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A563,08"°"' APPLICATION FOR ELECTRICAL PERMIT 1
V COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FADDG
BUILDING AND SAFETY DIVISION S.JOHN A.LAMBIN,COUNTY ENGINEERWILLIAM A.JENSEN, SUPT OF BUILDING Y IRAP
FOR APPLICANT TO FILL IN TT
PERMIT FEES OWNER L3
ITEM I NUMBER EACH FEE MAIL
OUTLET$i S $ ADDRESS
LIGHTS / RECEPT SW. .10
LIGHTING FIXTURES .IO CITY TEL NO -,O
ELEC.RANGES CLO.DRYERS ELECTRICIAN '
WATER HEATERS .50 ADDRESS '
ELEC.SPACE HTRS. DISHWASHERS CITY TEL.NO.
GARBAGE DISPOSERS AUTO.- STATE '
LICENSE NO.
WASHERS STA.COOKING UNITS .25
' MOTORS: OVER INC. H.P. DISTR�IC�.NO. GROUP ZEN PROCESSED BY
0 —
V2
—v$ = 2 so INSPECTION RECORD
a — s 1 1:00 / > c"/-, C–.�` O
a — is i.go Y a t�ti.�.._. u
1S — .50 . 2.50
so — 200: 5.00 '/Z
NO TRANS. _ / �!I ' ! i+�•�, 't'y/
SIGNS: No.LAMPS `�
SERVICE 0.60OV to
+
SERVICE OVER GOOV 5.00
MISC:
r
WIRING PERMIT 1.00
0 .1
FIXTURE PERMIT i.00
SUPPLEMENTARY PERMIT ,g0
TOTAL FEE s
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE+ INSPECTOWS SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ! „� ♦ws �'
CONDUIT,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICALWIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY-REGISTERED AND/OR /�'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES �. / 7l
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE .� /
DESCRIBED RESIDENTIAL PROPERTY. POWER 11/ I .E!:7/r •IIIA
w
Loll
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE FINA + v 1l y
-UALIDATION ARTHUR C.VEIT,
'neo' CASH SUPERVISING ELECTRICAL ENGINEER
A LE d 7 v
APPLICATION FOR ELECTRICAL, PERMIT . �
4
COUNTY OF LOS ANGiELZ$ `
DEPARTMENT OF COUNTY ENGINEER BUILDING
(BUILDING AND SAFETY DIVISION ADDRESS P
JOHN A.LAMUM CoUNrY ENGINEER
WILLIAM A.JENSEN. SUP'TOF BUILDING LOCALITY _ Q
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES
OWNERs <2 mac+
ITEM NUMBER MACH. FEE MAIL
OUTLET$y ADDRESS , S.�s
LIGHTS / RECEPT. SW. ,10 $ O
LIGHTING FIXTURES .10 -CITY fe4f Q TEL,N
ELEC.RANGES CLO.DRYERs ELECTRICIAN
WATER HEATERS .150 ADDRESS.
ELEC.SPACE HTRS. DISHWASHERS - - CITY, TEL.NO.
GARBAGE DISPOSERS AUTO.- STATE _
WASHERS STA.COOKING UNITE ,20 LICENSE NO.
MOTORS: OYER INC. H.P. ` DISTRICTO. GR• :2PR99E D
0—' %s .25
Va -" 2 .s0 . INSPECTION OCtD
2 15 t.00
15 -- I15 1.150 O
I15 -- 150 - V
2:15.0 cic
BO — 2000
15.00
SIGNS: NO TRANS. 4
NO.LAMPS .
- Z
SERVICE o.GOOV 1.00
SERVICE OVER GOOV 15.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT, 1.00".
SUPPLEMENTARY PERMIT .so
TOTAL FEE B
4
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. -I j r- 1 s• ,• .
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR WIRING: £
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF •FIXTURES f A 'Air
CALIFORNIA OR THAT I AM THE LENER OF THE ABOVE
DESCRIBED RESI POWERy d f!
SIGNATURE •. UTILITY GO.NOTIFIE� A!� (� �. �/�°,�•l,�f
OF FERMI TTE '-
FI A u
VALIDA7 AlHU1C.VETT,
CK Mo (CASH SU ERVISING EL;cTRICAL ENGINEER
U 2 9 5 1 SEP
2-2 2 D •.
76AS63 OBS SA 11-60 APPLICATION FOR PERMIT /3
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN o S
RECEIVED BY READY FOR DATE ISSUED
ADDRESS 5194 N. Ananim St. )1 FIRST INSPECTION '1
CITY '8.Y1 Gab. TEL. NO. AT 68583
COUNTY LICENSE NO. 1104 EXPIRES BUILDING
PERMIT FEES ADDRESS 6216 Primrose
NUMBER EACH FEE LOCALITY Tem le City
LIGHT OUTLETS 14 NEAREST
RECEPTACLES 23 CROSS ST.
WALL SWITCHES 19 OWNER Meeker
TOTAL OUTLETS X56 scl$ 2 80 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 1 2s 25
CITY TEL. NO.
FIXTURES 14 5 70 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS 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 LOS
NUMBER HORSEPOWER ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
FEE
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
1/2 B LEss $ .25 125 SIGNATURE OF
4 &24)
1/2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
s Is 1 1.50
is so 2.50
so 200 5.00
--
200 Boo 10.00
Boo 1000 15.00 Z
OVER 1000 20.00
M. G. SET/FREQ. CHANGER-HP Q'
WELDERS:AC-KVA 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (7s%OF ORIG.)
MOVED MOTORS (75%OFORIG.)
MISC.
SIGNS
NO. NO. TRANS. I APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT:
DATE INSPECTOR'S NAME
` y
WIRING $1.00 OO CONDUIT �N t V-1
FIXTURES $1.00 00 WIRING 7 nrl W1q
SUPPLEMENTARY .50 FIXTURES _ - l'7 edllw A
' POWER
TOTAL FEE $ 6 00 UTILITY CO. NOTIFIED
® FINAL Y
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION YOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self Insure, 76A663
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(7 If/'�//�g�rA)0Ce_ FOR APPLICANT TO FILL IN JOB // _
❑ �,-- /,n�e_J ADDRESS C� o
Certified copy is hereby furnished.G � New Residential Bldgs.&Pools NO. EACH FEE LOCALITY
❑ 1&2-Family,Sq.Ft. _ $ $
Certified copy is filed with the county building inspection NEAREST
department. Multi-family Sq.Ft. CROSS ST. G9/V
Date Applicant Residential Swimming Pools ASSESSOR U/
MAP BOOK /� PAGEE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' - Outlets:Rec. Light Sw.� J OWNFIRM NAME G,>2�
COMPENSATION INSURANCE First 20 ��t> /� O
(This section need not be completed If the work Involved by the 1p ADDRESS o ��/)') Q,Si
permit Is for one hundred dollars($100)or less.) Total No. Additional
���sG�' CITY /7 Tel.N,�,pp gg y
I certify that in the performance of the work for which this permit ���i2�d� ti,,/� AK (�� -OJ �D
is issued, I shall not employ any person in any manner so as to (��/`" �� PLAN CHECK
become subject to the Workers'Compensation Laws. I- ting Fixtures Firs�20 APPLICANT
Total No. Additional ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. /� p
provisions of the Labor Code, you must forthwith comply with such APP CANT 20G /�G-
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances ` / Q L/
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS &0� (d Q-iCPee`Z 1J/4 lea
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000)of Division 3 of the Business and CITY 2 Tel.No Z
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR CIS 1Q }
rye. /y� Over 50 to 100 Incl. REG.NUMBER�y �p t✓ d
License Number L�/ Lic.Class / Over 100 DISTRICT NO. Q P C SED BY U
a Services,Swbd.,MCC&PanelboardsD 0 G � .�c�f w
f, 0-399 Am Under 600 V FINAL a, Q
Contractor e // `' Date p' DATE H1:(:#,c
❑ 400-1000 Amp.Under 600 V ()
I am exempt under Sec. 1M`x.34 r LInDATION ,:r6.4, W
Over 1000 Amp.or Over 600 V FINAL y
BRANCH CIRCUIT FEES BYB.&P.C.for this reason i I EtE d.
D
e:2 X
15A,or 20A,120V,Lighting or Recept. Z
1 To 10 Branch Circuits Til I Al 36-45-
Signature 11 To 40 Branch Circuits r Ct ut
41 Or More Branch Circuits ;-~4E
❑ Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits !
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 Law 93}
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits lj)jIJQ—I,li�� _I Zit/
Code):
❑ Misc.IConduits&Conductors '53472 1 Ar110 o 4
I,as owner of the property,will do the work and the structure
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) /0 IG
Civ.C.)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE 3 �•
that the 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-mentioned property
for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE DATE
WOihat I S COMPENSATION DECLARATION 766A°6019 63 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby a5ic►�f-that have a certificate of consent to self Insure,
or a certificate of Worker's Compensation Insurance, or a certified COU"NTl WLOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Policy No./ Company S /[� FOR APPLICANT TO FILL IN JOB
ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
�9 _ $ $ LOCALITY
Certified copy is filed with the county buil g inspection 1&2-Family,Sq.Ft. _ NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date � T Applicant Residential Swimming Pools ASSESSOR
MAP BOOK I PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' u et .Rec. 3 Light Sw. OWNER OR
COMPENSATION INSURANCE g � �� FIRM NAME ��`
First 20 MAIL •�
(This section need not be completed If the work Involved by the Total No. Additional ADDRESS �� f E, ✓�j (,►.t s /
permit is for one hundred dollars(5700)or less.)
1 certify that in the performance of the work for which this permit CITY Tel.Nog f7e&'�
Is Issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code,you must forthwith comply with such PERMIT
ces APPLICANTli
e A
&L
t
r
Appaaus Large Appliances provisions or this permit shall be deemed revoked. Power ,
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000)of Division 3 of the Business and CITY !f` Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl.
Over 50 to 100 Incl. LICENSE OR �1 / (./ Class ` f1
REG.NUMBER
L l Over 100 DISTRICT NO. PROCESSE Y O
License Number Lic.Class —
(`, Services, Q]M�''m�C&Panelaarrds
ContractOt -- -� � Date , f y" i Ilec
/ evr'm " ' DATE O
❑ I am exempt under Sec. 400-1000 Amp.U2.1!600 V –Z3–41 w
Over 1000 Amp.or Over 600 V VALIDATION
P FINAL d
B.&P.C.for this reason BRANCH CIRCUIT FEES BY
Date: 15A,or 20A,120V,Lighting or Recept. _
1 To 10 Branch Circuits C
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits
SINGLE FAMILY Temp.Power Pole&Appurtenances s
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT.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 3303 8$°70
Code):
F11 ITEF�S
I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , TOTAL 43218 A 70
and Professions Code). CHECKHEGK I� CK 88.70
CONSTRUCTION LENDING AGENCY CHANGEI hereby affirm that there is a construction lending agency for the °
00
performance of the work for which this permit is Issued(Sec. 3097, PERMIT FEE (Sub-Total) /
Civ.C.)
PLAN CHECKING FEE QIJC)D-QDQ1 4I 9/96
Lender's Name
PERMIT ISSUING FEE �7 a 5792 1 AN 10°38
Lender's Address 6�
I certify that I have read this application and under penalty of purjury state TOTAL FEE /
that the above information is correct. I agree to comply with all County
ordinances State laws r elating Electrical wiring,and hereby authorize
pr se es of this Co ty to enter upon the above-mentioned property
I n tion purp s. f I SEE REVERSE FOR EXPLANATORY LANGUAGE
L4
IGNATURE OF PERMITTEE DATE
A663-CES06 4-60 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING _
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN. SUP'TOF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
cRoss sr. Cie 4
C
PERMIT FEES OWNER
I TE M INUMBER EACH FEE MAIL
OUTLET$: $ 10 $ ADDRESS (!/1C
LIGHTS / RECEPT SW.
LIGHTING FIXTURES 10 l!� CITY TEL.NO. -
ELEC. RANGES CLO. DRYERS ELECTRICIAN
WATER H EATERS .50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS CITY TEL.NO.
GARBAGE DISPOSERS AUTO.- STATE
LICENSE NO.
WASHERS STA. COOKING UNITS .25
MOTORS: OVER INC. H.P. DISTRIC NO. GROUP Z.gNE P 0CESSED BY
O — I/z .25 --TY( / I L�
V2 — 2 .50 INSPECTION RECORD
2 5 1.00 �
c`� :r/c, d
5 — 15 1.50 (s. O
15 w 50 2.50 0
H
50 200 5.00 U
W
SIGNS: NO TRANS. d
NO. LAMPS N
Z
SERVICE 0.600V 1.00
SERVICE OVER 600V 5.00
misc.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE $ �,
1 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER
SIGNATURE
{ lrf. UTILITY CO. NOTIFIED;
OF PERMITTEE
FINAL
-VALIDATION ARTHUR C.vEIT.
' SUPERVISING ELECTRICAL ENGINEER
CK MO CASH
z. . Q i22 JUL U > ��
iA889•C4806 4.80 APPLICATION FOR ELECTRICAL PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER rA
LDING
BUILDING AND SAFETY DIVISION DRESSS£'JOHN A.LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUP-TOF BUILDING CALITY Q
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
PERMIT FEES
OWNER d c P?v'e cc e IL4 a&' e
1 T E M INUMBER EACH FEE
OUTLETS• 11 .10
$ MAIL
LIGHTS J/ RECEPT. W. .1Q 0 ADDRESS - •- pS t //
LIGHTING FIXTURES 10 CITY i/yJ e � TEL.NO. ae-
-
ELEC. RANGES CLO. DRYERS ELECTRICIAN 2f <z i-
W A T E R H E A T E R S .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 O. GR Z P E D B
O I/z 25
li= - 250 INSPECTION E ORD
2 - 5 1.00
D_
5 15 1.50 0
V
15 — 50 2.50 Q�
O
50 — 200 5.00 u
U
U.1
SIGNS: NO TRANS. D.
NO. LAMPS N
Z
SERVICE 0.600V 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50 0
TOTAL FEE S a
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN IAL P O ERTY. POWER
SIGNATURE UTILITY CO. NOTIFIED
OF PERMITTE
FINAL
VALIDATPN-,, ARTHUR C.VEIT.
CK Mo cASH SUPERVISING ELECTRICAL ENGINEER