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Home My Public Portal About9608 LOWER AZUSA RD_Electrical__ C L- 78>R883-CE>60810/72 APPLICATION FOR ELECTRICAL PERMIT w 'COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS NO EACH FEE OWNER OR $ $ FIRM NAME RECEPT_ MAIL LIGHT TOTAL FIRST 20 25 ADDR CITY TEL NiV SWITCHOVER 20 10 PLAN HECK TOTAL LIGHTING FIRST 20 28 APPLICANT FIXTURES 10 OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY T NO PERMIT RANGE DRYER_WTR HTR APPLICANT STA COOK DISP F A U ADDRESOPT SPACE HTRAIR COND CI — , TEL N -� CLOTHES WASH DISHWASH LICENSE REG NUMOBR CLAS /d FAN OTHER 100 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 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR O - 1 100 LICENSED A8 REQUIR S ANGE S COUNTY ANO TATE OF' CALIFORNIA OR TH I M LE AL OWNER OF ABOVE ' - 10 300 DESCRIBED RESID IA PROP T ` yn C PERMITEE / V 10 - so lool SIGNATURE FFF O F- 50 - 100 10A0 DISTRICT NO ED BY yVj 100 - Soo 1500 G 06 2C SIGN, GAS=AND ONE CIRCUIT 500 APPROVALS DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE SERVI CENOTOVER 600 VOLTS OR 200 AMP 300 d�' UNDERSLAB WORK SERVI CE OVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT TEMP SERVICE,POLE,&APPURTENANCES Sop WIRING TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES POWER AUTHORIZED 7 UTILITY CO NOTIFIED FINAL / 7 PERMIT FEE (SUB TOTAL) NOTES PLAN CHECK FEE PERMIT ISSUING FEE 300 TOTAL FEE PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALI ION cK M o CASH cQ LACE, o 1 8 373 w 26 D 6.00 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76AGGS CROOS-1068 APPLICATION FOR ELECTRIC PERMIT 1 BUMMING AND SAFETY DMSION Department of Conatr EngWew BUILDING U I LD I N �� Comte of Los Angeles = a,.,-....L JOHN A. LAI�BIE,COUNTY ENGINEER CASSATT D. GRIFFIN. SUP-T OF BUILDING LOCALITY NEAEST FOR APPLICANT TO FILL IN CROS S r PERMIT FEES 1 LIGHTS RECEPTACLES SWITCHES OWNER NUMBER 1 T E M EACH PEE MAIL TOTAL OUTLETS S 10 s ADDRESS RLEC RANGES, WATER HEATERS, CITY TEL NO BLEC S DRYERS BO ELECTRICIAN BLBC SPACE HEATERS, STAT Y COOK ING UNITS, GARBAGE DISPOSERS, ADDRESS , AUTO WASHERS, DISHWASHER 25 LIGHTING FIXTURES 1p CITY TEL NO MOTORS STATE HORSEPOWER LICENSE NO Z N P OVER INC DISTRICT NO IGFP ZO READY FOR INSPECTION va a LESS 25 14 — 2 Ba ..1� IION RECORD If 2 I3 100 O B 1B 150 SC e 1 1B — SO 250 G,.1..- 50 200 Boo MISC SIGNS NO TRANS NO LAMPS SERVICE O-600V 1 00 6 SERVICE OVER SOOV 500 WIRING PERMIT 100 --/ FIXTURE PERMIT 100 O SUPPLEMENTARY PERMIT BO APPROVALS I TOTAL FEE DATE INSPECTORS SIGNATUR I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL R PERTY I SIGNATURE UTILITY CO NOTIFIED OF PERMITTEE r� FINAL JOHN y uNm m �4M)ATION AR HU C. COUNTY�+NGJNE�R `-C�1�31J MO CASH SUPERVISING LECTRICAL ENGINMM X23 07U x'16 2 9.75 9 76AS63-CESOO "S APPLICATION FOR ELECTRICAL ERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ` G BUILDING AND SAFETY DIVISION ADDRESS (p O O JOHN A LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST NO ACH F S OWNER RECEPT _ MAIL LIGHT TOTAL FIRST 20 20 ADDR SS ' SWITCH/ OVER 20 O CITY TEL NO + A� PLAN CH K LIGHTING 1TOTAL FIRST 20 20 LL! APPLICA T FIXTURES 1( OVER 20 10 ADDRESS RANGE_DRYER—WTR HTR CITY TEL PMn STA COOK_„DISP _F A u _ COIJTRAC TOR SPACE HTR AIR COND ADDIRFAS —041 CLOTHES WASH _DISHWASH CIT TEL NO FA N_0THER I 00 LICENSE NO fIe 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 ELECTRICAL WIRING 0 - 1 100 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - 10 3 00 a LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I TME LEGAL OWNER_OF AND I EN O 1 O - 50 b 00 RESIDE IN, TH A 9CR ED Al OP Y SIGNATURE CD C= 50 - 100 1000 OF PERMITTE p 100 - S00 1500 ~j DISTf+iIC� G ZO� ESS YSIG GAS CL TUBE OR SIGN AND ONE CIRCUIT 3 00 / CL Z MARQUEE [ADDITIONAL CIRCUITS 1 00 poll,E SERVICE NOT OVER 800 VOLTS OR 200 AMP 2 00 SERVICIeOVER 800 VOLTS OR 200 AMP 5 00 TEMP SERVICE, POLE &APPURTENANCES 3 00 APPROVALS. D TE INSPECTOR'S SIGNATURE TEMP POWER POLE w UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED (oJ PERMIT ISSUING FEE 2 00 0 UTILITY CO NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE JOSE H C. ROOHAN SUPERVISING,=L AL ENGINEER PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATIO cK M 0 CASH LAPo80500 JM16 2 a 7BQ- � IEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE • eeA,2d� APPLICATION FOR ELECTRIC PERMIT ]� bIVISION OF BUILDING AND SAFETY Depo=haeat of County Engineer ` County of Les Angeles 8 U 1 LD i NG WM J FOX. COUNTY ENGINEER ADDRESS D CASSATT D.GRIFFIN,SUP T OF BUILDING FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST FEE CROSS ST NUMBER EACH LIGHT OUTLETS OWNER ip p � RECEPTACLES ADDRESS��D *V—U�- WALL SWITCHES _w TOTAL OUTLETS 5# S CITY v TEL NO ELEC RANGES 25 ELECTRICIAN ELEC HEATERS 25 ADDRESS 6"VV* KW EA CITY TEL NO • —*—/ O FIXTURES 5 LICENSE N NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP ZONE READY FOR INSPECTION NUMBER OFR EPT LE RCU TS Cal MOTORS (r er6 NUMBER HORSEPOWER FEE INSPE ON RECORD NEW MVD HP OVER INC EACH _ a Lase $ 25 2 50 2 5 too 5 15 150 I I 15 50 250 I I 50 200 Boo MISC NO SIGNS NO TRANS Z� NO SIGNS NO LAMPS FOR EACH PERMIT WIRING S1 00 FIXTURES 81001 SUPPLEMENTARY 50 APPROVALS TOTAL FEE S D DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 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 ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE 0FINAL L OF PERMITTEE WILLIAM J.FOX,COUNTY ENGINEER VALIDATION c J&1 4 6A ,moi 4 . 2 2.00 >o DEPUTY � r 76"63 DBS SA 7-51 APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY �� COUNTY OFF LOS LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE �PERMIT NO. ELECTRICIAN ADDRESS RECEIV ® FIR13TADY FOR INSPECTION DA IBB ED CITY TEL.N AV101S,3 .S3 COUNTY LICENSE NO. ZZ JC EXPIRES + BUILDING Q W� use �I }� PERMIT FEES FEE ADDRESS / pd. NUMBER EACH LOCALITY 'C LIGHT OUTLETS NEAREST CROBB BT C / RECEPTACLES WALL SWITCHES OWN E i Y TOTAL OUTLETS SO S MAIL ELEC RANGES 25 ADDRESS ELEC HEATERS 25 CITY TEL NO FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC APPLICATION AND STATE THAT THE ABOVE 16 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 LOB NUMBER HORSEPOWERFee ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVD. HP OVER INC EACH OF THE RESIDENTIAL P PERTY DESCRIBED ABOVE. Ya / A LESS 111 25 SIGNATURE OF S 50 PERMITTEE. 2 5 1.00 INSPECTION RECORD 5 is ISO is s0 250 50 ZOO Boo 200 BOO 1000 J BOO 1000 is OO Q Y OVER 1000 2000 M G BET/FREQ CHANGER-HP WELDERS:AC-KVA 0 GENERATORS - KW TRANSFORMERS - KVA TEMP MOTORS (76 o OF ORIS) MOVED MOTORS (75% OF ORIS) ISC SIGNS NO NO TRANS. APPROVALS NO NO LAMPS FOR EACH PERMIT* DATE INSPECTOR'S NAME WIRING $1.00 CONDUIT FIXTURES S1.013WIRING �� g SUPPLEMENTARY ,50FIXTURES POWER i TOTAL FEE a 0, UTILITY CO.NOTIFIED FINAL y WORKER'S COMPENSATION DECLARATION 724009 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a certificate of 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 ADDRESS ❑ Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY ❑ — Certified copy Is filed with the county building Inspection 1&2-Family,Sq Ft $ $ department Multi-family Sq Ft — — NEAREST CROSS 3T Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec _Light Sw OWNERFIRM OR COMPENSATION INSURANCE First 20 ME (This section need not be completed If the work involved by the MAIL permit Is for one hundred dollars($700)or less) Total No Additional ADDRESS I certify that in the performance of the work for which this permit CITY Tel No is Issued, I shall not employ any person in any mann r s become subject to the Workers'Compensation L Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, qft� er flcate of CITY Tel No Exemption,you should become su�jact tote or Co�pensation OTHER APPLIANCES NOT ODER 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 ADDRESS i I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl r (commencing with Section 7000)of Division 3 of the Business and CITY Tel v Professions Code,and my license is in full force and effect Over 10 to 50 Incl >, Over 50 to 100 Incl REG67 Y UMBER Clew )L License Number �• �`� LIC CI88s "' ` O Over 100 DISTRICT NO ESSED BY V � rnces wbd M &P el Dards X •�ar � Contract V " 5 � Un r 800 V o/ a FINAL LLL 1 Am er 800 V 2 (�, V ❑ I am exempt under 1-3 J -t VALIDATION W Over 1000 Amp or Over 800 V FINAL a B&P C for this reason BRANCH CIRCUIT FEES BY Z Date 15A,or 20A,120V,Lighting or Recept _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El Exemption Or More Branch Circuits 2 Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits A��T a s SINGLE FAMILY Temp Power Pole&Appurtenance� _'f1 �nn HOME amexempt from OWNER-BUILDER DECLARATION Sign with One Branch Circuit �3 100.50 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 1 ITEMS Gt�td tS Code) ❑ I,as owner of the property,will do the work and the structure Misc Conduits&Conductors TOTAL 100 ®'_50 is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , C HECK 1(M,511 and Professions Code) CHANGE oGO 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) p CIV C) d 000H=1 S/ 1/94 Lender's NamPLAN CHECKING FEE b 1 AM11:36 e PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct I agree to comply with all County ordinances and State laws regoAng Electrical wiring,and hereby authorize representatives of this o er upo above-mentioned property for inspec /� SEE REVERSE FOR EXPLANATORY LANGUAGE DATE C/,[ WORKERS'COMPENSATIONDECLARATION CE-806G (2 80) APPLICATION FOR ELECTRICAL PERMIT CE-806G 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) (/ o17 FOR APPLICANT TO FILL IN SOB �D Policy No Company New Residential Bldgs &Pools EACH NO FEE ADDRESS Certified copy is hereby furnished 1&2-Family,Sq Ft $ — $ LOCALITY ❑ Multi-family Sq Ft — Certified copy is filed with the county building inspection CROSS ST department Residential Swimming Pools OWNER Off FIRM NAME 1-17A>-Y4 _7A41re� Date Applicant Outlets Rec_Light Sw MAIL First 20 ADDR CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional COMPENSATION INSURANCE CIT Tel No } PLAN allECK a (This section need not be,completed if the work involved APPLICANT 0 by the permit is for one hundred dollars ($100) or less,) Lighting Fixtures First 20 ADDRESS Total No Additional W I certify that in the performs of the work for which this Fixed Appliances Not Over 1 HP CITY permit is issued, I shall not e I a y person any manner PERMIT W so as to eco subject to e r rs'Com nsati s Range_Heater D W APPLICANT p. Oven _ Dryer_W M _ ADD Z Dat Applican Top _ FAU _W H _ Tel Hood _ Fan —Other NOT E T APPLICANT If, after making is Certificate of Disp _Room Air Cond_ LICENSE OR �� Exe ptio you should become subject the Workers' REG NUMB Class Ile Co pensation or., of the Labor Code, you must forth- Power Apparatus& Large Appliances J DISTRICT NO PROCESS BY with comply with such provisions or this permit shall be deemed revoked Size&Type HP,KW,KVA,or KVA �rO Up to 1 Incl Over 1 to 10 Incl FINAL LICENSED CONTRACTORS DECLARATION DATE VALIDATION fiver 10 to 50 Incl I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY 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 ness and Professions Code) ;.9-2 0 318 A Misc Conduits&Conductors j, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— # ° • • 9 • 2 structure is not intended or offered for sale (Section 7044, Business and Professions Code) 2- o37,00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency o o a 3 7 O O H for the performance of the work for which this permit is i issued(Sec 3097,Civ C PERMIT FEE (Sub-Total) 1.20-81) 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 inmation is correct I agree to comply with all County ordin ce and State laws regulating Electrical wiring, and her y orize representatives this C my enter u on th a v entioned naAy to Pett p s SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pelmit–w4e Date WORKERS'COMPENSATION DECLARATION CE4663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806C' insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY ora certified co y th r Co c 800, Lab C ) w-. oTicqJfRff y oC y QAp&; FOR APPLICANT TO FILL IN JOB � ❑ Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ❑ Certified copy is filed with th county bui ing 1 &2-Family, Sq Ft $ — $ LOCALITY r �r. tion epar mpnt Multi-family Sq Ft — NEAREST Date Applican Residential Swimming Pools OWNER OR FIRM NAME RTI CATE OF EXEMPT N F OM WORKER Outlets Rec Light Sw_ IL COMPENSATI IN RANCE First 20 ADDRESS (This section need not be c pi if the work I by Total No Additional CI Tel No the permit is for one hund ellen($100)or less) PLAN CHECK I certify that in the performance of the work for which this A"UCA 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 VM, Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT ��..``�� NOTICE TO APPLICANT If, after making this Certificate of APPLICANT �{�i�50 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 JMatktr Tel N QOR 1 LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ LICEI hereby affirm that I am licensed under provisions of Chapter 9 Disp , Room Air Cond REGGNSE NUMBE CI (commencing with Section 7000)of Division 3 of the Business DISTRICT NO PROCESSED BY and Professions Code,and my license is in full force and effect Power Apparatus&Large Appliances � Size&Type HP, KW, or KVARK,9O License Number?dmft Lic Class Incl Up to 1 Incl FINAL V r��` Date Over 1 to 10 Incl DATE r 0 Contracto f`� VALIDATION Q ❑ Over 10 to 50 Incl FINAL r I am exempt under Sec Over 50 to 100 Inc BY W 0. B&P C for this reason Over 100 Z Date Services,Swbd ,MCC&Ponelboords 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Mainf Elect Over 1000 Amp or Over 600 V 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) ;23636A ❑ I, as owner of the roe Misc Conduits&Conductors property,ror will do the work and the Other See Complete Fee Schedule ' e e e 2 structure is not intended or offered for sale (Section ( P )- 7044, Business and Professions Code) , 2 . 1 6 0 5 0 CONSTRUCTION LENDING AGENCY e'0 1 6 Q 5 O= I hereby affirm that there is a construction lending agency for , c5 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 7 1 3-83 (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 4VCIO Lender's Address O 1 certify that I have read this application and state that the TOTAL FEE above infor on is correct I agree to comply with all County ordino son to la egulating Electrical wiring, and here y authorize re rese ati s of this County to enter upon -menh ne prop ty inspection pur oses SEE REVERSE FOR EXPLANATORY LANGUAGE S1 re of Permittee Date