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Home My Public Portal About6270 ROSEMEAD BLVD_Electrical__ 76A663-CE606 3-69 / � �/�.y,��! .- /I/�•�,/ APPLICATION FOR ((�EELLYYYLECTRRI�C'fALG.CPERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING � /J BUILDING AND SAFETY DIVISION ADDRESS /V JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NO. EACH FEE � $ $ OWNER RECEIPT._ MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS CITY TEL.N0. SWITCH OVER 20 .10 PLAN CHECK LIGHTING TOTAL I FIRST 20 1 ,20APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE DRYER_WTR. HTR. CITY TEL.NO. STA. COOK DISP. F.A.U. CONTRACTOR - SPACE HTR AIR COND. ADDRESS CLOTHES WASH._DISHWASH. CITY TEL.N0. - FAN OTHER 1.00 LICENSE NO. Q CLASS. MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I 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 {�7y ELECTRICAL WIRING. O - 1 ' 1.00 y lJ CL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATEOF O 1 - lO 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO U RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 10 - 50 5.00 w SIGNATURE0 + 50 - 100 10.00 OF PERMITTE U w 100 - 500 15.00 DISTRICT NO. GRO P ZONE O SSED BY L0 SIGN,GAS SIGN AND ONE CIRCUIT 3.00 �'L Z TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK wkk2L 12 ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 1 FINAL TOTAL FEE y JOSEPH C. ROOHAN SUPERVISING ELECTRI L ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK." M.O. CASH 566pR JUL 16 2 D 3.00 SFE BACK OF APPLICATION FIR COMPLFTE FEE SCHEDULE „�J"� G 76A663-CE606 3-64 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, SUPT OF BUILDING LOCALITY NEAREST da 4 FOR APPLICANT TO FILL IN CROSS ST. RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 1 $20 $ 2� OWNER LIGHT MAIL --� ADD'L ADDRESS SWITCH. OVER 20 .10 let LIGHTING TOTAL F1RST20 .20 Gd CITY 4- TEL. NO. FIXTURES ADD'L 10 ELECTRICIAN 1-1 OV R 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL.N peh DISHWASH. AUTO.-WASH. STATE �/ G SPACE HTRS. STA.APP.lyi H.P.MAX.) ,50 LICENSE NO. l / MOTORS: OVER NOT OVER H.P. DISTR!I!gT NO GROUP ZONEPR E8SED BY O 1 1.00 1 3 1.50 INSPECTION RECORD 3 B 2.00 0 8, 15 2.50 p� O 15 50 3.00 1- V 50 . 100 5.00 0. SIGNS: NO.TRANS z NO.LAMPS. SERVICE 0.60OV-NOT OVER 200A 1.00 SERVICE 0.60OV•OVER 200 A. 2:00 SERVICE OVER 600V 5.00 MISC. PER IT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE is 4), y 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 i AM PROPERLY REGISTERED AND/OR LICENSED A8 REQUIRED BY L08 ANGELES COUNTY AND STATE OF FIXTURES •� w ✓" CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL-PROPERTY. POWER SIGNATURE UTILITY CO.NOTIFIED ""` - -'- - A OF PERMITTEE FINAL .7l� //C?�jn,,.f;•�,i y ;r-.. LIDATION ARTHUR C. VEIT MO CASH SUPERVISING ELECTRICAL ENGINEER CK 76"663-CE906 3-64 APPLICATION VOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ��' t NEAREST FOR APPLICANTTO FILL IN CROSS ST. /�/�^ r N RECEPT. L') TOTAL NO. EACH FEE OUTLETS FIRST 20 ffi ffi p OWNER P �r LIGHT :Z r .20 MAIL _ ADD'L ADDRESS SWITCH. 7 OVER 2O .10 LIGHTING l TOTAL FIRST 20 ' .20 O CITY r TEL. NO. Jf FIXTURES ADD'L ELECTRICIAN OVFR 20 10 RAN, CLO.DRYERS WTR.HTRS. 1.00 ADDRESS,�O A005el , n GARB.DISP. STA.COOK q � CITY TEL.NO.L� DISHWASH. AUTO.-WASH. STATE SPACE HTRS, BTA.APP.(y■H.P.MAX.) .SO LICENSE NO. MOTORS: OVER NOT OVER H.P. DISI! JCT NO. ROUP ONE CESSED Y O 1 7i 1.00 (? 5 1 31.50 INSPECTION RECORD �. a 3 s 2.00 0 V S 15 2.50 15 SO 3.00 0 V 50 100 5.001 CL a N SIGNS: NO.TRANS Z NO.LAMPS SERVICE 0.60OV-NoT OVER 200A / 1.00 SERVICE 0.600V-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTAgY PERMIT ISSUING FEE 1.00 TOTAL FEE ffi 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL IC TION APPROVALS OATS 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 LDESIDEN�IA17PROPERTY. CERTIFY THAT I AM PROPERLY REGISTERED AND/OR REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES OL OR THAT I AM THE LEGAL OWNER OF THE ABOVE NTIA17PROPERTY. POWER E / UTILITY CO.NOTIFIEDTEE INAL VAA6ATION ARTHUR C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER 5 5 0 7� ui;1 �7 D 21 .90- I �76A6 �ERICAL 63-CE806 9-64 APPLICATION FOPERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS -��- JOHN A. LAMBIE, COUNTY ENGINEER `. COLEMAN W. JENKINS, SUP'T. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. 109 ' e RECEPT. TOTAL NO. EACH FEE LIGHT OUTLETS FIRST 20 $20 $ OWNER MAIL J: d%L! LC h A DD'L 1O ADDRESS SWITCH. OVER 20 TOTALI CITY �' TEL. NO. v 1/®i3/ LIGHTING FIRST 20I .20 FIXTURES _ I AL 10 ELECTRICIAN v rG� E'G OV R 20 r RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. .STA.COOK // 42 CITY TEL.NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(+/z H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISSTTgICT GROUP ZONE P ESSED BY O 1 1.00 JPO f__ 1 3 1.50 INSP TION RECORD >- 3 s 12,001 D. O 8 1 s 2.50 V 15 50 3.00 ad 50 100 5.00 V SIGNS: NO.TRANS CIL NO.LAMPS In SERVICE 0.600V-NOT OVER 200A 1.00 pD SERVICE 0.60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 . O Q SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1HEREBY 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 ��Gr7.i7 / �M'✓�%y//�a'`�l I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LIC ENSEO AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PRO ERTY. POWER SIGNATURE UTILITY CO.NOTIFIED T /! OF PERMITTEE FINAL LIDATION JOSEPH`C. ROOHAN V r SUPERVISING ELECTRICAL ENGINEER �JKMO CASH LAO 2 �+ 0 5:� �II�rd �3 2 a 3.0 0- 17 76A663-CEfl06 9-64 APPLICATIOF®R IELECTRICAL ERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 $.20 $ OWNER LIGHT I MAIL d �y/ L / A 0D'L ADDRESS d SWITCH. OVER 20 .10 J� LIGHTING TOTAL I FIRST 20 ,20 CITY TEL.NO./7�'2 3 j� FIXTURES } _ ADD'L 10 ELECTRICIAN �-3166 '3 ov R 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL.NO./ew L' � 2//,'� G DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(%s H.P.MAX.) ,50 LICENSE NO. �.L 7✓�� MOTORS: OVER NOT OVER H.P. DIS�T.vR�I`C'T O. GROUP ZONE PRb ESSED BY 0 1 1.00 /1 i' c Gf� ✓ 1 s 1.50 INSPECTION RECORD 4 G " CL 3 8 2.00 W ."`� /9bL"r� �'�� .E'�� 0 e 8 15 2.50 / v e 15 50 3.00 /Z-- .50 c.50 100 5.00 / /' PS Gas G>ei�T i 6 U J NO.TRANS 0 •� / W SIGNS: / NO.LAMPS 1:31 AJ - A SERVICE D-600V-NOTOVER 200A 1.00et, SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. f PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ �' 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURIt AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT fid/�J 62 ELECTRICAL WIRING. v - J WIRING I ft I �1 HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR v .i✓�1��yj/✓Q4 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE A�B�OVE DES RIBED RESIDENTIA PROPERTY. POWER SIGNATURE UTILITY CO.NOTIFIE _OF PERMITTE / �� FINAL / �f�A .. -!�/�'.vf� ALIDATION JOSEPH E. ROOHAN ` SUPERVISING ELECTRICAL ENGINEER C MO CASH _Ts,,;, -O535" 14 w D 5.5vN 76A66j-CE806 8/63 APPLICATION FOR ELECTRICL PERME� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN cRoss ST. RECEPT, TOTAL NO. EACH FEE OUTLETS FIRST 20 $20 $ OWNER' LIGHT MAIL ADD'L ADDRESS SWITCH. .10 �~rjy.. OVER 20 t TOTAL CITY TEL.NO - D LIGHTING l FIRST 20I .20 FIXTURES 1 ADD'LO 10 ELECTRICIAN OV R Z RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.('/s N.P.MAX.) -.50 LICENSE NO. �- MOTORS: OVER NOT OVER H.P. DISTRICT N ROUP ZONE P E 0 1 / 1.00y 1 3 1.50 INSPE, ION RECORD 3 8 2.001d 8 1 5 2.50 0 15 50 3.00 O 50 100 5.00 SIGNS: NO.TRANS- �^ NO.LAMPS N Z SERVICE 0-600V-NOT OVER 200A 1.00 SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 misc. PERMIT ISSUING FEZ 2.00 SUPPLEMENTARY PERMIT-ISSUING FEE 1.00 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI ATION 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 A LEGAL O ER OF THE A OVE DESCRIBED RESIDENTIAL P POWER SIGNATURE UTILITY CO.NOTIFIED 1 OF PERMITTEE [ FINAL LIDATION AR KUR C. VEIT OKMO CASH SUPERVISING ELECTRICAL ENGINEER Li'1�o 5 5, 4 2.1, NOV 4 2 D 7.0 0 N A 76A663C- CES066 12,76 APPLICATION FOR ELECTRICAL PERMIT BUILDIN ND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB .+-�� New Residential Bldgs.&Pools EACH NO. ADDRESS ( IV C�, FEE T' 1 &2 Finaily Sq, Ft. $ — $ LOCALITY ( eA4j5L15 C-1 Multi-family Sq. Ft. — NEAREST p Residential Swimming Pools CROSS ST. /li9l bl �J P R M NA E �5lL Outlets: Light, Switch&Receptacle MAI L • First 20 ADDRESS { c0 �t Additibnal CITY �J�(� Tel. No. PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel. Na. Fixed Appliances Not Over 1 HP APPLICANT _tj4GAfI4j GAJ Range Heater D.W. ADDRESS Q Oven — Dryer W.M. Top FAU VV.H. CITY GI -lez"A Tel. No. 3-,?4 � Hood Fan RECG. OR NNUMBER �,-S �1 Class. el� o Disp..�T -A A.C. �� ,y C) C7N�rO'sp. v A rZ I EAICA HREBY CKNOWLEDGE THAT 1 HAVE READ THIS APPLTION � I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Q Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Size&T ELECTRICAL WIRING. V Type HP, KW, KVA,or KVAR LLj Up to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Z Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THA 1 AM THE AL OWN OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESID NS ID N ID PERT .PERT Over 50 to 100 Incl. ID RMITEE ,Ae. CFZ-Z Over 100 - GNATURE TRICT NO. RO ESSED Y Services 0-200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V APPROVALS DATE IGNATECTOURE Over 1000 Amp.or Over 600 V MP. POWER POLE Temp. Power Pole&Appurtenances DERSLAB WORK Sign with One Branch Circuit UGH CONDUIT Additional Sign Branch Circuits (Other) RING TURES WER AUTHORIZED PERMIT FEE (Sub-Total) ILITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) NAL PERMIT ISSUING FEE � TOTAL FEE NOTES PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 7 & 4 +: u U J.D j ,p�� 76A663-CE806 3-69 APPLICATION FOR ELECTRICAL PERMIT �J COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS a JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NO. EACH FEE RECEIPT. $ Is OWNER �Cj 1 MAIL ADDRESS X Q FIRST 20 ,20 - � LIGHT TOTAL _ Cz TEL.NO. SWITCH OVER 20 .10 CITY PLAN CHECK LIGHTING TOTAL FIRST 20 ,20 APPLICANT FIXTURES } OVER 20 .10 ADDRESS RANGE DRYER WTR. HTR. CITY TEL.NO. STA. COOKDISP. F.A.U. CONTRACTO SPACE HTR_ AIR COND. ADDRESSrj(Cqe)QCLOTHES WASH._DISHWASH. CITYORTEL.NO -Z'Z FAN OTHER 1.00 LICENSE NO. � CLASSo MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSEDAS REQUIRED BV LOS ANGELES COUNTY AND STATEOF 1 - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOV DE IBED RESIDENTIAL PROPERTY. O 10 - 50 5.00 • V SIGNATURE 50 - 100 10.00 OF PERMITTEE O 1OO - SOO 15,00 DISTRICT NO. GROUP ZONE P!j;EX13YVU SIGN,GAS SIGN AND ONE CIRCUIT 3.00 �! Lu TUBE, OR Z I MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEEp JOSE H C. ROOHAN T SUPE V SING ELECT ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VAL TI CK.� M.O. CASH I 5 5iz�DICT 7 2 4.9.0 At-,o SEE BACK OF APPLICATION FOR COMPLFTF FEE =CHFDULF I t -4 ,:dj►4a�tKRS`^COMPENSATION DECLARATION 76A663 10/81 1 hereby affirm that I have a certificate of consent to self CE-806G APPLICATION FOR ELECTRICAL PERMIT insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB / ff Certified co is hereby furnished. EACH NO. FEE ADDRESS (tea Q Q S - F /cs PY Y New Residential Bldgs. & Pools LOCALITY Certified $ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. — $ tion department. Multi-family Sq. Ft. NEAREST.T �Q/>t(j. �/ i1/ Residential Swimming Pools OWNER CROSS ST. Date Applicant OR FIRM NAME Sm/41,0 /ILI Q CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec gLight MAIL _ COMPENSATION INSURANCE Sw. ADDRESSS First 20 (This section need not be completed if the work involved by Total No. Additional CITY 7-� e ' Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 3 Q ADDRESS / Additional � �- y� CITY Tel. No. Date J Xpplicant 7S6 /'/ � �' '�� Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT �G� I L�Gr R e 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 ,;7 S- /"- with comply with such provisions or this permit shall be Top _ FAU —W.H. — p deemed revoked. CITY � L�� Tel. No. A Q'y s-t/ 8 LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ /4 LICENSE V I hereby affirm that I am licensed under provisions of Chapter 9 DisP' Room Air Cond. REG. NUMBER �7 7 -� Class. (commencing with Section 7000) of Division 3 of the Business power Apparatus& Large Appliances DISTRICT NO. PROCESS a and Professions Code,and my license is in full force and effect. p Size &Type HP, KW, KVA, or KVAR' ,y �t U License Number _c3 7� Lic. Class --6/�— Up to 1 Incl. u FINAL 0-1 se�� Over 1 to 10 Incl. VALI ION H' Contractor Z�/n A544(fT�0.-LJate r Over 10 to 50 Incl. DATE w � 0 DFIN (� Lit I am exempt under Sec. Over 50 to 100 Inc. B a' V) B.&P.C. for this reason Over 100 - Z Date: Services, Swbd., MCC& Panelboards , 0 -200 Amp. Under 600V �2998A Signature 201 - 1000 Amp. Under 600 V Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # o'o 0 o 02 SINGLE FAMILY Temp. Power Pole&Appurtenances0 5 2 5 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0 a 1 hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits o 0 s 5 Q 2 5 v Law for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, will do the work and the Misc. Conduits&Conductors a 2 5 8 5 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 7044, Business 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 PERMIT FEE (SubTotal) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE U Lender's Address �S q I certify that I have read this application and state that the TOTAL FEE Vor 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-mentione property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Per l Date •ofiirm that COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certif�i_ed co y thereof CgSSec. 3800, PolicyNo.—Company—I� �tVv FOR APPLICANT TO FILL IN JOB ❑ EACH NO. FEE ADDRESS s/�[0 � •-s= �— Certified copy is hereby furnished. New Residential Bldgs. & Pools 1 & 2-Famil S Ft. $ — $ LOCALITY Certified copy is filed e c unty bu I ing inspec- Y� 9• tion epa tment. Multi-family Sq. FL — NEAREST CROSS ST. Date ' • Applicant dentia) Swimming Pools OWNER OR �e FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKER Outlets: Rec Li ht Sw._ MAIL COMPENSATION INSURANCE g ADDRESS �� f�-� ��+ This section need not be completed if the work invo b First 20 Yi —=- (This Y Total No. Additional CITE Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 APPLICANT 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. CITY' wt�� Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— �� LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Canal. REG. NUMBER �� Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCES BY �' and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances /' O �� G Size &Type HP, KW, KVA, or KVAR' 5( if U License Number Lic. Class Up to 1 Incl. FINAL lw �� Over 1 to 10 Incl. DATE _(® VALI TION 0 r ContractoDate Over 10 to 50 Incl. FINAL V ��VVV W ❑ I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 t Z Date: Services, Swbd., MCC & Panelboards ► 0 -200 Amp. Under 600 V ;2 3 6-31 A. Signature 201 - 1000 Amp. Under 600 V❑ #.o 0 0-0 0 2 Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. I o o 2 5,5 0 SINGLE FAMILY Temp. Power Pole &A urtenances HOME OWNER-BUILDER DECLARATION - o b o 2'5.5 0 v I hereby affirm that I am exempt from the Contractor's License n,Branch Circuits Additional Sig Law for the following reason (Section 7031.5, Business and 1 21,0-85 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 Other (See.Complete Fee Schedule)_ 7044, Business and Professions Code). Pilo 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's NaLe ,f PERMIT ISSUING FEE U Lender's Add I certify that this application and state that the TOTAL FEE 5150 above info ect. I agree to comply with all County Wrdincesws regulating Electrical wiring, and ntatives of this County to en er upon perty for inspection purpo s. SEE REVERSE FOR EXPLANATORY LANGUAGE Iv m�tee Dafe