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Home My Public Portal About5701-5711 ROSEMEAD BLVD_Electrical__ i "--'"=RS'COMPENSATION DECLARATION CE 8o6G 10/81 APPI .ATION FOR ELECTRICAL PERMIT I hereby afi at I have a certificate of consent to self insure, or a certific___ Workers' Compensation Insurance, or a certified COUNTY _OS ANGELES I BUILDING AND SAFETY copy thereof Se 38r,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN I JOB ❑ Certified copy is herebyfurnished. EACH NO. FEE i ADDRESS p QCa New Residential Bldgs.&Pools � Certified copy is filed with the county building inspection I 1 & 2-Family,Sq.Ft. $ _ $ i LOCALITY U` department. Multi-family Sq.Ft. NEAREST Residential Swimming Pools COWN R ORROSS ST.� 3 0.f Date Applic nt _ I FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' 9� Outlets:Rec—Light_Sw.— I MaL COMPENSATION INSURANCE First 20 ADDRESS�j 5,5Vw (This section need not be completed if the work Involved by theTotal No. Additional I CITYjO6 Tel.N permit is for one hundred dollars($100)or less.) i I certify that in the performance of the work for which this permit PLAN CHECK to an APPLICANT is issued, I shall not employ y y person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional I Total No. I CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of I APPLICANT 1/11 s r 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._ i ADDRESS111 provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I CITY&a el.No. 3v/9 -i I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. , LICENSE OR 3K 7� Class. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER K ,D Professions Code,and my license is in full force and effect. I Power Apparatus&Large Appliances DISTRICT NO. pPi SED BY U / Size&Type HP,KW,KVA,or KVAR O p License Number l3 Lic.Class O o Up to 1 Incl. FINAL (� Over 1 to 10 Inc[. I DATE v�_ Z AJ VALIDATION 0 Contractor Date Over 10 to 50 Incl. 1 F- ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 9- N Date: Services,Swbd.,MCC&Panelboards I ® Z 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V I ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V � I SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit y hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits r the following reason(Section 7031.5,Business and Professions +. Misc.Conduits&Conductors I,as owner of the property,will do the work and the structure 1 { F i_; is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ® T U T AL 33 o 0 CONSTRUCTION LENDING AGENCY `,A i• ,y!�� 3a1�+ I hereby affirm that there is a construction lending agency for the i � performance of the Work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) ` ?.~Ht�I�IG e1_Ij 3 Civ.C.): PLAN CHECKING FEE Lender's Names =! PERMIT ISSUING FEE l Lender's Address iLyL6S +'"-'.t' I certify that I have read this application and state that the above TOTAL FEE t All '' 3 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 ig a of i e Date II - I .V'--'--RS'COMPENSATION DECLARATION 76A663 10/81 APP ATION FOR EL CT'RICAL a _ f CE-8060 I U-mby affi t I have a certificate of consent to self insure, or a certificl _ Workers' Compensation Insurance, or a certified COUNTY _._._-)S ANGELES BUILDING AND SAFETY , copy thereof(Sec 800, b.C.) 1 / Policy No. G CoJOB mpany541eFOR APPLICANT TO FILL IN i ADDRESS / . Se,/1 ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE 2-Family,1 & Ft. $ — $ LOCALITY 10- Certified copy is filed with the county buil�inspeon y,�• — department. Multi-family Sq.Ft. i NEAREST CROSS Residential Swimming Pools rWNEST. Date v Applicant OWNER OR ` r-, I FIRM NAME o CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light_Sw. . MAIL — COMPENSATION INSURANCE I ADDRESS Y$ ��d/► (This section need not be completed if the work involved by the First 20 CITY TeI� o permit is for one hundred dollars($100)or less.) i Total No. Additional CHECKPLAN �e Zi' o -Lb I certify that in the performance of the work for which this permit I 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 Fixed Appliances Not Over 1 HP FERMI NOTICE TO APPLICANT: If, after making this Certificate of APPLICA ® S 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 r ` 724 Yftid '/If" provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATIONi Hood — Fan _ Other_ CITY Re1fN 32-(GjLICE �' I hereby affirm that I am licensed under provisions of Chapter 9 I REG.NE OR (commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. ?�`3 Class �� REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus&Large DISTRICT NO. PRO SSED BY pp rg Appliances �/ d 33 (D I Size&Type HP,KW,KVA,or KVAR I • DO ��.vE -- O License Number 3-t ✓ Lic.Class ( Up to 1 Incl. FINAL (� Contra �C�v"��7 S ' ate / i Over 1 to 10 Incl. I DATE �� 17-At' VALIDATION 0 Over 10 to 50 Incl. FINAL C ❑ I am exempt under Sec. 6Over 50 to 100 Inc. BY Over 100 IL B.&P.C.for this reason N Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. I SINGLE FAMILY I Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I "^ 3 I hereby affirm that I am exempt from the Contractor's License Law I AOL. a r for the following reason(Section 7031.5,Business and Professions Additional Sign Branch It I _ Code): C/( ,{� f1 � ;�i •f 's}x`_,11: ElI,as owner of the property,will do the work and the structure Other Complete Fee Schedule) I Misd.Conduits&Conductors _ Y }j is not intended or offered for sale (Section 7044, Business I ( and Professions Code). 'Q I AL 103 00 I CONSTRUCTION LENDING AGENCY f'HECK i0130r, jr I hereby affirm that there Is a construction lending agency for the i performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) (X) CHANGE ')'}' Civ.C.). PLAN CHECKING FEE Lender's Name +- r PERMIT ISSUING FEE Lender's Address - F iAIM 1 t a=�a}_r: 1 certify that I have read this application and state that the above TOTAL FEE information is correct.1 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 4perfor inspection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE of Perini ee Date 'WORKERS'COMPENSATION DECLARATION 20.0019 DPW 3/87 V ' hereby cffirm that'( have a certificate of consent to self APPLICATION FOR EL CTRICAL PERMIT O insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO.FILL IN POB ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE DDRESS F-1Certifiedcopy is filed with the county building inspec- 1 &2-Family,Sq. Ft. $ — $ OCALITY "`Ls LI: C- tion department. NEAREST p Multi-family wi m ROSS ST. 1.AS Af IZ Residential Swimming Pools Date Applicant PWNER OR FIRM NAME Gf► DLY CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ I""AA COMPENSATION INSURANCE ADDRESS 100 OCeA&I 600 (This section need not be completed if the work involved by First ti CITY Tel. No. the permit is for one hundred dollars($100)or less.) Total No. Additional I�iJG' 1�t;Aal� Csl y37-eoHC PLAN CHECK I certify that in the performance of the work for which this i JAPPLICANT 1)�L4,li L Ff C. permit 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. g g I • Additional I Total No. CITY Date Applicant hjof;:fplRlb 1; GC Tel. No.772,-g22s NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION 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— ICITY Tel. No. LICENSED CONTRACTORS DECLARATION (LICENSE OR Disp. — Room Air Cond. — Class. • I hereby affirm that I am licensed under provisions of.Chapter 9 REG..NUMBER (commencing with,Section.7000)of Division'3 of the Business Power Apparatus&Large Appliances IDISTRICT NO. P ESSED BY d and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR ', U License Number Lic. Class Up to 1 Incl. !FINAL -�,.,- Z= d i 2 (DATE 3 07 _J_ LIL Over 1 to 10 Incl. VALI ON 0 Contractor Date Over 10 to 50 Incl. ;FINAL I- U �l ❑ I am exempt under Sec. Over 50 to 100 Inc. ;BY I�L �,. B.BP.C. for this reason Over 100 Services, Swbd.,,MCC&Panelboards , -HECK 34. 2" Date: 0-200 Amp'Under 600 V -11 O 'CHANGE Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. Ir317 —�slli �1�tii SINGLE FAMILY Temp. Power Pole&Appurtenances HOMEOWNER_BUILDERDECLARATION 1 PM 51 -yr 1 hereby affirm that I am exempt.from the:Contractor's License Sign with One Branch Circuit Law for the following reason (Section'7031.5, Business and Additional Sign Branch Circuits Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other(S a Complete Fee Schedule)— Business and Professions Code). L G C i"3 Z ' 00 ; CONSTRUCTION LENDING AGENCY 6 C_I It J 2 OO I hereby affirm that there,is a construction lending agency fat the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 4,,pp (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE , Lender's.Address I certify that I have read;this application and state that the TOTAL FEE. above.information is correct. I agree to comply with all County ordinances and State laws regulating Electrical'wiring, and S ITIL L.i&NT ItJ G. hereby authorize representatives of this County to enter upon I the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ®° WORN OMPENSATION DECLARATION 7° 3DPW 3/87 APP � ION FOR ELECTRICAL PERMIT hereby offirr' I have a certificate of consent to self CE-W6G S r i I' ) O sure, or a cer.,.._.=of Workers'Compensation Insurance, COUNTY \ _ NGELES DEPT. OF PUBLIC WORKS r a certified cop 'thhereaf(Sec. 3800, Lob. C-.) r ff 'No. 3' '� a Company �' � � FOR APPLICANT TO FILL IN JOB ^�- C Certified copy is hereby furnished. `�j �'-�(�^ [New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 't' LAS 1 ��RS o Certified copy is filed with the county 1 &2-Family, Sq. Ft. $ — $ LOCALITY TM L[T 7 tion department. Multi-family Sq. Ft. NEAREST A S Residential Swimming Pools CROSS ST. LAS ate ~71 Applicant OWNER OR FIRM NAME C 1h F1DN DEV, CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec Light Sw._ Q - �E/' COMPENSATION INSURANCE ADDRESS a OC` v- 6U First 20 This section need not be completed if the work Involved by Total No. Additional CITY Lo�CT&�H Tel. No.f� G he permit is for one hundred dollars($100)or less.) PLAN CHECK certify that in the performance of the work for which this APPLICANT ermit 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 UD Y L Total No. (Lr, Additional CITY Tel. No, o�n1� . t7?,-;�'X® ate Applicant -�' ( Fixed Appliances Not Over 1 HP PERMIT I-, NOTICE TO APPLICANT: If, after making this Certificate of p, Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION L l/�t C- Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS Ia"60 N Ve 431-1 with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY (p1 Tel. No. 16_51_)_qWA LICENSED CONTRACTORS DECLARATION LICENSE ORq Class.&f 0 I hereby affirm that I am licensed under provisions of Chapter91 Disp. — Room Air Cond. — REG.NUMBER 15 � ( (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY d and Professions Code,and my license is in full force and effect. (� �y C_r Size&Type HP, KW, KVA, or KVAR �'��J �`.t O License Number L '[ Lic. Class I Up to 1 Incl. FINAL �� L7 Over 1 to 10 Incl. DATE l� J 1J VALIDATION 0 Contractor Date Over 10 to 50 Incl. l "L � O 50 t 100 Inc.F1I FINAL U I am exempt under Sec. Over o BY LLi B.&P.C. for this reason Over 100 d Date: Services, Swbd., MCC&Panelboards 0%0 ® Z 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 L I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits �14�; s Law for the following reason (Section 7031.5, Business and g Professions Code): j __I ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors 1 1 0 structure is not intended or offered for sale(Section 7044, I Other(See Complete Fee Scheduled ® _ Business and Professions Code). - 4 CONSTRUCTION LENDING AGENCY r•+ nt I hereby affirm that there is a construction lending agency for n ,,-I r+ -: the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name I PERMIT ISSUING FEE Lender's Address I �j l i �1��.�='_u I certify that I have read this application and state that the TOTAL FEE � � above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and (71iZ� (_((,/-f r/—(,.� t!n!i f this County to enter uponed property o inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE N-7-ICY-2! j Sig ure of ermi ee Date I ®s WORKER'S COMPENSATION DECLARATION I°s3 DPw.9169 APPLICATION FOR ELECTRICAL PERMIT u I hereby affirm that I have a certificate of consent to self insure, 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(Seco.3800 Lab.C.) Policy No. Company. L��-C.' rc.� FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy Is hereby furnished. �� New Residential Bldgs.&Pools EACH NO. FEE $ _ $ LOCALITY .Lu 1:1 Certified copy is filed with the county building Inspection 1&2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. — CROSS ST. Date Applicant Residential Swimmm Poo s ASSESSOR G/ � '� I /5 Cl MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw FlRM NAME COMPENSATION INSURANCE f First 20 7P ��' (This section need not be completed if the work Involved by the a MAIL y permit Is for one hundred dollars($100)or less.) Total No.1LAdditional ADDRESS -;620 1 certify that in the performance of the work for which this permit CITY Z �`,. Tet.No. Z YO Is issued, I shall not employ any person in any manner so as to 3y PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant 120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of 15 OR 20A, CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code,.you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH APPLICAN LICENSED CONTRACTORS DECLARATION ADDRESS .{ ��. . C I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH o (commencing with Section 7000)of Division 3 of the Business and Tel.No. C Professions Code,and my license is In full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances REG.NUMBER f'`�3�8 Class. A6 C License Number �!�/ 6� Lic.Class l Size&Type HP,KW,KVA,or KVAR DISTRICT NO. POC SED BY F ' 2 LI Up to 3 Incl. > � Over 3 to 10 Incl. FINAL D Contractor 10 Date Over 10 to 50 Incl. DATE ❑ 3 0 Z� VALIDATION I am exempt under Sec. Over 50 to 100 Incl. FINAL B.&P.C.for this reason Over 100 BY Services,Swbd.,MCC Ilk Panelboards Vlbeboarrds Date: 00, 0-200 AmpY Signature 201-1000 Amp.Under 600 V 3 ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect.SINGLE FAMILY. HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances ACCT.1L I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit $9 . 1 for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits ,7M Code): 1 ITEMS ❑ 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)• TOTAL 392.31 and Professions Code). , CHECKS $92.31 CONSTRUCTION LENDING AGENCY Cf1tiWE .00 I hereby affirm that there is a construction lending agency for the fUi,n� performance of the work for which this permit Is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE QST-0001 5/27/r,' Lender's Name PERMIT ISSUING FEE 5240 1 AMIOe54 Lender's 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 wiring, and hereby authorize 4,rIAN presentatives of this County toe er upon the above-mentioned surSEE REVERSE FOR EXPLANATORY LANGUAGE 2E OF APPLICANT OR AGENT DAT ' + IS � LI WORKER'S COMPENSATION DECLARATION" :,"'%'0019 D r 9/89 I hereby affirm that I'have a certificate of consent to self insure, WAM APPLICATION FOR ELECTRICAL PERMIT or a certificate of Worker's Compensation-Insurance, or a certifled- i COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof.(Sea.3800 Lab.C.) ; NJ Policy Nod lQ Td •. lompany FOR APPLICANT TO FILL IN JOB 1 ADDRESS ❑ Certified copy is hereby'fumished. EACH NO. FEE New Residential Bldgs.&Pools $ _ $ 'LOCALITY de rtifiedecopy is filed with the county building In n 1&2-Family,Sq.Ft. Multi-family Sq.Ft. NEARES T, i . CROS Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM URKEOWNER OR COMPENSATION.'INSURANCE Outlets:Rem_Light Sw. FIRMMAME. First 20 +(This section need not be,completed-if the work Involved by the' Total No. Additional - ADDRESS permit Is.for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CI el..No. Is issued, I shall not employ any person in any manner so.as to PIAN cWECw. become subJ t to he Workers.''Compena ion'La. Lighting Fixtures First 20 gpPLICANr Total No. Additional s•- ADDRESS Datet9F1 q 01 Ft N= Ir 15 OR 2DA,120V BRANCH CIRCUITS- NOT APPLICANT: If, after making t Is,' Icate f CITY Tel.No. Exemption,you should become subject to the Wor ers'GUmpensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code,.you.must forthwith comply with such'` 11 TO 40 INCLUSIVE EACH PERMIT. APPLI —A. provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATIONADDRESS Q d I hereby affirm that I am licensed under provlsions',of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH ! (Commencing with Section 7000)•of Division 3 of the Business and CITY ' Tel.N /rmrwoV Professions Code,and my Iioense is.in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HPLICENSE OR Q Power Apparatus&Large Appliances, - 'REG.NUMBER Claes. 0 1 Size&.Type HP,KW,KVA,or KVAR DISTRICT NO. 'PROCESSED BY V License Number 'Uc.Class - p ° Up to 3 incl: �: •Tl0 d ContDate .. Over 3 to 10•Incl. I. DATE /71� f/) Over 10 to 50 In01: " q Z ❑ I am,exempt under Sec. " Over 50 to 100 Incl. � /'Z VALIDATION B.&P.C.for.this reason Over 100 FBY INAL - ServicesIf . ,Swbd.,MCC&Panelboards ate: — + J l 0-200 Amp.Under 800 V Signature 201-1000 Amp.Under 800 V- Over 1000.Amp.or Over 600 V, ElExemption'for Reg. aint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances r,. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit At L•T•.v I•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. 3307 _ i rIy--,�; Code): i +_ ❑ I,as.owner of the property,will-do the work and the structure, Misc.Conduits&Conductors Ck s•� Is not:Intended or offered for saleSection 7044., Business Other See Complete Fee Schedule I' ( ( P ) and Professions Code). t-. g.f �� ''[s�° f� � r s. J.62 CONSTRUCTION LENDING AGENCY hereby.affirm that there is a construction lending agency for the G•'"irEssi� ,?I:r performance of the work for which this permit Is issued (Sec.3097,, PERMITTEE (Sub-Total) Civ.C.) ; PLAN CHECKING FEE t-Fji,,^(;.i2lfl i2/72 Lender's Name PERMIT ISSUING FEE o�� w;7'•` 1h+' I° Lender's-Address I certify that 1 have read this application and state that the.above TOTAL FEE Qol•�� Information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize represent vea of this County to enter upon the above- entioned property or spect' p poses. SEE REVERSE FOR EXPLANATORY LANGUAGE 'SIGr NA RE OF APPLICANT PR AQEFrDA '