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Home My Public Portal About5622 ROSEMEAD BLVD_Electrical__ 76AGGS-CESOG 8-69 •f APPLICATION FOR ELECTRI AL PERMI !� COUNTY OF LOS ANGELES Ir DEPARTMENT OF COUNTY ENGINEER BUILDING aa BUILDING AND SAFETY DIVISION ADDRESS J b JOHN A. LAMBIE, COUNTY ENGINEER aVA COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NO. EACH FEE $ $ OWNER RECEIPT. MAIL ��qq ADDRESS LIGHT_� TOTAL FIRST 20 .20 {J 3d ' SWITCH OVER 20 ,10 CITY TEL.NO. PLAN CHEC ol LIGHTING TOTAL FIRST 20 ,20 APPLICANT FIXTURES OVER 20 ,10 ADDRESS RANGE_DRYER_WTR. HTR. CITY TEL.NO. STA. COOK_DISP._F.A.U. CONTRACTOR ^ (j SPACE HTR. AIR COND. ADDRESS CLOTHES WASH._DISHWASH. J CITY 6 .ti ,4�TEL.NO. FAN_OTHER. 1.00 LICENSE NO. CLASS. e_-10 MOTORS,TRANSFORMERS RATING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 - 1 1.00 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR L ICENBE. AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 1 - 10 3.00 00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND 0 f RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPER \� 10 - 50 5.00 SIGNATURE � 50 - 100 t0A0 OF PERMITTEE 100 - SOO 15.00 DIST-R�I IT NO. GROUP Z NE PR D B Ci SIGN,GAS SIGN AND ONE CIRCUIT 3.00 Jaa TUBE, OR FI MARQU � EE ADDITIONAL CIRCUITS 1.00 NOTES:,p��`/l� � p� _ SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 ^i^ � k�J t. f• r SERVICE OVER SOO VOLTS OR 200 AMP 5.00 P TEMP SERVICE, POLE, &APPURTENANCES 3.00 - APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING FIXTURES PERMIT FEE (SUB TOTAL) POWER AUTHORIZED IA PLAN CHECK FEE (50% PERMIT FEE) jp PERMIT ISSUING FEE 2.00 72 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE JOSEPH C. ROOHAN jo SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.Q. CASH PERMIT VALIDATION cK. M.O. CASH I �r�4 13 19 MR17 2 D 8.40 Ntv SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ,iLl9///l�%//V WORKERS'COMPENSATION DECLARATION 78-663 10/e1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I'have a certificate of;consent to self Insure, 10E-BoeG or a certificate of Workers' Compensation Insurance, or a.certified COUNTY OF LOS ANGELES 4r BUILDING AND SAFETY copy thereof(Seo.3800,Lab.C.) Policy Ng06 4f company, FOR APPLICANT TO FILL IN I• -JOB , o2 IJK� ❑ Certified copy is hereby furnishe EACH NO. FEE j ADDRESS New Residential Bldgs.&Pools ❑ Certified.copy is filed with the county uildmg inspe ion 1 &2-Family,Sq.Ft.. $ — $. i LOCALITY' department. Multi-family Sq.Ft. — NEAREST Residential Swimming Pools CROSS ST 'I Date Applicant OWNER OFr FIRM NAME ! CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light_Sw.— I MAIL f COMPENSATION INSURANCE ! ADDRESS (This'section need not be completed If the work involved by the First 20 / Total No. Additional CITY Tel.No. Q/�p 06 I permit is.•for one hundred dollars($100)or less:) PLAN HECK ' 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 become subject to the Workers.'Compensation.Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel.No. Date' Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMrT Exemption,,you should become subject'to the Workers'Compensation Range_ Heater_ D.W.`— APPLI T I provisions of the Labor Code,you.must forthwith comply with such Oven _ 'Dryer_ W.M:._ ADDRES provisions or this permit.shall be deemed revoked. Top FAU _ W.H. LICENSED CONTRACTORS DECLARATION CITY ((t� Tel.No: B��Qa I Hood — Fan Other_ hereby'affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with.Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Claw(y�V Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY I Power Apparatus&Large Appliances > tIL i Q/ ' Size&Type'HP,KW,KVA,or KVAR eaQ b ' License Numr_� 6 5�f Z Lic.Class v �� Up to,i Incl, FINAL' V + Over 1 to 10 Incl. DATE 9 2 VALIDATION O ' Contract Date -3 Over 10 to 50 Incl. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LV .B.&P.C.for this reason Over'100 iL Date: Services,Swbd.,MCC&Panelboards ® Z 0-200 Amp.Under 600 V Signature 201•- 1000 Amp.Under'600'V El Exemption 1000 Amp.or Over 800 V Exemption for Reg.Maint.Elect. - SINGLE FAMILY Temp.Power Pole•&Appurtenances r HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 'I hereby affirm that I am exempt from the Contractor`s License Law '' ` r for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): ❑ i 1�'�'� 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 Compl Ba ete Fee Sc dule)._ ® "r:•; rt:;C_ and Professions Code). CONSTRUCTION.LENDING AGENCY off.%Lit 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 V (Sub-Total) ' Civ.C.). PLAN CHECKING FEE Lender's Name PERMII°'ISSUING FEE ' 'rux Lender's Address . h 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 wiring, and hereby authorize represe tative of this County to enter upon the above-mentioned ` pro for i ection poses. ' s r SEE REVERSE FOR EXPLANATORY LANGUAGE �� SignaturePermittee Date WO ' DECLA PEN ON hereby affirmRhatRII haveMa certificlate of consentlOto self insure, fIfE-806G 110181D/a1 I APPLICATION FOR,, �CTRICAL,PERMIT or a certificate of Workers'Compensation Insurance, or a certified t COUNTY OF L0�qq ANGELES t BUILDING AND SAFETY �. copy thereof(Sec.3800,Lab.C.) I �!}' � Policy No.PC 9 4 3 6.7 8company Rep_ T n d Pmn FOR APPLICANT TO FILL IN JOB Certified copy,is hereby furnished. EACH NO. FEE, : ADDRESS 5622 Rosemead Blvd. New Residential Bldgs..&Pools $ _ $ i LOCALITY ® Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. — I department. Multi-family Sq.Ft. NEAREST Residential Swimming Pools. CROSS ST. Date' Tz Pipplicant m . i - +-i ---L-- ` OWNER OR. .- 1 I n c I FIRM NAME Un J CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light—Sw.— ! MAIL COMPENSATION INSURANCE �• ADDRESS same (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 Tel.No-305-126C I certify that in the performance of the work for which this permit , ' PLAN CHECK APPLICANT is issued, I shall not employ any person in any manner so as to A become subject to'the Workars"C•ompensation Laws.. Lighting Fixtures First 20 1 ADDRESS Additional ' Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of '; APPUCANTTalbOtt Exemption,-you should become subject to the Workers'Compensation Range_ Heater_ D.W. ;rovisions of the'L'abor Code,you must forthwith comply with.such Oven Dryer_ W.M._`, I ADDRESS 1 8 provisions or this permit shall be deemed revoked. Top FAU W.H. LICENSED CONTRACTORS DECLARATION ` -I CITY.Pasadena Tel.No. 1 10 — Hood — Fan, _ Other_ - , hereby affirm that I am licensed Under provisions of 'Chapter 9 i LICENSE OR Disp. Room Air Cond. Class. (commencing with Section 7000)of Division 3 of the Business and REG:NUMBERI 9 6 5 4 1 ssions'Code;and my license is in full force and effect. ; power Apparatus&Large Appliances DISTRICT NO. PRO S§ED BY Q LL` Size&Type HP,KW KVA,or KVAR �O License Number. 19 6 5 41 L'ic:Class OUp.to'I Incl. ; FINAL (� 1 Over 1 to'10 Incl. DATE VALIDATION Q 'o Da Elect 5=94 5=94 —� ,, — 0 Over 10 to 50 Incl. �3 4 1 3 FINAL I am exempt under Sec: Over 50 to 100 Inc. BY W Over 100 BAP:C.for this reason vi Z Services;Swbd.,MCC'&Panelboards Date: '0-2.00 Amp..Under 600;V - - -- 201 - 1000 Amp.Under 600 VSi nature _.. ACC T°t 3307 73°26 ' Over 1000 Amp.or Over 600 V Exemption for Reg:Maint.Elect. l I ITEMS SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit: TOTAL -73.246 hereby affirm that I am exempt from the Contractor's License Law i h Ci Branch rancCircuits r the following reason(Section 7031.5,Business and Professions Additional SCHECK T3.26 ode): , CHANGE' ° 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) and Professions Code). 08DQ-0001 9/11/92 CONSTRUCTION,LENDING AGENCY s 544.5 1 AM 9:03 hereby affirm that there is a construction'lending agency for the r erformance of the work for which this permit is issued(Sec.3097,, PERMIT FEE (Sub Total) 58 '51 IV.C.): PLAN CHECKING FEE rider's Name PERMIT ISSUING FEE 2 4 7 5 nder's Address certify that i have read this application and state that the above TOTAL FEE. 7 3 2 6 'formation is correct.I agree to comply with all County ordinances 47— Ind State laws regulating Electrical wiring, and hereby authorize presentatives.of this County to enter upon the above-mentioned ro er for i ection ur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE i 92 of Permittee. 9 % to ' i WORKERS'COMPENSATION DECLARATION 7 63-806 10/8 APPLICATION FOR'J�ELECTRICAL PERMIT by affirm that I have a certificate of consent to self insure, C -aoaG Certificate of Workers'.Compensation Insurance,or a certified ! COUNTY OF LOS ANGELEV" '' I BUILDING AND SAFETY thereoof(See .3800,Lab.C.) NP `�f("r ompany QJ r A+ FOR APPLICANT TO FILL IN. .JOB �� " ADDRESS Certified copy is hereby furnished. New Residential BEACH NO. FEEldgs.&Pools w 1 &2-Family,SFt. $ — $ LOCALIT Sq.Certified copy is- filed with the county building Inspection — NEAREST depa ment. Multi-family Sq.Ft. 'CROSS ST. Applicant d I & Residential Swimming Pools OWNER OR I FIRMNAME CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL Outlets:Rec—Light_Sw._ ' COMPENSATION INSURANCE .I � OD oneed not be completed If the work involved by the .j lret'20 ADDRESS CITY Tel.No. ,section A It is for one.hundred dollars($100)or less.) i Total No. Additional ify that in the performance of the work for which this permit PLAN CHECK ' upd,•1 shall not employ any person in. any manner so as to I APPLICANT e subject to the Workers'Compensation Laws. ighting Fixtures _ First 20 ADDRESS Additional , .Total No.. CITY Tel.No. Applicant'— Not Appliances Not Over 1 HP' ' E T0'• APPLICANT: If, after making this Certificate of PERMIT ption,you should become.subject to the Workers'Compensation i Range_ Heater D.W. APPU ions of the Labor Code,you must forthwith comply with such j Oven _ Dryer_ W.M._ ADDRES . ions or this permit shall be deemed revoked. Top _ FAU _ W.H. _ y ..LICENSED CONTRACTORS DECLARATION I Hood — Fan — Other_ CITY Tel. by affirm that I am licensed under provisions.of Chapter 9 I . Disp. — Room Air Cond. UCENS OR /47654 /1/ i � Com• ening with Section 7000),of Division 3 of the Business and REG.NUMBER 6 sions Code,and my license is in full force and effect. 'IIPower Apparatus..&Large Appliances' DISTRICT NO. PROCESSED.BY a > ' Size&Type HP„KW,KVA,or KVAR a0 e Numb r /��r Lic.Class I Up to 1 Incl. FINAL. Over'1 to 10 Incl. DATE/ g�Y VALIDATION O actor Over 10 to 50 Incl. / [• !J' FINAL a I am exempt under Sec. Over 50 to 1.00 Inc. BY BAP.C.for this reason Over 100 Services,jt dd.,MCC&Paneiboards Date: 0 0 mp.Under 600 V / .•� Signature i 201 - 1000 Amp.Under 600 V pC Over 1000 Amp.or Over 600 V / -Exemption for Reg.Maint.Elect. SINGLE FAMILY (Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION IS'ign with One Branch Circuit �� by affirm that I am exempt:from the Confmctoes License Law Additional Sign.Branch Circuits e'.following reason(Section 7031.5,Business and Professions jl I,as owner of the property,will do the work and the structure Circuits- 'Conduits&Conductors is not Intended or offered for sale (Section.7044, Business Other(See Complete Fee Schedule) _ pop. Professions,Code). " CONSTRUCTION'LENDING AGENCY by affirm that there'is•a construction lending agency for the mance of the work for which this permit is issued.(Sec.3067., ;PERMIT-FEE (Sub-Totalj (PLAN CHECKING FEE -r's Name ;PERMIT ISSUING FEE ' is Address ify that I-have read this application and state•that the above :TOTAL FEE ation is correct.I agree to comply with all County ordinances tate laws regulating Electrical wiring, and hereby authorize e. tives of this County to enter upon the.above-mentioned ft i rty inspecti pur s i SEE REVERSE FOR EXPLANATORY LANGUAGE ; of Permittee Dat- j WORKERS'COMPENSATION DECLARATION 76AB63 10/81 CE-806G APPCI OCATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOP ANGELES BUILDING AND SAFETY u copy thereof(Sec.3800,Lab.C.) Plicy No.PC 9 4 3 6 7 8Company Rex- T n d Amn FOR APPLICANT TO FILL IN i JOB LJ Certified copy is hereby furnished. EACH NO. FEE ADDRESS _5622 RosemeaG� Blvd New Residential Bldgs.&Pools LOCALITY ® Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ — $ _ department. Multi-family'Sq.Ft. — NEAREST CROSS 3T. Date 9 9-9�—Applicant�lbE3 +- Bleet-1 I"CResIdential Swimming Pools I FIRM NAME ; CERTIFICATE OF EXEMPTION FROM WORKERS' - I MAIL COMPENSATION INSURANCE Outlets:Rec—Light—Sw.— ADDRESS same (This section need not be completed if the work involved by the First 20 CITY Tel.No. permit is for one hundred dollars($100)or less.) Total No. Additional PLAN 309-1 2 6 I certify that in the performance of the work for which this permit APPLICANT CHECK is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: if, after making this Certificate of APPLICANTTalbott 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._ ADDRESSI8 8 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITYTel.No. LICENSED CONTRACTORS DECLARATION Hood — Fart _ Other_ Pasadena — I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Class. (commencing with Section 7000)of Division 3 of the Business and REG.NunneER1 9 6 5 41 Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROC SSED BY Size&Type HP,KW,KVA,or KVAR �J'D� Gam ' U License Number 19 6 5 41 Lic.Class C-10 Up to 1 Incl. FINAL Talvbott Elect 5=94 1 Over 1 to 101nc1. DATE — 2, VALIDATION Q Contractor (Yate �—Over 10 to 50 Incl. " 4 1 0 3 FINAL ! (� ❑ I am exempt under Sec. Over 50 to 100 Inc. BY a t B.&P.C.for this reason Over 100 Services,Swbd.,MCC&Panelboards Z Date: 0-200 Amp.Under 600 V ; ..a Signature 201 - 1000 Amp.Under 600 V ACCT A ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V 3307 733026 SINGLE FAMILY Temp.Power Pole&Appurtenances 1 ITEMS HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit TOTAL 73.26 1 hereby affirm that I am exempt from the Contractor's License Law I+ for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits CHECKS 7302:. Code): ❑ Misc.Conduits&Conductors CKNGE .00 1,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) _ is not intended or offered for sale (Section 7044, Business and Professions Code). 00011-0001 9/11/9` CONSTRUCTION LENDING AGENCY 5445 1 AN 9903 1 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) 58 51 Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 24 . 75 Lender's Address I certify that I have read this application and state that the above TOTAL FEE 73 26 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 oro er for in ection ur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sirr of Permittee ate WORKERS'COMPENSATION DECLARATION CEA8o8G 10/81 APPLICATION FOR ELECTRICAL PERMIT , I hereby affirm that I'have'a certificate of consent to self insure, ; �i ora.certificate of Workers' Compensation Insurance, or aicertified r' COUNTY OF LOS ANGELES 4' BUILDING AND SAFETY u copy thereof(Sec.3600,Lab.'C.) Policy'Nq�� ompany FOR APPLICANT TO FILL IN 1, •d0B , ❑ Cetfified co is hereby furnisl a EACH. NO. FEE. I' ADDRESS PY New'Residential Bldgs.&.Pools LOCALITY Certified.copy is filed'with the county uiidrn 1 &:2-Family,Sq.Ft. $ _ $ ' Ing (rispe ion •I• NEAREST department. Multi-family Sq.Ft. + CROSS ST _ Date Applicant Residential Swimming Pools OWNER OFr FIRM NAME. CERTIFICATE OF-EXEMPTION FROM WORKERS' Outlets:Rec—Light Sw.— . MAIL COMPENSATION INSURANCE ADDRESS ��' First 20. (This section need not be completedIf the work involved by the I CITY Tel.No. Q/� 6 -permit.-Is for one hundred dollars-($100)or-loss.) Total No. Additional 1 certi that in the performance of the work•for which thisermit PLAN CHECK (Y P P 'APPLICANT � is issued,1 shall,not employ any person in any..manner so as to become subject to the Workers'Compensation.Laws. Lighting Fixtures First 20• l ADDRESS Additional Total No. ' CITY; Tel.No. Date' Appl'I.cant •Fixed'Appliances Not Over 1 HP I PERMIT NOTICE TO' APPLICANT: If, after making' this Cerlificste of Exemption,,you should become subject.to the Workers'Compensation Range_ Heater_ D.W. _,. } APPLI T . provisions of the Labor Code;you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRES provisions or this permit:shall,be"doemed•revoked. Top FAU _ W.H. — CITY' -4L,0 Tel.No. LICEN,5ED CONTRACTORS DECLARATION Hood Fan Other_. I.hereby'affirm that I am licensed. under provisions of,'Chapter 9 LICENSE OR commencin Dist). Room Air Cond.. .(commencing with 7000).of Division,3.of the Business and REG.NUMBER Professioris Code,and mjr license is in full foroe'and effect. Power Apparatus&Large Appliances DISTRICT NO. PRO E SED BY Size&Type.HP,'KVII,KVA,or KVAR; ��r �0� i License.Numb 7 w 5 �' Lid.Class v Up to,1•incl. FINAL ' I Over 1 to 10 Incl. DATE _!� n= ` Contract Date Over FINAL 4 W� .f VALIDATION 0 ' 10 to 50 Incl. i ❑ I am exempt.unde�Sec_ Over.50tto 100 In BY a ,B.&P,C.for this reason Over 100 Services,Swbb.,MCC&Panelboards 'z l Date: 0-200 Amp.Under 600 V Signature 201'- 1000 Amp.Under 600'V ❑ Over 1000'Amp,dor Over 600 V- Exemption for Reg.Maint.Elect.. SINGLE FAMILY Temp,Power Pole,&Appurtenances -' -HOME OWNER.-BUILDER DECLARATION' Sign with'One Branch Circuit '-:K:�", 5 I hereby affirm that I am exempt from the Contractor's License Law , Additional Sign Branch Circuits I for the following reason(Section 7031.5,Business and Professions Code): ; MI'sc.Conduits&Conductors r '; i 41 NK ❑ I,as owner of the property,will do the work and the structure Other(See Complete Fee Sc duls). '" -^> =- ' Isnot intended or offered for sale (Sectiori 7044, Business ® i!_ti;�,., �r and Professions Code). y , 76 Ar7 r CONSTRUCTION LENDING AGENCY y4 I hereby affirm that there is a coristruction lending agency for the � �''�=• " �' perfofmance 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 1 certify that I have read this-application and state that the above TOTAL FEE 'information is correct.I.agree to•oomply with all County ordinances and State laws regulating Electrical wiring,, and,hereby authorize + represe tative of this County to enter upon the above-mentioned ' 3•pro for i s ection ' poses. ti SEE REVERSE FOR'EXPLANATORY LANGUAGE Signature Permittee Date.