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76A663-c2"�9-_"�PPLICA
TIO ORifirTl PERMIT ��l
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS ® L✓ I Cl�
JOHN A. LAMBIE, COUNTY ENGINEER J +/`_
COLEMAN W. JENKINS, SUP'T. OF BUILDING LOCALITY 'e-L&. `� C l�y
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. ZrJCQ �V V
REC EPT. TOTAL NO. EACH FEE LL
LIGHT OUTLETS FIRST 20 ffi 2O $ OWNERPIS-(, J.4C k-jr b
MAIL C�UA�
ADD'L 10 ADDRESS J
SWITCH. OVER 20
LIGHTING 1 TOTAL i FIRST 20 .20 CITY ,(� TEL.NO.
FIXTURES l} _ ADO'L .1O ELECTRICIAN J11ZK 1- H"4,Le
OVER 20 �7 ��A y.
RANGES CLO.DRYERS WTR.HTRS. Loo ADDRESS / 7 4 a s Ci 0 e 6. q✓e-.
GARB.DISP. STA.COOK CITY O "141.Qa C TEL.NO. � .6.0
DISHWASH. AUTO.-WASH. STATE r7 L
SPACE HTRS. BTA.APP.(V$H.P.MAX.) .50 LICENSE NO. fes,
MOTORS: OVER NOT OVER H.P. DIST CT G . P ZON P FTD BY
O 1 1.00 Q
1 3 1.50 INSPECTION RECORD
3 s 2.00 a
O
s is 2.50 V
15 50 3.00 oe
so 100 5.00 O
SIGNS: NO.TRANS. 3
NO.LAMPS
rA
Z
SERVICE 0.60OV-NOT OVER 200A 1.00
SERVICE O-SOOV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
1 HEREBY ACKMQ.WLEDGE THAT 1 HAVE READ THIS APP ICATION APPROVALS DATE INSPECTOR' SIGNATURE
AND STATE THAT TNB ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL -COUNTY ORDINANCES AND STATE LAWS REGULATING _
ELECTRICAL WIRING. WIRING
1 oE
HEREBY.CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES r •� •Y � `
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF w„
CALIFORNIA OR THAT 1 THE LEGAL OWNER AND INTEND TO
RESIDE IN,THE ABOVE D CRIBED RE DENT OPERTY. POWER /N/�,�
SIGNATURE UTILITY CO.NOTIFIED dl 1m
OF PERMITTE FINAL
/ MLIDATION JOSEPH C. ROOHAN
(CK,
MO CASH SUPERVISING ELECTRICAL ENGINEER.
LhUo 4 5 0 ?,.o SEP 1 2 D 4.2 0^' ca
U"°IIII-`81106'-50 APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS O Cel
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
IPEMCT FEES CROSS ST.
ITEM NUMBER I EACH FEE OWNER
OUTLETS: • MAIL
LIGHTS REPT SW. 10 ADDRESS
LIGHTING FIXTURES .10 CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS .50 ADDRESS .
ELEC.SPACE HTRS. DISHWASHERS
CITY TEL,NO.
GARBAGE DISPOSERSL�AU70.- STATE v- 2
WASHERS STA.COOKING UNITS .25 LICENSE NO. nCP +J
MOTORS: OVER INC. H.P. DISTRICT NO. (GROUP ZiO,.A�E P OCES BY
o— 1/2 .28
va- 2 50 INSPECTION BECOBD
2— 5 1.00
5— i8 1.50
i5-- SO 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT 5o
TOTAL FEE S
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE 1NSP�CT R'S SIGNATURE '
AND STATE THAT THE ABOVE IS CORRECT AND,AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND SPATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THIS LEGAL WNER OF THE ABOVE
10011)
DESCRIBED RESIDENTIAL FROPER7Y. POWER ol
SIGNATURE UTILITY CO.NOTIFIED /9 a "-.�
OF PERMITTE
9p IONCASH SUPERYISiNG ELECTRICAL ENGINEER
K O CASH
"�'0 6 8 0 3 OCT 3 0 2 A
1A5
WORKERS'COMPENSATION DECLARATION 78-883 10/87 APPLICATION FOR ELECTRICAL PERMIT
Q,gwelp of rm that I have a certificate,of consent to self insure, CE-8o8G
a certifbate of Workers' Compensations Insurance, or a certified COUNTY OF LOS ANGELES BUILDING A14D SAFETY
copy thereof(Sec.3800,Lab.G) 7
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO.I FEE
$ _
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ LOCALITY 7, " 446 E L5,
department. Multi-family Sq.Ft. NEARESTCROSS ST. 67f
Date Applicant Residential Swimming Pools OWNER OR / L
[� FIRM NAME ' .A A V
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Lb Light_I�Sw. �Y AD RESS a
COMPENSATION INSURANCE First 20
>
(This section need not be completed if the work Involved by the Total No. Additional CITY Tel.Noa7 J
permit is for one hundred dollars($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this permit APPLICANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'*amaking
n La �� Lighting Fixtures First 20 ADDRESS
7 � Total No. 7� Additional CITY Tel.No.
Date S//_/ ApplicFixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: y,/ this Certificate of 1
Exemption,you should becoge subjlzct to the Workers'Compensation Range_ Heater D.W. _ APPLICANT
provisions of the Labor Cod�G must forthwith comply with such Oven _ DryerW.M._ ADDRES
VV
provisions or this permit shall be deemed revoked. Top — FAO _ W.H. _ CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. — Room Air Cond. REG.NUMBER Com$
(commencing with Section 7000)of Division 3 of the Business and
Professions Code,and my license is in full force and effect. &Large Appliances DISTRICT NO. PROCE
Power Apparatus BY >
/�
Size&Type HP,KW,KVA,or KVAR ,�IL V U
License Number Lic.Class Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE V IDATION Q
Contractor Date Over 10 to 50 Incl. FIN (~)
❑ I am exempt under Sec. Over 50 to 100 Inc. W
B.&P.C.for this reason Over 100 71 Q 7 A can
Services,Swbd.,MCC&Panelboards Z
Date: 0-200 Amp.Under 600 V # 0 0 0 0 02
Signature 201 - 1000 Amp.Under 600 V 1 - - 6-550
El
Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect. 0 o 0 6 S 5 0 5
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o S 2 7=8 7
1 hereby affirm that 1 am exempt from the Contractor's License Law Additional Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions
Code):
1Gi Misc.Conduits&Conductors
LJ 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)
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 above TOTAL FEE ��
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives of this 50,!1
to enter upon the above-mentioned
pro• 7t r insp ion a. SEE REVERSE FOR EXPLANATORY LANGUAGE
// 1,177
Sig ature of Permittee Date