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Home My Public Portal About10241 LOWER AZUSA RD_Electrical__ 76A663-CE80610/72 APPLICATION FOR ELEC RICAL PERMIT " ' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESS 4low, LOCALITY C. �• NEAREST l• FOR APPLICANT TO FILL IN CROSS ST, OUTLETS NO. EACH FEE OWNER OR 1 $ Is FIRM NAME OM Oc) , K/✓ ..l of C, RECEPT._ MAIL ADDRESS y i9/�, 4"- SWITCH TOTAL FIRST 20 .25 �O 3 - + CITY 1/(i /j TEL. NO.,,S SWITCH✓ li• OVER 2010 PLAN CHECK LIGHTING � FIRST 20 ,25 APPLICANT TOTAL T OVER 20 ADDRESS FIXTURES .10 RESIDENTIAL APPLIANCES CITY TEL. N0. PERMIT yv RANGE DRYER WTR. HTR. APPLICANT F/J j tG/ 1 C. STA. COOK DISP. F.A.U. ADDRESS oo,, f,C� SPACE HTR. AIR COND. CITY TEL. NO. y CLOTHES WASH. DISHWASH. LICENSE OR ! 3� CLASS. - REG. NUM9ER tr FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 a LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE .J„ 1 - 1O 3.00 DESCRIBED RESIDENTIAL PROPERTY. 0 PERM ITEE c� 10 - 50 5.00 SIGNATURE ' = CD 50 - 100 10.00 w DISTRICT N0. PROCE SED BY 100 - 500 15.00 ' d N SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSP TOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.001 1 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 3.00o TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONCK. M.O. CASH 3 '9?3 OCT 2 4 2 D 8.2 5 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CE806 6/63 gppLICA ION FOR CTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS 'o.X 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 ffi 20 $ OWNER LIGHT MAIL ADD'L 10 ADDRESS SWITCH. - OVER 20 LIGHTING , TOTAL FIRST .20 LCITY - TE . � FIXTURES ADD'L 10 ELECTRICIAN OV9R 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS .... GARB.DISP. STA.COOK ( CITY �]Qy�VI.J TEL.NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(Ya N.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT-OVER H.P. DISMRICT/NO. GROUP ZONE PRO,CESSEED BY O 1 1.00 g r G- 1 3 1.50 INSPECTION RECORD 3 S 2.00 (L a 80 2.50 u 15 50 3.00 O 50 100 5.00 U SIGNS: NO.TRANS- CLN NO.LAMPS �y V) SERVICE 0.600V.NoT OVER 200A 1.00 SERVICE 0.600V-OVER 200 A. 2:00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 per. (5 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 0 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I D HEREBY CERTIFY THAT 1 AM PROPERLY REGISTEREAND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RE9IDENTI ROPERTY. POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL /�YALIDATION_ ARTHUR C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER LAGo 3 5 3 5 SEP 8 2 D 4.0 0- z' 76A663-CE806 8/63 APPLICATION F R ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT 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. RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 $20 $ OWNER LIGHT MAIL A DDADDRESS 2 SWITCH. OVER 2O1OLIGHTINGT=l FIRST 20 ,20 CITY TEL.NO.FIXTURESADD'L 10 ELECTRICIAN OV R 2O RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRES S- GARB.DISP. STA.COOK CITY TEL. NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(/a X.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H . DIS RICT NO. ROUP ZONE P13OCESSED BY 0 1 1.00 ma— i 3 1.50 INSPECTION RECORD 3 a 2.00 a 8 15 2.50 0 15 50 3.00 SO 100 5.00 ¢- SIGNS: ' NO.TRANS 0 p 0 d NO.LAMPS r h _z SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0.60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 pP SUPPLEMENTARY PERMIT ISSUING FEE 1.00 _ TOTAL FEE $ dp 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES ALIFORNI CA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA OPERTY. POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL ` i— ALIDATION a THUR C. VEIT V C MO CASH SUPERVISING ELECTRICAL ENGINEER ALO 3 5 3.6 SEP 8 2 DN N u' 76A663-CE806 8/63 APPLI�10N FOReCTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ACIRESS/d� JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN, SUP'T OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN cRoss sr. RECEPT, TOTAL NO. EACH I FEE OUTLETS FIRST 20 $20 $ OWNER LIGHT MAIL ?�3O ADD'L 10 ADDRESS SWITCH. � OVER 20 (� � � TOTAL CITY EajT��/ TEL.NO. /�/ LIGHTING 'FIRST .20 FIXTURES ADD'L 10 ELECTRICIAN OV R20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS 3 G► L?�r GARB.DISP. STA.COOK ��''++ CITY_O�! TEL. NO. � 1 DISHWASH. AUTO.-WASH. STATE 4! SPACE HTRS. STA.APP.(y=H.P.MAX.) .SO LICENSE NO. 17% `J -91 MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP ZONE PROCESSED BY O 1 1.00 1 a N T 4r 1 3 1.so INSPECTION RECORD 3 8 2.00 d 8 15 2.50 0 15 50 3.00 O 50 100 5.00 V w SIGNS: i NO.TRANS Ilea NO.LAMPS '? N °C� Z SERVICE 0.60OV-NOT OVER 200A 1.00 SERVICE 0-60OV-OVER 200 A. 2.00 l SERVICE OVER 600V 5.00 MISC. _ D WAIT-r f3 L. J3 S NY PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 154 i' I HEREBY ACKNOWLEDGE THAT I 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. WIRING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL-PROPER POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITT FINAL VALIDATION ARTHUR C. VEIT MO CASH SUPERVISING ELECTRICAL ENGINEER LRUo 3 5 3 71 SEP 8 2 D 6.5 0 76A663-CE806 8/63 APPLICA ION FOR CTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ,r BUILDING AND SAFETY DIVISION ADDRESS ®a2Y 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 10.20 S OWNER ~ LIGHT MAIL SWITCH. ADD'L 10 ADDRESS OVER 20 TOT CITY TEL.NO. / LIGHTING 1 FIRST 20 .20 FIXTURES 1 ADD'L 10 ELECTRICIAN OV R 20 `` RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS d GARB.DISP. STA.COOK CITY TEL. NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(1/.H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H . DISTRICT NO. GROUP ZONE PROCESSED BY 0 1 1.00rg E— / + 3 1.50 INSPECTION RECORD 9 a 2.00 ��1, V'� t a +s 2.50 lam . O 15 50 3.00 5 - 100 5.00L F- SIGNS:2. O. RA ILUI NO.LAMPS Z SERVICE 0.60OV-Nor OVER 200A 1.00 SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. _ L, a-/Z 12 D Q 3u s PERMIT ISSUING FEE 2.00 Z SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 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. WIRING 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL.PROPERTI POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL /^VALIDATION AIRTHUR C. EIT CPQ MO '. CASH SUPERVISING ELECTRICAL ENGINEER uta 3 5 3 41-0 SEP 8 2 D 1 0.0 0~ �' 16A663-CE806 5-62 APPLICATION FOR ELECTRICAL PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESStoavLove,, z ' JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY J NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT. TOTAL NO. EACH FEE ' OUTLETS FIRST 20 $20 $ dp OWNER P' I LIGHT MAIL .'� ADD'L ADDE2ES8 Qd SWITCH.f OVER 20 .10 io 1 'e LIGHTING TOTAL 1 IF1R5T2OI�L .20 vCIT TEL. NO. FIXTURES J( � 3 ADD'L ELECTRICIAN ..l.7 0VFR 20 •1O O RANGES CLO.DRYERS WTR.HTRS. 1.001 1 ADDR S GARB.DISP. STA.COOK J/r�� CITY /f L.NOZ3146- DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(yy H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. VDISTIRICT ROUP NE P BED BY 1.00 co 2 Z L= t 3 1.50 �� INSPECTION RECORD 3 S 2.00 a Q 815 2.50ff 15 50 3.00 50 t00 5.00 cl� O NO.TRANS- - - I-- SIGNS: NO.LAMPS ` k / �-� S A W SERVICE 0.600V-Nor OVER 200A 1.00 �f C Z SERVICE 0-60OV-OVER 200 A. / 2.00 Z c) , n SERVICE OVER 600V 5.00 MISC. - PERMIT ISSUING FEE 2.00 2 do SUPPLEMENTAIRY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS p DA1TE' INSPECTOR'S,,SIGNATURE D ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT N:I� ✓�J Y' ..C.-"N;^.0.. LD=CRIABtED COUNTY ORDINANCES AND STATE LAWS REGULATING L WIRING. WIRING j. Y CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR �\ AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES lJ CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE RESIDENTIA ROP Y POWER RE UTILITY CO.NOTIFIED ITTEE FINAL DATION ARTHUR C. VEIT CK O CASH SUPERVISING ELECTRICAL ENGINEER Leto 5 1 0 8 OCT 2 2 2 D 3 3.10~ a 76A663-CE806 9-64 , APPLICATION- FOR EUNCTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AICD SAFETY DIVISION ADDRESS (7 < ( WCI�`' .T Ui,''� U JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUP'T. OF BUILDING LOCALITY NEAREST �P� FOR APPLICANT TO FILL IN cRoss sT. REC EPT. TOTAL NO. EACH FEE - OUTLETS FIRST 20 $20 $ OWNER LIGHT -/ MAIL A Y ADD'L f0 ADDRESS lqO3 Q1 A,4N —,V'e1�01 jJ SWITCH. OVER 20 - TOTAL I - CITY 'r°D`F7 TEL. NO. LIGHTING FIRST 20 .20 FIXTURESf _ ( OVER 2 f0 ELECTRICIAN �� N U�l/CT OV R 20 RANGES ' CLO,DRYERS 'WTR.HTRS. 1.00 ADDRESS i Q- 1 Ov P GARB.DISP. STA:COOK CITY N P/0&1,26 TEL.NO. DISHWASH. AUTO.-WASH. STATE t SPACE HTRS. STA.APP.(1/z H.P.MAX.) .50 LICENSE NO. 619 9 6.. MOTORS: OVER NOTOVER H.P. DISTRICT O. IGROUP. ZONE P C SSED O t ( 1.00' ) 1 3 1.50 INSPE ION RECORD 3 8 2.00 - IL 8 15 2.50 V 1.5 50 3.00 d. O 50 100 5.00 Yom' ,) NO.TRANS v W SIGNS: !/ NO.LAMPS f� Z_ SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. 00 W. PERMIT ISSUING FEE .2.00 - SUPPLEMENTAgY PERMIT ISSUING FEE 1.00 .TOTAL FEE $ 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 q ELECTRICAL WIRING. WIRING I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS. ANG LES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEG OWNER OF, AND INTEND TO RESIDE IN, THE ABO ESC RI'ED R IDENTIAL PROPERTY. POWER SIGNATURE UTILITY CO.NOTIFIED /egn t /. OF PERMITTEE ll.� I*/,O l �� .fZA�1'ra-?f FINAL , ALIDATION JOSEPH C. ROOHAN . MO CASH SUPERVISING ELECTRICAL ENGINEER CK ' �tufl 4 p. 4 7"'03, JUL28 2 D6 rU r . r APPLICATION gy� ®.�p��dp 9p Q�q� /app p��-ap FOR ELECTRIC p}� app pp�� g�+p_, PERMIT p�a� �pp�[�rypp/p/g� q®� 1J1�■�I, DBS-5A 11.55 DIVISION OF. BUILDING AND SAFETY . Deportment of County Fugfaee! BUILDING} County of Los Angeles ADDRESS 10241 Lower Am sa Rd. JOHN A. LAMBIE.COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY E1 Monte FOR APPLICANT TO FILL IN NEAREST PERMT FEES CROSS ST. NUMBER OWNER 10_ LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES FEE CITY TEL. NO. 'TOTAL OUTLETS @ '1165 - ELECTRICIAN G. E. CORBIN ELEC.- CO. ELEC. RANGES 25 ADDRESS Z OO So. urt i s 4ve, ELEC. HEATERS 25 CITY Alhambra- . TEL. NO. Cu33526 KW EA STATE FIXTURES' S O LICENSE NO. MOTORS DISTRICT NO. G ROUP ZO READY FOR INSPECTION` NUMBER HORSEPOWER FEE MEW NEW MVD. HP OVER INC. EACH - Y2&LESS $' .25 INSPECTION RECORD _Y2 2 .50 2 5 1.00 5 15 1.50 15 50 2.50 50 1 200 1 5.00 MISC. e: NO.SIGNS NO.TRANS. NO. SIGNS NO. LAMPS' FOR EACH PERMIT: ' WIRING $1.00 1 00 4 FIXTURES $1..00 1 00 I - - " SUPPLEMENTARY .50 ,,++ ..' APPROVALS TOTAL FEE $ �t DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND ATE LAWS REGULATING WIRING �/ ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PERLY REFSTAD 'AND/OR FIXTURES •/ LICENSED AS-REQUIRED BY LOS S CO TYD STATE OF CALIFORNIA OR THAT I AM 0 E F THEf ABOVE POWER DESCRIBED RESIDENTIAL UTI LITYCO.NOTIFIED SIGNATURE OF PERMITTEE. FINAL J Cori JOHN A.LAMBIE.COUNTY ENGINEER ATION ARTHUR C.VEIT,CHIEF ELECT. INSPECTOR CK MO - CASH .., LA 07 286- APR 17 2 4.1 5 WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT .I hcreb%•2ffirm that I have a certificate of consent to self insure, CE-Bose or a certificate of Workers' Compe ation ns ance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY co threooff ec.38p0, / , PoliJOB ( Policy 166.d � V Ompa7ny FOR APPLICANT TO FILL IN ADDRESS OZ l/ Lowe Q✓ L.Lt S o ed ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE t� _ $ LOCALITY l IL`G Certified copy is Jiled,with the county building inspection 1 & 2-Family,Sq.Ft. $ de art n. Multi-family Sq.Ft. NEAREST CROSS ST. Date `� plicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. AMAIL DDRESS a COMPENSATION INSURANCE (This section need not be b if the work involved completed First 20 �p p Y the CITY Tel.No. -JCJ/ permit is for one hundred dollars ($100)or less.) I I Total No. Additional PLAN CHECK 1'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. I Lighting Fixtures First 20 ADDRESS Additional. Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HPERLICANT MIT NOTICE TO APPLICANT.: If, after making this Certificate of a 11 C eC.-.- 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 D provisions or this permit shall be deemed revoked. Top — FAU — W.H. CITY M04 Tel.No.9/D/ LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9Disp. — Room Air Cond. LICENSE OR (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER 3 Ol Class.C�b Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO.57E Size&Type HP,KW,KVA,or KVAR . v U License Number T Lia Class Up to 1 Incl. FINAL Contractor MBXf�P1I 61e>C� Date 6 Over 1 to 10 Inc]. DATE VALIDATION Over 10 to 50 Incl. 0 ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY 10 B.&P.C.for this reason Over 100 CL C/) Services,Swbd.,MCC&Panelboards ► 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. c SINGLE FAMILY Temp.Power Pole& Appurtenances AI,"C T o 0a HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I herebyaffirm that I am exempt from the Contractor's License Law ;.- ¢� `}� for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits +=!a ! Code): i ITEMS ❑ �• I,as owner of the property,will do the work and the structure Misc.Conduits &Conductors TOTAL j!HL. 2�c o �'a0 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). , H',n 25.50 CONSTRUCTION LENDING AGENCY CHANGE of l�j 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.). l �sf ftp—til !°1 2% 6/39 PLAN CHECKING FEE• • Lender's Name I lLe:I 3 Ar.10 0�!a ! PERMIT ISSUING FEE Lender's Address /I I certify that I have read this application and state thatthe above TOTAL FEE 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 prope for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 2 b _ Signature ofPermittee Date