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'°AIMScSMSap APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER r
CASSATT D GRIFFIN SUrT OF BUILDING LOCALITY
FOR APPLICANT TO FILL W NEAREST
P,1• FM CROSS ST
ITEM NUMBER I EACH FEE OWNER
OUTL ; $ MAIL
LION RECMI 81N 10 ADDRESS
LIGHTING FIXTURES47, 10 CITY1 �p EL TNO v 32
Ewan.RANGES Caf
DFlYMi9 ELECTRICIAN
WATER HEATERS 80 ID ADDRESS
UL.=SPACE HTRS DISHWASHERS CITY TEL NO
GARBAGE DISPOSERS AUTO STATE
WASHERS STA COOKING UNITS YS LICENSE NO
MOTORS OVER INC. HP DIS Rl P OCESS
o— Iia 23
lea— Y 50 IIVSPE MON EWORn
Y— S too 3 v
15— to 1150 ST A 4.d c�Fx C✓�-R
IS— SO 250
310—goo goo
�y09 -WA �9 <:)076e-;r
��e= �oiyrx 6=/e S�'Ti�c ri
SIGNS NO TRANS
NO LAMPS
SERVICE O SOOV 100 ` �`..
SERVICE OVER GOOV goo
MISC.
�c> S J•2 i�9 c Irc d,r J"?u -or
c
WIRING PERMIT too
FIXTURE PERMIT too PAR N
SUPPLEMENTARY PERMIT 80 t v
TOTAL FEE S
I t IO
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP N APPROVALS DATE INSPECTOR 8 SIGNATURE
AND STATE THAT THE ABOVE 16 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING WIRING
1 HEREBY CERTIFY THAT I 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 RESIDENT PERTY POWER
SIGNATUREUTILITY CO NOTIFIED —�1-L t.
OF PERMITTE
FINAL .T 0 6
®v Vtra.urA� SAFF��CCRTHUR C V 1_T
CK Mo UPERVISING CTRICAL ENGINEER
LICO 6 8 6 1 €'EB 2 4 A 4.4 O P1
D88BA 11 BB APPLICATION FOR ELECTRIC PERMIT 1
DBS DA
DrMON OF S WING AND SAFM
DlcomtvI of Couutr Of � ADDRESS
JOHN A LANIBIE COU ENGINEER
CABBATT D GRIFFIN SUP T or Su1LDINe LOCALITY
FOR APTPLIF CANT TO FILL IN NEAREST
c oss ST
NUMBERI OWNER
LIGHT OUTLETS MAIL
RECEPTACLES ADDRESS
.WALL SWITCHES FEE CITY TEL-AM A .1441
' TOTAL OUTLETS S2 ELECTRICIAN 10
ELEC RANGES 215 ADDRESS
ELEC HEATERS 25
KW EA CITY L NO
STATE
FIXTURES S LICENSE NO
MOTORS DISTRICT N GROUP — E READY FOR INSPEOTION
NUMBER HORSEPOWER FEE
NEW MVD HP OVER INC RACH
16 a LESS f 25
INSPECTION AD
Yz 2 so
2 s 100
Ls
is ISO
18 SO 280
SO 200 S 00
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING f1 00 G
FIXTURES f 1 00
SUPPLEMENTARY so APPROVALS
TOTAL FEE f ZS DATE INSPECTOR 8 SIGNATURE
AHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING S
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE AL ER OF THE ABOVE POWER
DESCRIBED RESIDE ER UTILITY CO NOTIFIED SCS
SIGNATURE
ICLAA
OF PERMITTEB FINAL
JOHN A LAMBIE COUNTY ENGINEERy, ATIcpN ARTHUR C VEIT CHIEF ELECT INSPECTOR
P&6600'UA M 1 2 125
A
,
1
ft WORKERS COMPENSATION C 76A663 ,D,6, APPLICATION FOR ELECTRICAL PERMIT {�
I h reby affirm that I have a certificate of con to 4 insure CE 8o6G_ I.J
or T-certifirate of Workers Compensation Insurance ora certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec 3800 Lab C) it A nil /� �/ f� /�
Policy Nc o aY ny01110 Ck LITS FOR APPLICANT TO FILL IN JOB
ADDRESS 3 2 ✓/��Il /'0 `� /�/���
❑ Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE
14 Certified copy is filed with the county building inspection 1 &2 Family Sq Ft $ —is LOCALITY T M L� GZ
department Multi family Sq Ft NEAREST
CROSS
3AJ �(�( Residential Swimming Pools OMER OR p ^ T t
Date G ApplicantS� �. FIRM NAME R1 CAA RD AND iJ G r
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Recio—Light-a—Sw Ir— MAIL S 2/ I✓Q H jti Z!/�
COMPENSATION INSURANCE ADDRESS
(This section need not be completed If the work Involved by the First 20
permit is for one hundred dollars($100)or less) Total No Additional CITY �/H �� �ZT Tel
PL
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 u 0
become subject to the Workers Compensation Laws Lighting Fixtures ,, First 20 V - ADDRESS
Total No 12�// Additional CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT If after making this CertA
rficate of PERMIT
Z G
Exemption you should become subject to the Workers Compensation Range_ Heater_ DW ���IjT �
provisions of the Labor Code you must forthwith comply with such Oven _ Dryer_ W M ADDRESS 141,2 C#1(19 .44 #
provisions or this permit shall be deemed revoked Top — FAU _ WH
LICENSED CONTRACTORS DECLARATION Hgqd _ Fan _ Other_ CITY .% M NI f= Tel No 2—��/
1 hereby affirm that I am licensed under provisions of Chapter 9Disp — Room Air Cond LICENSE OR �f 0� Class C-109
(commencing with Section 7000)of Division 3 of the Business and REG NUMBER �r
Professions Code and my license is in full force and affect Power Appargtus&Large Appliances DISTRICT NN05 PR D BY
1�/ �i p� ��/O Size&Type HP KW KVA or KVAR O
License Number — Lic Class Up to 1 Incl FINAL ozQ
Contractor 6ML WCDate 3 O Over 1 to 10 Incl DATE ���� VALIDATION Q
❑ Over 10 to 50 Incl
FINAL � �
1 am exempt under Sec Over 50 to 100 Inc
B&P C for this reason Over 100 Z
Date Services Swbd MCC&Paneiboards ►
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600 V
❑
ExemptOver 1000 Amp or Over 600 V
Exemption for Reg Maint Elect
n
SINGLE FAMILY Temp Power Pole&Appurtenances d
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit AMAJL
I hereby affirm that I am exempt from the Contractors License Law Additional Sign Branch Circuits 3�7
for the following reason(Section 70315 Business and Professions 111■44
Code)
❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors 1 ITM
is not intended or offered for sale (Section 7044 Business Omer(See Complete Fee Schedule) _ PON. TOTA. 111-40
and Professions Code)
G`ECK 111.40
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the C ■00
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total)
Civ C)
PLAN CHECKING FEE 000D—=1 3/23/KI
Lenders Name
PERMIT ISSUING FEE 9671 1 AM11:13
Lenders Address
I certify that I have read this application and state that the above TOTAL FEE
information is correct I agree to comply with all County ordinances
and State laws regulating Electrical wrung and hereby authonze
representatives of this County to enter upon the above mentioned
Cproperty for i pection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
JT u/vt 31.3 60
Signature of Permittee Date