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76AC67-CisO0_11-t"APPLICATION FOR ELECTRIC PERMIT �.
COONTY OF LOS ANGELES
DUAHTKMff OF COUNTY ENCE 13 U I LID]N G �^
RU=ING AND RAFE7Y DIVMON ADDRE89 .J
L *�'–�ry Co�t�
D. I3. 9ap't o! LOCALITY
FOR APP_ LICANTFTO�LL IN CNR06 ST.
1 T t Y ppm NUMIMMI XACH ra LAIDI
NE
O s s
LIQHTI RST. .10 LIGHTING FIXTURES .10 T O - -
KLZa.RAHau aLo.Dtrfxiks ELECTRICIAN
WATER H[ATt Re 0ADDR�.AH
E
Kum SPACI HTFAL DIlHWAAHJ"
OARAOX DISPOSIiY AUTO— CITYIfU JfEL.No
WASHOM sTA.COOKING UHiTs 215 STATE
MOTORS, OVIoe IHC. H.P. LICENSE NO
O — 1S RD wAtrr ME ttursa ION
-2 1
Y .DO
Y — b
1.00
INSP=0N RECORD
D — iD 1.150
115 — 150 2.150
DO— 200 15.00
SIGNS& NO.TRANIL
NO.I.A1iPs
SmiVICE 0-150QV 1.00
SERVICE OVEtR 80-OV 15.00
MISC.
WIRING PERMIT 1.00
FLXTURK PERMIT 1.00
SUPPLEMENTARY PERMIT .DO
TOTAL FEE116
APPROVALS
I DEBT ACII]tOt1EDGI THAT I HAVE READ THIS A PUCATIOX DATE INSPECTOR'S SIGAATURE
AAD STATE THAT THE ABOVE IS CORRECT AND AGREE TO r0 MPLT CONDUIT
Wi'TH ALL COUETT ORDINAACES AAD STATE LAWS 'REGULATING
ELECTRICAL WIRING. WIRING
I MMEBT CERTIFT THAT I AM PROPERLT REGISTERED AAD/OR
LICENSED AS REQUIRED BT LOS ANGILES COUNTT AND STATE OF FIXTURES
CALIFORKIA OR THAT I AI THE LEGAL 0 THE ABOVE POWER
DESC�IQEa RESIDENT EmIK
SIGNATURE UTILITY CO.NOTIFIED
OF Pi2M FINAL
ATIQNIS C
No CASH �U!'@[VL}IN6>=L[GT7t1CAL BN61NS:Di ,
LAC01 17IR DEC 24 2
WORKERS'c`I have a "°" DECLARATION '61,663 DPW 3/V APPLICATION MR ELECTRICAL PERMIT O
I here•-� affl;�,n'�hat I have a certificate of consent to self
fnsunFs dr_d certlftcate of Workers' Compensation'Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or s'`certlfi;Z copy thereof (Sec. 3800, Lab. C-)
FEZ c No Company FOR APPLICANT TO FRl IN ASS w
u Certlfled copy Is hereby furnished. New Residential BIdgs. 8 Pools EACH NO. FEE J
❑Certified copy is flied with the county building Inspec- 1 8 2-Family, Sq. Ft. S = $ LOCALITY
tion department. Multi-family Sq. Ft. NEAREST
CROSS ST. L
Data Applicant Residential Swimming Pools RM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re1�Llght__6_1Sw._Y / MAIL ADO1;55
COMPENSATION INSURANCE /y First 20
(This section rimmed m
ed not be completed If the work Invohred by Total No. Additional CITY Tel. No t
the pertrrtt Is for one hundred dollars (=100)or leas.) PLAN CHECK
I certify that In the performance of the work for which this APPLICANT
permlt Is Issued, I shall not employ any Person In any manner Lighting Fixtures First 20 ADDRESS
so as to become subject to the Workers Compensation Laws.
14 Additional
Total No. CITY Tel. No.
Date ATallcont Fixed Appliances Not Over 1 HP fERRWT
NOTICE TO.APPLICANT: If, after making this Certificate of APPLKAT10N
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. Hood — Fan —Other— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Dlsp. — Room Air Cord. — N OR Class.
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. BY >_
and Professions Code,and my license R In full force and effect. O
Slxe 8 Type HP, KW, KVA or KVAR 01
License Number Llc. Class Up to 1 Incl. FINAL dd
Over 1 to 10 Incl. DATE �-Z{�"( Z VALIDATION 0
Contractor fie Over 10 to 50 Incl. FINAL U
❑ I am exempt under Sec. Over 50 to 100 Inc. BY LLI
B.BP.C. for this reason Over 100 0-
Services, Swbd., MCC 8 Panelboards , Z
to:DaZ
0,-200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600
❑ Exemption for Reg'. Malnt. Elect. Cher 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 Appurtenances i
HOME OWNER-BUILDER DECLARATION
Sign with One Branch Circuit + '•'�' i
I hereby affirm that I am exempt from the Contractors License (il•l•1 .r
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
97
Professions Code): ��7 'D•1'-'
® I, as owner of the property, will do the work and the NK- Conduits 8 Conductors ] ITels
structure Is not Intended or offered for sale(Section 7044, Other (See Com lete Fee Scheduled , TOTAL 90 - 13
Buslneu and Professions Code).
CONSTRUCTION LENDING AGENCY 1.•rKn 1 713.L�
I hereby affirm that there Is a construction lending agency for ^ CA*GE `��I
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE Lenders Nome I313 10/11/91
PERMIT ISSUING FEE / Gi
Lenders Address 9459 1 Am 7:4L
I certify that 1 have read this application and state that the I TOTAL FIE
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 abovo-mentloned property for'nspectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Pwmlttee Date—�