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8
APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES _
DEPARTMENT
BUILD NG AND SAFETY DIVISION ENGINEER !BUILDING C, 5 /V I M cIS C•� I Ja l-. GL
ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER I 1
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY.SA N� A 13 IR 1
FOR APPLICANT TO FILL IN ;NEAREST
FEES CROSS ST.C 4�1
I T E M NUMBER EACH FEE :OWNER C I�'+R E-�C i • !�
OUTLETS: S. $ MAIL �c _
LIGHTS RECEPT. SW. .10 (ADDRESS �;(� /" Ll 5 e/a
LIGHTING FIXTURES .10 CITY (. ! L. NO. lrrT7. 3s 7�
ELEC. RANGES CLO. DRYERS ;ELECTRICIAN
WATER HEATERS •50 iADDRESS
ELEC.SPACE HTRS. DISHWASHERS
GARBAGE DISPOSERS AUTO.- CITY TEL. NO.
STATE
WASHERS STA. COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT NO. G�Q/�,L]P zON .ROLES D BY
O— 1/2 .25 �L
+iP— 2 .50 INSPEG"PION RECORD
2— S 1.00
5— 15 1.50
1s— So 2.50
50-200 6.00
SIGNS: No. TRANS. S C F % O 44,Ew
NO. LAMPS
SERVICE O-SOOV 1.00
SERVICE OVER SOOV 5.00
_FGF TAG f w/Tc /L f.
MISC. �w
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE / 1 APPROVAIS
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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&1ERTY.
THE LEGAL OWNER OF HE ABOVE
DESCRIBED RESIDENTIA `'OWERUTILITY CO.NOTIFIED
SOF APERMITTEE � v v� -M'
FINAL
JMf.1DATlO SU ERVISINGC.ELERTHUR CTRICAL ENGINEER
fl
CK M� CASHH
1�',.8 4 5 7 An DEC 3 2 A 2.0 0
i
°='C;BOe9'°° APPLICATION FOR ELECTRIC PERMIT �.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER ,
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY w
FOR APPLICANT TO FILL IN NEAREST � R ��1
p$g "M EACH
ST.
OWNER ERAICIE
I T E M
NUMBER EACH FE6 MAIL A jJ J
L01GHT8 RECEPT. SW. E✓ $ .1O ADDRESS O /Y
LIGHTING FIXTURES .10 CITY 'T L.NO. — S
ELEC.RANGES CLO.DRYERS 1ELECTRICIAN
WATER HEATERS .50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS CITY TEL.NO.
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS ,25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT NO. I GROUPI ZONE I PR CESSED BY
O— Va .25 Vs'�
V2— 2 .50 INSPECTION RECORD
2— 5 1.00
5— SS 1.50 I
IS— 5o 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE O-BOOV 1.00
SERVICE OVER 800V 5.00
MISC.
WIRING PERMIT 1.00 , e
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
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 i
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING I��O�lj A �'r 'f ' .•�•it
I HEREBY CERTIFY THAT i AM 'PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT L AM THE LEGAOWNER OF THE ABOVE
DESCRIBED RESIDE P1�OPERTY. POWER
SIGNATURE y,rge'�a /�/j ��r UTILITY CO.NOTIFIED
OF PERMITTE �LG� e/
7a VALMATION ARTHUR C.VEIT,
CK Mq 'CASH SUPERVISING ELECTRICAL ENGINEER
5 1 1 6 JAfid 13 2 A 2.80 2
7 /
6d076
76A66S-CE806 9-64 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES p
DEPARTMENT
BUILD NG AND SAFETY ENGINEER
AD13 LDIINI
DRESS /& Gv /
JOHN A. LAMBIE, COUNTY ENGINEER w
COLEMAN W. JENKINS, SU P'T. OF BUILDING LOCALITY 3
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
LIGHT . TOTAL OUTLETS FIRST 20 $.20 $ OWNER
LIGHT MAIL / j f
A D D'L .ADDRESS
SWITCH. OVER 20 .10
LIGHTING 1t TOTAL I F1R3T 20 .20 CITY41_,& �r/ TEL.NO. �T
FIXTURES 1 OVER ADD'2L0 10 ELECTRICIAN �� AI IT
/J
RANGES CLO.DRYERS NRR.HTRB. 1.00 ADDRESS 11,4
L S ('JCA� �/ C�►jj���4!�j
GARB.DISP. STA.COOK CITY / / �/� TEL.NO. T(J /
DISH WASH. AUTO.-WASH. STATE
SPACE HTRB. BTA.APP.(yA H.P.MAX.) .50
LICENSE NO. oz (p46
MOTORS: OVER NOT OVER H.P. DISTRICT NO. I GROU3UPCESSED B
O 1 1.00
1 s 1.50 INSPECTION RECORD
>
s s 2.00 11.6
8 is 2.50 UO
Is 50 8.00
s0 100 5.00 i V
SIGNS:
NO.TRANS.
NO.LAMPS y
Z
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
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 I8 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 FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER F, AND INT ND TO
RESIDE IN, THE AGO DESCR ED RE ENTIA OPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED a
OF PERMITTEE
FINAL
CCK
O CASH DATION SU ERV SING ELECTRICAL ENGINEER
i
_,►„a 4 L 7 "' 023 2 A 3.60-
WORKERS'COMPENSATION DECLARATION X6-883 10/81 APPLICATION FOR ELECTRICAL PERMIT
i hereby affirs"t that I I�ve'a certificate of consent to self`insure, ELECTRICAL
or a certif'ipate of Workers' Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.
3800,Lab.C.)
poli No. S0 Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
$ _ $ LOCALITY
rl
Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft.
department. Multi-family Sq.Ft. 71-9AAb I up
NEAREST
CROSS ST.
Residential Swimming Pools ER OR
Date 7 Applicant
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec!Light__Sw.•� MAIL L A
COMPENSATION INSURANCE ADDRESS 6o
(This section need not be completed if the work involved by the First 20 CITY���f Gl Tel.No. ' •
permit is for one hundred dollars($100)or less.) Total No. Additional
I certify that in the performance of the work for which this permit P CHECK
is issued, I shall not employ any person. in any manner so as to PPL
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
I Total No. CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making 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._ ADDRESS e:^
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _
LICENSED CONTRACTORS DECLARATION i Hood — Fan _ Other_ CITY Tel.N .7il� _
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Claw
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO/ PR CESS D BY
Size&Type HP,KW,KVA,or KVAR 0-4Z pp
License Number.tt�'C� �Lic.Class Up to 1 Incl. FINAL
�;D /',-.-, .��� 7 Over 1 to 10 Incl. DATE O
Contractor =F.O'�/ ate VALIDATION
❑ Over 10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. By
BAP.C.for this reason Over 100 pW
Services,Swbd.,MCC&Panelboards N
Date: 0-200 Amp.Under 600 V
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 Sign with One Branch Circuit 2
1 hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits AT o g
for the following reason(Section 7031.5,Business and Professions
Code):
37-07 20.211
Misc.Conduits&Conductors
I,as owner of the property,will do the work and the structure C
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® ITEM
and Professions Code).
TOTAL 20.20
CONSTRUCTION LENDING AGENCY I CHECK 20.20
1 hereby affirm that there is a construction lending agency for the a
performance of the work for which this permit is issued(Sec.3097, ' gERMIT FEE (Sub Total) u CHANE oQ�l
Civ.C.). I
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE 6 0000"0001 II7I 0
Lender's Address C17�� � A� 9936
I certify that I have read this application and state that the above TOTAL FEE Q 42O
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
repreqentatives of thip County to enter upon the above-mentioned
prop for inspecti urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Pe mittee Date
% .M g,
.1rN�'RKERS'COMPENSATION DECLARATION 76A663. 10,61 APPLICATION FOR ELECTRICAL PERMIT
"I �by afftrin�that I have a+'certificate of consent to self insure. CE-6066
os a certificate 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 � w
S f d q (w�
❑ Certified copy is hereby furnished• New Residential Bldgs.&Pools EACH NO. FEE ADDRESS' l
` y, q• t•
1.&2-Family,S F $ _ $ LOCALITY L2 Go ;
Certified copy is filed with the county building -inspection
department. Multi-family Sq.Ft. NEAREST
CROSS ST
Date —ZZ pp Residential Swimming Pools OWNER R
A licant C FIRM NAME Z (Q
CERTIFICATE OF EXEMPTION FR WORKERS' a� (zJ 0 �' MAIL
Outlets:Rec Ligh Sw.— /� _
COMPENSATION INSURANCE First 20 V ADDRESS
(This section need not be completed If this work-involved by the CITY Tel Nb.
permit is for one hundred dollars($100)or less.) Total.No. W Additional CK Int
• PLAN CHECK
I certify that in the performance of the work for which this permit
)APPLICANT
is Issued, I shall-not employ any person in any manner so as to
It-
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 U ADDRESS
Tofal No. Additional to OV
CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT'
Exemption,you should become subject to the.Workers'Compensation Rahge.� Heater D.W. l_ APPLICANT
provisions of the Labor Code,you must forthwith comply with such Oven Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top FA J_ W.H.
r
LICENSED CONTRACTORS DECLARATION Hood � Fan __ Other— CITY Tel.No.
1 hereby affirm that I am licensed under provisions of Chapter 9 �tLICENSE.OR ��
Disp. _ Room Air Cond. l` 10 Class.
(commencing with Section 7..000)of Division 3 of the Business.and REG.NUMBER
Professions Code,and my license is in full force and effect. DISTRICT NO. PR CE Y
Power Apparatus&Large Appliances �(
Size&Type HP,KW,KVA,or KVAR S�V.
License Number2p-5(O= p 9 Lic.Class I Up to 1 Incl. FINAL•
LT>D�NOIc41$ ZZ � Over 1 to 10 Incl. DATE�f \� IDATION 0
Contractor '�L7 Date Over 10 to 50 Incl. !�
FINAL
❑ 1 am exempt under Sec. Over 50 to 100 Inc. BY 9 4 4.8'A • pW,
B.&P.C.•for this reason Over 100
Services,Swbd.,MCC&Panelboards// #'o 0 0 0 0 2 Z
Date: 0-200 Amp.Under 600 V V ►
Signature 201 - 1000 Amp.Under 600 V
I o 0930'0
❑ Over 1000 Amp.or Over 600 V' {
0,0 0 9 O 0
Exemption for.Reg.Maint.Elect:
SINGLE FAMILY Temp.Power Pole&Appurtenances 4.2 2•_8'8
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 7031.5,Business and Professions
Code): .
❑ 1,.as owner of the property,will do the work and the structure Misc.Conduits$Conductors
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 n0
I certify that I have read this application and state that the above TOTAL FEE (f
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
roperty for inspection pur o es.
• SEE REVERSE FOR EXPLANATORY LANGUAGE
g ure of Permittee Date