIFIED TOTAL FEE FINAL DBS SA 25M SETS 1-4B DEPARTMENT (DEPARTMENT OF BUM DING AND SAFE T �'P3.ICATIOT� "FOR PE RART COUNTY Or LOS ANGELES Ei LEC RIC W .1FOX. CHIEF ENGINEER Z _ DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS �U CITY _ TEL.NO. ! RECEIVED ay RFADY FOR DATE ISSUED FIRSI'INSPECTION COUNTY CERT.NO. EXPIP.ES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB (DESCRIPTION OF WOn€K ADDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS i NEAREST LIGHT OUTLETS luW.I PLUGS FoxTj C O5S ST. CIRCUIT A B C 171 E F" G I H I !Y NAME '0' - Z MAIL 3 ADDRESS O _ CITY TEL..NO. I AM THE LE<"F.L POSSESSOR OF THE ABOVE LOS ANGUEB COUNTY CERTIFEGATF..OF QUALIFICATION.. ELECTRICIAN. �£{' 1 AM THE LEG"OWNER OF THE 'Rur'�RTY DESCRIBED A13OVS OWNER. CORR.ECgIONS ,l I J — a z i TOTAL NO. OF OUTLETS - $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. _$ _WIRING NO. OF RANGES OR 4EA7ERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE $ - UTILITYCO.NOTIFIED _ TOTAL FEE �' FINAL W-11.51.5A 25M SETT 10-47 - APPLICA ION FOR PER511r DEPARTMENT OF BUILDING ANO S COUNTY OF LOS ANGELES ELECTRIC FOX, CHIEF ENGINEER _< NAME 1--Ly r DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS tY / RECEIVED BY READY FOR DATE ISSUED TEL.NO.! C FIRST INSPECTION J COUNTY w CERT.NO. EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTI�ONN ONLY DESCRIPTION OF WORK JOB DRESS '2 3 NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST / LIGHT OUTLETS JSW. PLUGS FUCT CROSS ST. CIRCUIT A B I C D E F G H w NAME La 1 Z MAIL 3 ADDRESS O CITY TEL.NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS G ANELES COUNTY CERTIFICATE OF QUALIFICATION.. ELECTRICIAN. I AM THE"GAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER. N t', CORRECTIONS a — z L3 E TOTAL / No. OF OUTLETS $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO. OF RANQES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE $ v UTILITY CO.NOTIFIED TOTAL FEE 0 FINAL 7BA663-CES06 9-67 X APPLICATION FOR ELECTRICAL PERM y- COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS C G-�S'�T17 JOHN A. LAMBIE, COUNTY ENGINEER c / COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGLOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. iJr NO. EACH FEE �/ $ $ OWNER RECEPT._ MAIL pp gA LIGHT TOTAL FIRST 20 .20 ADDRESS � Wim' B UL)frS SWITCH_ OVER 20 .10 CITY LIF CJTTEL. NO. LIGHTING JTOTAL FIRST 20 .20 CONTRACTOR ��q�1�1� 0 tT�FIXTURES OVER 20 .10 ADDRESSOVA-Mg1�� RANGE—DRYER—WTR.HTR._ CITY Ir' A I q'- RTEL. NO. STA.COOK_DISP.—F.A.U.— LICENSE NO. 'I SPACE HTR. AIR COND. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CLOTHES WASH. - 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 THA 1 AM T LEGAL OW R OF, AND INTEND TO IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE A OVE SCRIB fl ID TIAL PpOPERTY. SIZE & TYPE OVER TO SIGNATURE 0 - 1 1.00 OF PERMITTEE 0 1 - 10 3.00 DIST ICT O. OUPENE P D B U ' 10 - 50 5.00 0 50 - 100 10.00 NOTES• G W 100 - 500 15.00 yyll N SIGN,GAS [SIGN AND ONE CIRCUIT 3.00 QV' Z TUBE, OR MARQUEE DDITIONAL CIRCUITS 1.00 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 ISSUING FEE 2.00 �® WIRING FIXTURES SUPPLEMENTARY ISSUING FEE 1.00 POWER AUTHORIZED e PERMIT FEE UTILITY CO.NOTIFIED PLAN CHECK FEE (50% PERMIT FEE) FINAL W A-/ TOTAL FEE ('5­001JO EPA C. ROOHAN SUPERVISING ELE�CK AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH 2 U 89 DEC S 2 D 5.00 �' -E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 76A663 CE 806R 10/77 APPLICATION FOR ELECTRICAL PERMUC � iC T-OUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS -7 JOB jr— BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN LOCALITY New Residential Bldgs.&Pools EACH _ale el�c NO. FEENEAREST 1 &2-Family,Sq. Ft. $ .025 — $ OWNER CROSS ST. T. OR Multi-family Sq. Ft. •02 — FIRM NAME Residential Swimming Pools 25.00 MAIL ADDRESS Outlets: Rec Light—Sw. L CITY Tel. No. First 20 .50 © PLAN CHECK Total No. Additional .30 APPLICANT ADDRESS Lighting Fixtures First 20 .50 CITY Tel. No. Additional .30 PERMIT Total No. APPLICA Fixed Appliances Not Over 1 HP ADDRESS �S' , Range—Heater_D.W._ CITY Tel. No. Oven _Dryer—W.M. LICENSE OR Top —FAU —W.H.— REG.NUMBER Class. �'1C 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 250 REQUIRED BY LOS ANGELES C UNTY AND STATE OF CALIFORNIA OR THAT I AM . Up to 1 Ind. THE LEGAL OWNER OF THE E DESCRIBED RESIDEN PROPERTY. Over 1 to 10 Ind. 5.00 v Over 10 to 50 Incl. 12.50 PERMITTEE SIGNATU �' G Over 50 to 100 Inc. 25.00 v Over 100 40.00 DISTRICT NPR D Services 0-200 Amp. Under 600 V 12.50 INSPECT S 201-1000 Amp.Under 600 V 25.00 APPROVALS DATE SIGNA RE Over 1000 Amp.or Over 600 V 50.00 TEMP. POWER POLE Temp. Power Pole&Appurtenances 10.00 UNDERSLAB WORK 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 Schedule) POWER AUTHORIZED UTILITY CO.NOTIFIED FINAL J PERMIT FEE (Sub-Total) NOTES ' t PLAN CHECKING FEE (One-Fourth Permit Feel PERMIT ISSUING FEE $7.00 C TOTAL FEE PLAN CHECK VALIDATION CK, M O CASH PERMIT VALIDATION CK, M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CES06-11-57 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, CountEag�aeer CASSATT D. GRIFFIN, Sup t of Building LOCALITY 1 NEAREST ly�� FOR APPLICANT TO FILL IN CROSS ST. Lt PERMIT FEES ITEM NUMBER EACH FEE OWNS OUTLETS: $ $ MAIL LIGHTS RECEPT. SW. .10 ADDRESS LIGHTING FIXTURES .10 CITY TEL.N ELEC.RANGES CLO.DRYERS ELECTRICIAN WATER HEATERS .50 ADDRESS C �~ ELEC.SPACE HTRS. DISHWASHERS GARBAGE DISPOSERS AUTO.- CITY WASHERS STA.COOKING UNITS .25 STATE --7 3 / LICENSE NO. / _[ MOTORS: OVER INC. H.P. 0 — 1/2 25 DISTRICT NO. 1GROUPI ZONE READY FOR INSPECTION 1/2 - 2 �� .50 INSPECTION RECORD 2 — 5 1.00 5 — 15 1.50 15 — 50 2.50 50 — 200 5.00 SIGNS: NO.TRANS. / 0 U NO.LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE , S OQ APPROVALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE I NSPECTOR'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 �- IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I ,A THE XEGAL R OF THE ABOVE POWER DESCRIBED RESIDENTI TY SIGNATURE ! .�� UTILITY CO.NOTIFIED OF PERMITTE i FINAL VALIDATION ARTHUR C.VEIT, CK mo CASH SUPERVISING ELECTRICAL ENGINEER CO3 3 1 1 tri ,AUL 2 �_' 2 A 3.0 0 r, 76A663-CE606 468 APPLICATION FOR ELECTRICAL PERMIT COUNTY,OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS lE, ti > JOHN A. LAMBIE, COUNTY ENGINEER A COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN INEAREST ST. NO. AC FEE RECEPT._ $ $ OWNER `� UP MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS S SWITCH_ OVER 20 .10 CITY TEL. NO. LAN CHECK P LIGHTING TOTAL FIRST 20 .20 APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE_DRYER_WTR.HTR._ CITY TEL. NO. STA.COOK_DISP._F.A.U._ CONTRACTOR SPACE HTR. AIR COND. ADDRESS CLOTHES WASH._DISHWASH._ CITY N / TEL. NO. FAN—OTHER 1.00 LICENSE IJO.� CLASS. C-�S 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 - 1.00 ELECTRICAL WIRING. 1 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 AM THE LEGAL OWNER OF, AND INTEND TO 10 - 50 5.00 RESIDE IN, THE ABOVE OESCRIF.EO RESIDENTIAL PROPERTY. O 50 - 100 10.00 SIGNATURE ,I n �J\ U OF PERMITTEEbllC:) 100 - 500 15.00 DISTRICT O. GROUP ZONE P OCESSED BY w SIGN,GAS SIGN AND ONE CIRCUIT 3.00 3 Oo ♦Q �` /� _L D" TUBE, OR a `N'le% N MARQUEE Z 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 FIXTURES PLAN CHECK FEE (50% PERMIT FEEL POWER AUTHORIZED PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE 00 J >SEP C. ROOHAN SUPERVISING EL/FF��11�,yR1�/IAL ENGINEER PLAN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION ( C/ M.O. CASH U0~°E3 0;-S std 2 4 2 U 5.00- `E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE t __ 76A 663 DBS-5A IZAPPLICATION FOR ELECTRIC PERMIT ], B5-SP. DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING WM. J. FOX, COUNTY ENGINEER ADDRESS T!/i✓.fzs CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST CROSS ST. r NUMBER EACH FEE _ LIGHT OUTLETS - OWNER RECEPTACLES MAIL ADDRESS S � WALL SWITCHES TOTAL OUTLETS I 54 $ O CITY TEL. NO. ELEC. RANGES 25 ELECTRICIIIA/N/ L p y ELEC. HEATERS 25 ADDRESS X 7'� r /7 /`�5 7 / //, KW EA CITY 5 /¢/�( C�-/�!iF'Ir°'� TEL. NO FIXTURES 5 LICENSE NO. NUMBER OF LIGHT CIRCUITS NUMBER ODISTRICT NO. �GROUP ZONE READY FOR INSPECTION F RECEPTACLE CIRCUITS ,., MOTORS ✓ (f '/CJI-- NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH I12 a LESS $ .25 1f2 2 .50 2 5 1.00 5 15 1.50 15 50 2.50 50 200 �-5.00 MISC. NO. SIGNS NO. TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00__� Q 6) FIXTURES $1.00 SUPPLEMENTARY 50 APPROVALS TOTAL FEE $ W DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION _CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY —--�-�- f WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS AN ELES COUNTY AND STATE OF CALIFORNIA OR THALPRO E GAL/ WNER OF THE ABOVE POWER DESCRIBED RESIDENTITUTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE - I -L _ FINAL WILLIAM J. FOX, COUNTY ENGINEER VALIDATION 2 1 .30 n G2 2 7 Our) APR 5 BY ® 'DEPUTY j.. 76AS63 DBS SA 7-51 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELCTI�IIC 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. _ELECTRICIAN_ J! RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION CITY � TEL. NO..R �^ COUNTY LICENSE NO. EXPIRES 3v v ADDRESS / Y✓(rJ �J Z&:)1ydu PERMIT FE_E _ ---�� //�� NUMBER EACH FEE LOCALITY <CI✓IIyL•� L.lTS6 LIGHT OUTLETS NEAREST CROSS ST. RECEPTACLES WALL SWITCHES OWNER_ TOTAL OUTLETS _SC $ MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY _ TEL. NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. -�w+ APPLICATION AND STATE THAT THE ABOVE 18 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 NuMeER HORSEPOWERANGELES COUNTY LICENSE,`` OR I AM THE LEGAL OWNER FEE NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL,.PROPQRTY DESCRIBED ABOVE. SIGNATURE OF V2 S LESS $ .25 ff// _ ... 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 J 500 1000 15.00 Q Z OVER 1000 20.00 La M.G. SET/FRED. CHANGER-HP WELDERS: AC-KVA D GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75/o or ORIG.) MOVED MOTORS (75% of ORIG.) M15C. r.',, 1,_ �r t �- t....- SIGNS NO. NO.TRANS. APPROVALS NO. NO. LAMPS — DATE INSPECTOR'S NAME FOR EACH PERMIT: ' WIRING $1.00F.'4w CONDUIT FIXTURES $1.00WIRING SUPPLEMENTARY .50FIXTURES POWER TOTAL FEE UTILITY CO. NOTIFIED e,>r ? FINAL v,:r' � '' ` '_ : ��' WORKERS'COMPENSATION DECLARATION 20-0019 DPW 3/87 n �p n /p� �,n p 5� ®p� 1 -re ffirm that I have a certificate of consent to self CE�� �11�11���w��®ll Cl ©� �[� � LI ����� ��®`IY,'� O ; ' a certificate of Workers'Compensation Insurance, I COUNTY OF LOS ANGELES I DEPT. OF PUBLIC WORKS a certified copy thereof (Sec. 3800, Lab. C.) i 1 Policy No. Company I FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS ❑Certified co is filed with the count building inspec- 1 &2-Family, S Ft. $ — $ LOCALITY Py y g p y q NEAREST tion department. Multi-family Sq. Ft. ST. Residential Swimming Pools 'OWNER OR Date Applicant IFIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ (AMAIL DDRESS COMPENSATION INSURANCE First 20 (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.) 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 Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'C m en tion Laws. +p -7 (/�j' Additional Date r 1 6 Applicant I Total No. CITY Tel. No. NOTICE 4O PPLICANT: If, after makingthis Certificate of Fixed Appliances Not Over 1 HP PERMIT Range— Heater—D.W. APPLICATION Exemption, you should become subject to the Workers' � Compensation provisions of the Labor Code, you must forth- I Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY Tel Nod Hood — Fan —Other. LICENSED CONTRACTORS DECLARATION LICENS O Disp. — Room Air Cond. — Class. ' I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCE Y a and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR �� O License Nu b r L-RXL Lic. Class CA D Up to 1 Incl. FINAL 7. Over 1 to 10 Incl. DATE VALIDATION fO Contract / Date Over 10 to 50 Incl. F- Q' UJ I am exempt under Sec. Over 50 to 100 Inc. g LV B.&P.C. for this reason I Over 100 4 Services, Swbd., MCC&Ponelboards Z Date: Z 0-200 Amp. Under 600 V L 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 ISign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License g Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits # o,o•d;1 A Q 2 o o e' Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors I -.-2550 . structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)— Business and Professions Code). D 0 0 -2550V CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 1 I 07.07-88 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FES I Lender's Name PERMIT ISSUING FEE lV Lender's Address I certify that I have read this application and state that the TOTAL FEE ,5� 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 Aebov nti ned roperty for inspection pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE & Signature of Permiti6e7 ate WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT CE-806 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 New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 7 Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — Is LOCALITY ❑ Multi-family wi mi NEAREST /9LA 1 Certified copy is filed with the county building inspection Residential Swimming Pools department. OWNER OR FIRM NAMEU [�/L/ N/ N- Date Applicant Outlets: Rec._Light-116w. MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel Not C?/2s,-2— COMPENSATION s,-2COMPENSATION INSURANCE PLAN CHECK d APPLICANT 0 (This section need not be completed if the work involved 0 by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Additional cc Total No._ 0 I certify that in the performance of the work for which this CITY Tel No. F- permit Appliances Not Over 1 HP permit is issued, I shall not employ any person in any manner PERMIT W so as to become subject to the Workers' Compenws. Range_ Heater_D.W. APPLICANT ,&Vl Oven _ Dryer_W.M._ ADDRESS CD Date� �QApplicant Top FAU _W.H. �P eG Prt i ,�/�J Z Hood _ Fan —Other CITY NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond.— LICENSE OR Exemption, you should become subject to the Workers' REG. NUMBER373l Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. OCES ED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW, KVA,or KVAR Up to 1 Incl r FINAL Over-1 to 10 Incl. DATE c LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALI DAT I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL BY 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. �y Services License Number1�3 Lic.Class-( Q 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contracton77�:a!Z ��EIT Date 2—Z5 9'0 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 I, 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 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 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 ordinInces and State laws regulating Electrical wiring, and hereby authorize representative 's County to enter upon the above-mentioned rty for inspec ' n purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of P6rmittee Date ems. WORKERS'COMPENSATION DECLARATION 78-883 70/81 APPLICATION FOR ELECTRICAL PERMIT I hereb `affirm that I have a certificate of'consent to self insure, CE-8060 sy or a certificate of Workers' Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sea 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE $ — $ LOCALITY Certified copy is filed with the cc y build' g inspection 1 &2-Family,Sq.Ft. department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date '� Applicant Residential Swimming Pools OWNER OR • FIRM NAM �U �����/j� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— ,�,3 / Light_Sw..' MAIL �� COMPENSATION INSURANCE g ADDRESS wp"4res L.� /[6iU,11$ 42 First 20 (This section need not be completed if the work involved by the Total No. Additional CITY Ldp Tel:NoX J�^f�$ permit Is!for one'hundred dollars($100)or less.) PLAN CHECK I certify that.in the performance of the work for which this permit APPLICANT 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 Total No. CITY Tel.No. Date' Applicant Fixed Appliances Not Over 1,H.P PERMIT NOTICE TO APPLICANT: If, after making, this Certificate of APPLICANT LtJS��Sst .�r Exemption,you should.become subject to the Workers'Compensation Range_ Heater D.W:,_ / provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS �G Ee�a`UE �✓1 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ 1 LICENSED CONTRACTORS DECLARATION CITY / /� Tel.No Hood --Fan Other— LICENSE hereby affirm that I am licensed under provisions of Chapter 9 uCENSE OR 2®ICzo a f Zd Di Room Air Cond. e�Oa�� as (commencing with Section 7000)of Division 3 of the Business and .y�pe 3m�M� REG.NUMBER Professions Code,and my license is in full force and effect. '" 'pp DISTRICT NO. _r� f� PROLE D BY war Apparatus&Large Appliances t/!/Qy _ Size&Type HP,KW,KVA,or KVAR , License Number, Lie.Class` J Up to 1 Incl. J FINAL D y 7 3W�_Over 1 to 10 incl. DAA�• 5 / � V IDATION8 A O Contractor Date / Over 10 to 50 Incl. FIN ❑ I am exempt under Sec. Over 50 to 100 Inc... ° 0 0 02 B.&P.C.for this reason N Over 10.0 Services,Swbd.,MCC&Paneiboards ® ° 7.50 Z Date: 0-200 Amp.Under 600 V e1' Signature 201 - 1000 Amp.Under.600 V o 0 o 17,.5 a 35 Over 1000 Amp.or Over 600 V E] Exemption for Reg.Maint.Elect. 1 1.20-87 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 Law Additional Sign Branch Circuits for the following reason(Section 7.031.5,Business and Professions Code): Misc.Conduits&Conductors 0 i,as owner of the property,will do the work and the structure 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 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.CJ. ' PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE r information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represents f t is County to enter upon the above-mentioned propert r i pe ion urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S;dwture of Permittee Date "C"C,".`�,, RKERS'COMPENSATION DECLARATION 76A663 10/e1 p i.+ 1'here�by�'ffirm that I have a certificate of consent to self CE-&MG AP LICATION •F®R ELECTRICAL PERMIT insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copf thereof(Sec. 3600, Lab. C.) PolPolicy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS �� TL� Certified copy•is hereby furnished. t New Residential Bldgs. & Pools EACH NO. FEE � Certified copy is filed with the county buildi g inspec- 1 &2-Family, Sq. Ft. $ — Arls $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST RPools CROSS ST. Date Applicant Residential Swimming OWNER OR a FIRM NAME CERTIFICATE OF EXEMPTION IR0 WORKERS' Outlets: Rec 6 Li ht Sw._ COMPENSATION INSURANCE g ADDRESS (This section need not be completed if the work involved by First 20 l No, Additional CITY Tel. No. the permit is for one hundred dollars($100)or less.) TotaPLAN 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 Total No. Additional CITY Tei. 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 Workers' Range_ Heater_D.W. APPLICANT Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M. ADDRESS d with comply with such provisions or this permit shall be Top _ FAU —W.H: — CITY/ Tel. IVo y deemed revoked. Hood _ Fan _Other— • LICENSED CONTRACTORS DECLARATION LICENSE Disp. _ Room Air Cond. S Class. (commencing with Section 7000) of Division 3 of the BusinessDISTRICi.NO. PROCES E BY 0!.,l and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances i M ��-Q Size&Type HP, KW, KVA, or KVAR V (/� License Number J O Lic. ClassUp to 1 Incl. FINAL a: O ` �U DATE Over 1 to 10 Incl. V IDATIORI Contractor. _ Over 10 to 50.Incl. ' ❑ FI' a' I am exempt under Sec. Over 50 to 100 Inc.• B N BAP.C. for this reason Over 100 Date: Services, Swbd., MCC&Panelboards 0 -2.00 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 Licenand se Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 1 o o 1 5,0 0 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). o 0 o 1 5.005 CONSTRUCTION LENDING AGENCY 1220-85 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 !, Lender's Address PERMIT ISSUING FEE (/ AA d I certify that I have read this application and state that the TOTAL FEE 15� 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-mens' ned property for . spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /a-20 49S , gnat a of ermittee Date 1 low, ' 7.._ ,WQi COMPENSATION DECLARATION' 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT '• � ''�q � ir�rrr� that I have'a certificate of consent to self CE-806G {� naucertificate of Workers'Compensation Insurance, IuI �or a certified copy thereof(Sec. 3800, Lab. C.) ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 1 Company FOR APPLICANT TO FILL IN JOB V A Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS A- Certified copy is filed with the county building inspec- 1 &246mily, Sq. Ft. $ — $ LOCALITY J tion department. Multi-family Sq. Ft. — NEAREST f r'., CROSS ST. Residential SwimmingPools Date� � Applicantjn�5� I CA FAAC- ��� OWNER OR I� �� ,�/ FIRM NAME 17 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Li ht _ MAIL / / COMPENSATION INSURANCE g Sw. ADDRESS b G S �r/1Y S (This section need not be completed if the work involved ey First 20 the permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel. No. I certify that in the performance of the work for which this PLAN CHECK 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 Date Applicant Total No. Additional CITY Tel. No. � NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT1 , Exemption, you should become subject to the Workers' Range_ Heater—D.W. APPLICANT V �l L C t�� Compensation provisions of the Labor Code, you must forth- , Oven —Dryer _W.M. ADDRESS � 1,)/1<(S dff Sr/r with comply with such provisions or this permit shall be Top _ FAU —W.H. — r deemed revoked. Hood _ Fan' =Other_ CITY ' .... eA Tel. rVo. LICENSED CONTRACTORS DECLARATION Dis _ Room Air Cond. LICENSE/091 1 hereby affirm that I am licensed under provisions of Chapter 9 p' REG. NUMBER Class.6-'to (commencing with Section y license of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT N PROCE D Y d and Professions Code,and my license is in full force and effect. V �-• Size 8 Type HP, KW, KVA, or KVAR' License NumberS•� y Lic. Class �0 (� ,1 .r- Up to 1 Incl. FINAL ContractoryC/7�'CIr��` z UD'te 1 Over 1 to 10 Incl. DATE ,�� O VALID ION t ❑ Over 10 to 50 Incl. I am exempt under.Sec. Over 50 to 100 Inc. O. B.&P.C. for this reason Over 100 z Date. Services, Swbd., MCC&Panelboards ;M4 0 7,6 A 0 -200 Amp. Under 600 V d Si nature # 0 0 0 0 0 2 9 201 - 1000 Amp. Under 600 V , ❑ Over 1000 Amp. or Over 600 V .(' o o40,50 Exemption for Reg. Mainf. Elect. SINGLE FAMILY o 004Q 5 0 Temp. Power Pole&Appurtenances HOME OWNER-BUILDER,DECLARATION Sign with One Branch Circuit 0220-86 0(156 I hereby affirm that I am exempt frm the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): I , I, as owner of the property, will do the work and the Misc. Conduits 6 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ \7044, Business and Professions Code). I 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. 3617, Civ. C.). PLAN CHECKING FEE Lender's\Npme \ Lend'er's Address PERMIT ISSUING FEE ' gj I certify that I have read this application and state that the TOTAL FEE Ds above inform.-on is correct. I agree to comply with all County ordinances an State laws regulating Electrical wiring, and hereby authorizerepresentatives of this County to enter upon the above-ment' ed operty for inspection purposes. Q- i• SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PerDate �� t WORKERS'COMPENSATION DECLARATION CE- 0 A86G '0'81 APPLICATION FOR ELECTRICAL PERMIT rl hereby.@f`.�rm that I have a certificate of consent to self insure, or•a dertificate of Workers' Compensation Insurance, or a certified COUNTY OF LdS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab,C.)' Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS (,L New Residential Bldgs.&Fools LOCALITY p ❑ Certified co 1 &2-Family,Sq.Ft. $ _ $ copy is filed with the,county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets:Rec-Light_Sw. ADDRESS Y y (This§ection need not be completed if the work involved by the F14 20 CITYTel.N . _ // permit Is for one hundred dollars($100),or less.) Tdtal No. Additional C tr+ I certify that in the performance of the work for which this permit PLAN CHECKPLICANT is issued,'I shall not employ any person in any manner so to17 become subject to the Workers'Com ens Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel.No. Date plicant Fixed Appliances Not Over 1 HP PERMIT :I NOTICE TO APPLICA : If,•after aking this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. provisions of the Labor Code,you must forthwith comply with such Oven Dryer_ W.M._ O ADDRESS provisions or this permit shall be deemed"revoked. Top FAU _ W.H. _ CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9Disp. Room Air Cond. REG..NUMBER Class:LICENSE OR (commencing with Section 7000)of Divisi°n,3 of the Business and • Professions Code,and my license is in full force and effect. Power Apparatus&Large Appjidnces DISTRICT NO._ /(� PROCESSED • Size&Type HP,KW KVA,or KVAR v Q License Number Lic.•Class Up to 1 Incl. FINAL V Over 1 to 10 Incl. DATE Contractor Date v VA I ATION �O Over 10 to 50 Incl. FI 13 ❑ I am exempt under Sec. Over 50 to 100 Inc. V y B.&P.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards �8 5 6 7 A Z Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V 0 0 0 0 0 2 ❑ Over 1000 Amp.or Over 600 V 0 0 1 Z 2 5 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances o 0 o T 2 5 c=, HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sf�n Branch Circuits for the following reason(Section 7031.5,Business and Professions 2.1 1 Code): Misc.Conduits&Conductors $7 1,as owner of the property,will do the work and the structure 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 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) CIV.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE ISR Lender's Address r7 I certify 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 represe atives Of this County to enter upon the above-mentioned per or'nspection purp es. SEE REVERSE FOR EXPLANATORY LANGUAGE Slaffatu7b of Permittee Date • WORKERS'COMPENSATION DECLARATION CE 806G 10/8 1 APPLICATION FOR ELECTRICAL PERMIT I hereby affiAn that I have a certificate of consent to self insure, or a Mr lMate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800.Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ' g — $ LOCALITY' ❑ 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 P olsOWNER OR �. CERTIFICATE OF EXEMPTION FROM WORKERS' L - 7 S FIRM NAME Outlets:Rec�LightV..— MaL COMPENSATION INSURANCE' vDRESS t (This section need not be completed if the work Involved by the First 20 CITYel.No. permit is for one hundred dollars($100)or less.) Total No. Additional C I+ I certify that in the performance of the work for which this PLAN CHE permit APPLICANT is issued,'I shall not employ any person in any manner so as to become subject to the Workers'Comp ati n Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel N . Date �pplicant5il Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLIC.AN lf. after m • aking this Certificate of APPLICANT Ldr Exemption,you should become subject to-the Workers'Compensation Range_ Heater D.W. provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY Tel No. ' LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR. (commencing with Section 7000)of Division 3 of the Business and Disp, — Room Air Cond., REG.NUMBER Com$ Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. ,/ PROCE9§ED BY (((i///•)`b/ Size&Type HP,KW,KVA,or KVAR License Number Lic.Class Up to 1 Incl. FINAL , Over 1 to 10 Incl. DATE IDAI 10N Contractor DateG Over 10 to 50 Incl. FIN ❑ I am exempt under Sec. Over 50 to 100 Inc.. BY W B.&P.C.for-this reason Over 100 ' Services,Swbd.,MCC&Panelboards Z Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V 8 6 2 7 A ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. 0 0 0 0 0 2 SINGLE FAMILY. Temp.Power Pole&Appurtenances I o o 2 2 5 0 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits .° ° ° 2 2 5 for the following reason(Section 7031.5,Business and Professions Code): ❑ ° Misc.Conduits&Conductors 2. 7 8 7 " I,as owner of the property,will do the work and the structure 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 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.C.). ' PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and sfate 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 n �•� representatives of this County to enter upon the above•mentioned X111 1.7 propert r' spection purpolps. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature.of Permittee Mate