HomeMy Public PortalAbout9665 LONGDEN AVE_Electrical__ 7eA88C•CE#806.9-61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cRoss sT.
PERMIT FEES OWNER
ITEM. NUMBER EACH FEE MAIL
OUTLET.Ss $ S ADDRESS
LIGHTS RECEPT. SW. .10 CITY TEL- NO.
LIGHTING FIXTURES _ .10
ELEC.RANGES CLO.DRYERS ..ELECTRI AIV lV�AQ
J)
WATER HEATERS • .sO V� ADDRESS 4--
'
ELEC.SPACE HTRS. DISHWASHERS CITY �` L—" TEL NO.
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKllld UNITS ,25 LICENSE NO. tm!i MOTORS: OVER INC. H.P. DL9T,RICT G Z E
0— '/s 28 v r
V,— 2 .so INS ION ORAD
•
2— 5 1.00 �Y t! i. � ,.; . - rj
O
s— is 1.50 +_.. �y
is— so 2.50
so— 200 0.00
NO TRANS. .� •/ ��-i .�. ,ei'J
SIGNS:
NO.LAMPS ";t '•.. •••! ....�.,�,r.. �..
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MISC. 'I�C/�� - '..r'd.�/ f4
WIRING PERMIT 1.00
FIXTURE PERMIT
1'.00
SUPPLEMENTARY PERMIT .So
TOTAL FEE S
1. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR-S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE'TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR' WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF.' FIXTURES
CALIFORNIA OR THAT A tTELEGA ER O 'THE ABOVEwn 'i eDESCRIBED RESIDENTI P POWER )d ,1 tI
SIGNATURE UTILITY CO.NOTIFIED 'wl
OF PERMITTE FINAL " ,%OF �11�Iq
VALIDATI AR HURIC.VETT
M
CK MoSUPERVISING ELECTRICAL ENGINEER
8 7 , ?2 2 D 2,50 fi:
TEMPLE CHTY
7BA66C-CE#806 6-61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARMENT OF COUNTY ENGINEERf— ADDRESS
ING r
BUILDING AND SAFETY DIVISION ESS
JOHN A. LAMBIE. COUNTY ENGINEER
�.
WILLIAM A.JENSEN,SUPT OF BUILDING LITY
EST
FOR APPLICANT TO FILL IN S ST.
PERMIT FEES ER
I T E M NUMBER EACH FEE
OUTLETSs S $
LIGHTS RECEPT. SW. .10 TE,. O.
LIGHTING FIXTURES 10
ELEC.RANGES CLO.DRYERS TRI N
WATER HEATERS .SO ADDRESS L_
ELEC.SPACE HTRS. DISHWASHERS
CITY L'� TEL NO.
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS ,25 LICENSE NO. Com- ✓'
MOTORS: OVER INC. H.P. DISTRICT NO. G U O ECESSED BY
0— 1/$ .211
1/2— 2 :so INSPECTION RECORD
2— 5 1.00
5— is 1.50 V
1s— so 2.50 ad
SO— 200 ~U
's.00
W
SIGNS: NO TRANS. IL
N
NO.LAMPS Z
SERVICE 0-690V 1.00
SERVICE OVER 600V 5.00
M ISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE g
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE iS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT ROPERTY POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERM171
FINAL
• VALIDA/C '1 ARTHUR C. VETT
AS!
CK NO case tl,j SUPERVISING ELECTRICAL ENGINEER
76A663 DOG 6A 7-s1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY •
COUNTY OF LOSANGELES ELECTRIC
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN _rL j[I / Ault ,C?7r d Jr / A— /
n RECEIVED BY READY FOR DATE ISSUED
ADDRESS �/t 4//�1` G AS �(,//orf?(' //�j//� �) FIRBT INSPECTION
CITY 'f_A/ l7�). �fJ�� TEL NO.
COUNTY LICENSE NO. EXPIRES ADDRE BUILDINBG
PERMIT Elm
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREBT
RECEPTACLES CROBB ST.
WALL SWITCHES // OWNER ✓osrl /t�h> ic�.5e•a/
TOTAL OUTLETS :i(� Y sC 19 U MAIL
ELEC. RANGES f [)iV gB ADDRESS
ELEC. HEATERS {l 28 CITY TEL NO.
FIXTURES ff��-7;7. „�n�, 5
MISC. �� y 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THISV,
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 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY INCENSE. OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH DF THE REBIOENTI PROPERTY DESCRIBED ABOVE.
A UE®R s .85 SIGNATURE OF
va 7 .BO PERMITTE
s B 1.00 INSPECTION RECORD
s 1B I.BD ,
is so 2.80
00 200 6.00
Boo BOO 1OAD J
800 Iwo 18.00 Q
Z
OVER 1 COO 20.00 n
M:G. BET FREq. C NGER-HP 1• m
WELOERSIAC-KVA O
GENERATORS - KW
TRANSFORMEWB - KVA '
TEMP. MOTORS (78% or oaf D.)
MOVED MOTORS (75%, or DR1m.)
MISC.
SIGNS
NO. NO.TRANS.
NO. NO:LAMPS APPROVALS
FOR EACH PERMITI DATE INSPECTOR-1111 NAME
WIRING $1.00 CONDUIT
FIXTURES 81.00 WIRING
SUPPLEMENTARY .60 FIXTURES
POWER
TOTAL FEE � r /A UTILITY co.NOTIFIED �v /�(7.�,,, �,• /_
FINAL
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of CountBUILDING
EngineerF ��������
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN+ t[� 1 YV 4 6 71,6 d
ADDRESS p I.� tF1a1,A„S M, N �j
RECEIVED BY FIRST(INSPECTION OATS ISSUED
CITY sZ p . TEL NO. /4,-`� p - �
COUNTY LICENSE NO. EXPIRES ADDRESS �h � �9 i� �/9/�i D
PERMIT FEES
^}�
NUMBER EACH PEE LOCALITY /
LIGHT OUTLETS D NEAREST
RECEPTACLES CROBB
WALL SWITCHES OWNER V.
TOTAL OUTLETS 5C MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS a5 CITY TEL. NO.
FIXTURES B r HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS 3'3 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELEB COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEw MVC. HP CVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2 A LESS $ .25 .SIGNATURE P-0
%2 2 .50 PERMITTEE-
2
z 5 1.00 INSPECTION RECORD
5 15 1.50 LEG_'z /G
1 S 50 a.5O `
50 20D 5.00 3"Z ##!Y/a
2013 Sao 10.013 (JNGr�OUNO, n1_IJCr Q
Boo 1000 15.00
OVER 1000 20.013 ` Z
M.G. SET/FREQ. CHANGER-HP
WELDERS.*AC-KVA /
GENERATORS - KW
TRANSFORMERS - KVA -
TEMP. MOTORS (75% CF GRID.) r 3 '
MOVED MOTORS (75% OF CRIB.) Wo r od&x,Are, w !!
MISC. 11�1- �1) M 1) A /) 1.1 A CA -
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
FOR EACH PERMIT.* // DATE. INSPECTOR'S NAME
WIRING $1.00 CONDUIT 6F ' 3%
FIXTURES $1.00 WIRING R 1
SUPPLEMENTARY .50 FIXTURES
I
POWER
TOTAL FEE !is UTILITY CO.NOTIFIED
FINAL
g6A663 DBS# 5A 4-5E
i t:f•
eA66aCE-806(8/791 APPLICATIO FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL INJOB 00,
New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
1&2-Family,Sq.Ft. $ .025 — $ LOCALITY
Multi-family Sq.Ft. .02 — NEAREST
25..00 CROSS ST.
s
Residential Swimming Pools OWNER OR `
FIRM NAME
Outlets:Rec Light—Sw.I MAIL
First 20 50 ADDRESS
Total No. Additional .30 CITY No. ..,
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 ,50 ADDRESS
Additional .30
Total No. CITY Tel.No..
Fixed Appliances Not Over'1 HP PERMIT
Range=Heater_D.W._ APPLICANT
ADDRESS
Oven_Dryer—W.M.�_
Top —FAU _W.H._ CITY Tel.No.
Hood_Fan —Other LICENSE OR '
Disp._Room Air Cond. 2.50 5D REG.NUMBER Class.
I-HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCA-
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&TYp e HP,KW,KVA,or KVA.R COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING ELECTRICAL WIRING.
2.50
Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
25.00 DESCRIBED RESIDENTIAL PR ERTY.
Over 50 to 100 Inc. PERMITEE
Over 1000 40.00
SIGNATURE V0
Services DISTRICT NO. SED BY
0-200 Amp.Under 600 V 12.50
201-1000 Amp.Under 600 V 25.00
Over 1000 Amp.or Over 600 V 50.00 Z
O
Temp.Power Pole&Appurtenances 10.00 a
Sign with One Branch Circuit 10.00 0
Additional Sign Branch Circuits 2'00 INSPECTION >
Misc.Conduits&Conductors 10.00 INFORMATION uON REVERSE z
Other(See Complete Fee Schedule) SIDE W ;2 0 R 7 0 A
Z
g # o 0 o 0 o 2
20 . 1000
PERMIT FEE (Sub-Total)
PLAN CHECKING FEE (One-Fourth Permit Feel O o 0 0 a G'(j
PERMIT ISSUING FEE $7.00 0 1 0,25-78
TOTAL FEE >
F
INSPECTION FINALED
date: / 2((�� By IL es
.R �:• % J
.f
'6A663CE•60616ne1 APPLICATION FOR. ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
1 &2-Family,Sq.Ft. $ .025 — $ LOCALITY
Multi-family Sq.Ft. .02 — NEAREST
CROSS ST.
Residential Swimming Pools 25:00 OWNER OR J
'n FIRM NAME
Outlets:Rec—ZLLightSw. ^ MAIL
First 20 .50 f! ADDRESS 7aoJ
Total No. �. Additional .30 CITY Tel..No. y,7O
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 •50 1 ADDRESS
Additional .30
Total No., CITY Tel.No.
Fixed Appliances Not Over 1 HP PERMIT
Range_Heater_D.W._ APPLICANT Alf
ADDRESS
Oven—Dryer_W.M.—
Atr
Top _FAU —W.H.T CITY Tel,No.
Hood_Fan —Other LICENSE OR Disp._Room Air Cond. 2.50 REG.NUMBER Class.
I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA.
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP,KW,KVA,or WAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
2.50 REGULATING ELECTRICAL WIRIrVG.
Up to 1 Incl: I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0
Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF W
Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AMTHE LEGAL OWNER OF THE ABOVE INO
25.00 DESCRIBED RESIDENTIAL P PERTY. 0
Over 50 to 100 Inc. {
Over 100 40.00 PERMITEE
SIGNATURE
Services 12 50 DISTRICT N .. t j9REWfS5ED BY
0.-200 Amp.Under 600 V D
201.1000 Amp.Under 600 V 25.00
Over 1000 Amp.or Over 600 V 50.00 z
O
Temp.Power.Pole&Appurtenances 10.00
Sign with One Branch Circuit 10.00
Additional Sign Branch Circuit's 2.00 INSPECTION
Misc.Conduits&Conductors 10.00 INFORMATION W. 12396611
Other(See Complete Fee Schedule) ON REVERSE u # 0 0 0 0 0 2
SIDE. z
s 20020.50
y o o o 2Q5'G'c
PERMIT FEE (Sub-Total)
z 04.2 t;.-74
PLAN CHECKING FEE (One-Fourth Permit Feel O
PERMIT ISSUING FEE - $7.00 0
TOTAL FEE
INSPECTION FINALED
p ��� d
WORKER'S COMPENSATION DECLARATION DPW(12-81) APPLICATION FOR ELECTRICAL PERMIT
76A669
I hereby affirm that I have a certificate of consent to self insure, 76A663
or a certificate ol,Worker's Compensation 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 FOR APPLICANT TO FILL IN ppDRESSS, XMI
❑ Certified copy is hereby furnished. New Residential Bidgs.&Pools NO. EACH FEE LOCALITYtr
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. — $ $
department. Multifamily Sq.FL NEAREST
RROSSS ST.
Date Applicant `Residential Swimming Pools ASSESSOR '
yy�� �/ //.qq�'' MAP BOOK PAGE PARCEL
CERTIFICATE OF-EXEMPTION FROM WORKERS' Outlets:Rec.Zr_Light Y� _Sw.� OWNER ME
COMPENSATION INSURANCE /�Q FIRM NAME p
First 20
(Thls section need not be completed If the work Involved by the O MAIL.
permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS ��.Ly •�, d.�
I certify that In the performance of the work for which this permit CITY CN– M�f /i
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
Data � `Applicant - RESIDENTIAL APPLIANCES NOT OVER 9 HP.
NOTICE TOO APPLICANT: If, of r making this ertificate 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
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESSIA Q BBi}( U13.7
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. 9
(commencing with Section 7000)of Division 3 of the Business and CITY
Professions Code,and my.license is in full force and-effect. Over 10 to 50 Incl. 1
LICENSE OR Class:
Over 50'to 1110 Incl. REG.NUMBER 0.
(B Over 100
License Number E6/92`�' DISTRICT NO. R EBBED BY
Lic.Class U
Services,Swbd.,MCC&Panelboards �.J' d� (_
Contractor Date 0-399 Amp.Under 600 V DNA 0
❑ I a exempt under Sec. 40.0-1000 Amp.Under 600 V -G VALIDATION W
Over 1000 Amp.or Over 600 V FINAL IL
W
B.&P.C,for this reason BRANCH CIRCUIT FEES BY (n
• Date: 15A,.or 20A,120V,Lighting or Recept. Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Cifcuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,WA,208V To 2M Lighting Br..Circuits r�
SINGLE FAMILY Temp.Power Pole&Appurtenances y
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT N'T
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-Circuits3303
;Errs
Code):❑ Misc.Conduits&Conductors i ITEMS
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) 31111. TOTAL . 115.80
and Professions Code). 115.8D
CONSTRUCTION.LENDING AGENCY
I hereby affirm that there is a construction lending agency for the CHA14GE .)JU
performance of the work for which this permit is Issued(Sec. 3097, PERMIT FEE (Sub-Total) Q
Civ.C.)
PLAN CHECKING FEE 0000_0001 8/ 5/9.
Lender's.Name
PERMIT ISSUING FEE a(p 1116 1 AM 8 25
Lender's Address
I certify that I have read this application and under penalty of pufjury state TOTAL FEE. Q
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' action purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
.. �J -
SIGN RE
01 PERWITEE DATE�n[ '
WQRKE S'C.Ok,kNSATION'DECLARATIO 76A663 A 4+
CE-S06G (2.80) APPLICATION FOR ELECTRICAL PERMIT
hprel affirm: hat I have a certificate of cons.. to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure344a certiVicate of Workers'Compensation Instyrance,or
a certified'�copy thereof(Sec.3800,Lab.C.) 1
1 FOR APPLICANT TO FILL IN' JOB
Policy No. Company EACH NO. FEE ADDRESS A
New Residential Bldgs.&Pools
Certified copy is hereby furnished. 1 &2-Family,Sq.Ft. $ — $ LOCALITY +
OMulti-family Sq. Ft. — NEAREST 1)..
Cdrtified copy is filed with the county building inspection CROSS ST ,
department. d Residential Swimming Pools OWNER OR
,,LL r� 7 FIRM NAME
Date Applicant Outlets: Rec.&Light�SwJ5. ,, C � MAIL �9
First 20 r. 6 nl!e CiDDRESS '1
-CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. 40 Additional D CITY C. T No. �1
COMPENSATION INSURANCE PLAN CHECK "/.- a
(This section need not be completed if "the work involved Lighting Fixtures First 20 > APPLICANT V
t?
by the permit is for one hundred dollars ($100) or less.) ADDRESS . ✓ W_
Total No. AdditionalO
I certify that in the performance of the work for which thisCITY 1 0.
--permit is issued, I shall not employ any person in any manner Fixed Appliances Not Over 1 HP i
P W R � PERMIT W
so gs to become subject to the Workers''Compensation Laws. Range_Heater D.W. APPLICANT iL
N
Oven — Dryer_W.M. ADDRESS 17
Date Applicant. Top _ FAU, _W.H..
Hood ..Fan _Other_ CITY Tel-No..
•NOTICE T APPLICANT: If, er making this Certificate of Dlsp. _Room.Air Cond— LICENSE OR
Exemption, you should be co a subject to the Workers' REG.NUMBER Class
Compensation provisions of the Labor Code, you must forth-, Power Apparatus&Large Appliances DISTRICT NO. PR OC SS D BY'
with comply with- such provisions, or this per shall. be Size&Ty a HP,KW,KV Up to 1 Incl.1.or KVAR ` /�
deemed revoked.
FINA
Over 1 to 10 Incl. DA EL
LICENSED CONTRACTORS DECLARATION VALI TION'
Over 10 to 50 Incl. ,
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINA
9 commencin with Section 7000 of Division 3 of the Busi- BY
'(commencing ) Over 1.00
ness and Professions.Code, and my license is in full force.and
effect. Services
License Number Lic.Class 0-200 Amp.Under 600 V
. 201=1000 Amp.Under 600 V
Contractor Date Over,1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's` Sign with One Branch Circuit
License Law for the following reason (Section.7031.5, Busi- Additional Sign Branch Circuits f6.3 0,9
ness and Professions Code):
Misc.Conduits&Conductors # o••0 0 0 0.2
C9I, as owner of the property, will do-the work and the Other(Seeomplete F e Schedule— o o U 9 5 '
structure is not intended or offered for .sale (Section
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY 0 ° ° 4 9.2 5 5.
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) 0 1.08 i$7
issued(Sec.3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE DPC
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-m ion. r petty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
n.11. (ZA'....)
Sigr) t re of Per ittee Da
// t I