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78A688-CESOS 12-BS APPLICATION FOR E LE CT R I Ci PERM I
COUNTY OF LOS ANGELES {� I
DEPARTMENT OF COUNTY ENGINEER BUILDING
• 'BUILDING,AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE,COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF BUILDING 'LOCALITY-
FOR
L'OCALI FOR APPLICANT TO FILL IN: NEAREST
CROSS ST.
L PERBUT FEES i
OWNER'
t ITEM NUMBER'.EACH FEE ,
$ $
MAIL
ADDRESS ESSLIG ;k- ,
: LIGHTING FIXTURES I .10 CITY' T L.NO,
ELEC.RANGES CLO.DRYERS •ELECi^TRIC.^I
g
e
t WATER HEATERS ,50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS
RBAgr;o1SPeseoa ,AUTO.- CITY TEL.N
STATE
k WASHERS STA.COOKING UNITS ,z5 LICENSE NO.
MOTORS: OVER INC. H.P. DISTR10. GR U Sns..ONE I P . CESSc BY
1,
1/2— 2 .50 INSPECTION RECORD
i -
2— 5 12.00 l D `cZ
i 5— 15 1.50
15— 50 2.50
SO-200
SIGNS: NO.TRANS. -
NO.LAMPS yr. .��
SERVICE 0-660V 1.00
9 1.
SERVICE OVER 600V 5.00
MISC. -
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT 50
TOTAL FEE S APPROVALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A PLICATION 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 PRO ERLY GISTERED AND/OR -
LICENSED AS RE RED BY LOS ANGE ES NTY AND STATE. OF FIXTURES '°b —13 ,-+�-•,—v�' ---�
CALIFORNIA OR TH T I THE LE L N OF THE ABOVE
DESCRIBED RES1. IAL PER OWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITT t/
- FINAL - 7�
�F, ATION ARTHUR C. V E1T,
SUPERVISING ELECTRICAL•ENGINEER
CK MC CASH
�iGo 8 3 8 2- JJPl 2 3 2 q' 9.9 5 M
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�ce0ified ,;� ther7f(Sgc�800;Lab.C.) FOR APPLICANT TO FILL IN SOB
74 Policy�U Company al ADDRESS
New Residential Bldgs.&Pools EACH NO. FEE
E] Certified copy is hereby furnished. 1 &2-Family,Sq.Ft. $ — $ 1 LOCALITY I
Multi-family Sq. Ft. — NEAREST
Certified copy is filed with the county building inspection CROSS ST
department. Residential Swimming Pools OWNER OR
IN
Date Applicant � G
r Outlets: Reo�0Light , Sw.� S� V ADDRESS
First 2
ERTI ICATE OF EXEMPTI N FROM WORKERS' Total No. Additional CITYe
COMPENSATION INSURANCE PLAN CHECK o_
(This section need not be completed if the work involved S� O APPLICANTf PA V
Lighting Fixtures First 20
by, the permit is for one hundred dollars ($100) or less.) g ADDRESS �
Total No.—a Additional. O
I certify that in the performance of the work for which this CITY Tel No.
Fixed Appliances Not Over 1 HP - -
permit is issued, I shall not hmploy any person in any manner PERMIT e
so as to become subject to the Workers'Compensation Laws. Range_Heater D.W. _ APPLICANT 10 ri
N
• Oven _ Dryer_W.M._ ADDRESS � Z
Date Applicant Top _FAU _W.H.
Hood _ Fan —Other CITY el No.
4 NOTICE'TO-APPLICANT: If, after making this Certificate of Disp. _Room Air Cond-_ LICENSER
Exemption, you should become subject to the Workers' =NUS Class
JCompensation provisions of the Labor Code, you must forth Power Apparatus&Large Appliances DISTRICT NO. PRO SED$Y
*itp comply with such provisions or this permit shall be
Size&Type HP,KW,KVA,or KVAR
deemed revoked. U o
1 , Up to 1_Incl..
FINAL
1 Over 1 to 10 Incl. DATE
! LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. �j® VALIDATION
I
I Thereby affirm that Lam licensed under provisions of Chapter Over 50 to 100 Inc. FINAL, �
9!(fommencing with Section 7000)of Division 3 of the Busi- Over 100 BY
ne ¢¢ and Professions,Code, and my license is in full force and
ef,dct. Services �7 '
License Numb c.Class 0 200 Amp.Under 600 V
I 201-.1000 Amp.Under 600 V
Corjtracta v Over' 1000 Amp.or Over 600 V
f! I
HOME OWNER-BUILDER DECLAR TION r Temp.Power Pole.&Appurtenances,
I hereby affirm that I am exempt from*the Contractor's Sign with One Branch Circuit
Licehse 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)— 094,2A•
structure is not intended or offered for sale (Section , 0 0 0 0 0
7044,Business and Professions Code.).
CONSTRUCTION LENDING AGENCY ( o - 2750
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.). .2 Q 5 a 00275060
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 1 0 827-81
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
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-rhentioned property for inspection purposes. SEE•REVERSE FOR EXPLANATORY LANGUAGE
r- 2
0 p
Si ature of Permittee ate (J