HomeMy Public PortalAbout4333 TEMPLE CITY BLVD_Electrical__ 7f"t°' s®EA 741 APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY ELECTRIC
COUNTY OFF LOS LOS ANGELES R��I
WILLIAM J FOX. CHI[r ENGINEER
FOR APPLICANT TO FILL IN DISTRICT No GROUP I ZONE //PERMIT NO.
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ELECTRICIAN ECO N e.0 '
Z 1 (I 1 RECEIVED BY READY FOR DAT[ IBSUEO
ADDRESS
✓! LV • rlREErrMBPECTION
CIT0IaEL iaY o W AC3
6OUNTYy
NO I EXPIRES BUILDING '�'�
PERMIT FEES. ADORESB Zd raJC�s[
FEE d
NUMBER EACH LOCALITY
LIGHT OUTLETB NEAREST
RECEPTACLES 73
_ CROSS CT
YZA
WALL SWITCHES OWNER
TOTAL OUTLETS So MAIL w
ELEC RANGES 25 ADDRESS
ELEC HEATERS 25
CITY TfL NO
FIXTURES S
� 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT 1 POWERS THE ABOVE VALID LOS
Nuwe[q HORSEPOWER ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
FEE
NEW Mw HP avcR INC EACH OF THE RESIDENTIAL"OPERMY DESCRIBED ABOVE
I A Liu 23
SIGNATURE
I/ p SO PERMITTEE
a e loo INSPECTION RECORD
S ie i SD
is S13 250 —
SO 200 S 013
_ 2130 SOO 1000 J
SOo 1000 1500 • Q
2
OVER 1000 20 GO 0
MG SET/FREQ CHANGER-HP
WELDERS AC-KVA G
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS (76 or oRIC)
-MOVED MOTORS (7S Cr oRle)
IS J
SI NS
NO NO TRANS
No No LAMPS APPRQVALS
FOR EACH PERNITI - T[ IN ORM NAM[
WIRING vim Fin oCONDUIT
FIXTUREB pl 00 WIRING
vff
RUPPLEOWENTARY So FIXTURES
/ POWER
TOTAL FEE B! UTILITY DO NOTIFIED
FINAL
'aAaa[ b RM 7�1 APPLICATION FOR PERMIT `
DEPARTMENT OFNG AND SAFETY ��������
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN
ADDRESS Z �-�. C//-T'➢ y L(/ DISTRICT NO. GRGOUP MZONE PERMIT
ERMIT NO
.
ELECTRICIAN ?6 6-/Z
R[C[ Y READY FOR DAT[ ?MUM
RST
[OTIOM L,4-
COUNTY
/�
OI oh /�� TEL T
COUNTY LIGEt�n[ NC EXP,R[9 1 -S' BUILDING �/_ �_3 7 _ __ O ' A //
PERM FEES ADDRESS ��y[ / _ C�.y .C.ari� .
F[[
NUMBER EACH LOCALITY
LIGHT OUTLETS qgr N[AR[BT 1
RECEPTACLES RDBBYT/n��' r
WALL SWITCHES L OWNER AK RR IF_
�[ N IV
TOTAL OUTLETS •�� 6c B D MAIL 1
ELEC. RANGES IIB ADDRESS
ELM HEATERS sB CITY TEL NO
FIXTURE➢ - B
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NIHO
APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT ,
NUMBER OF LIGHT CIRCUITB AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS ANO STAT[ LAWS R[GULATINO ELECTRICAL WIRING
MOTORS 1 CERTIFY THAT 1 POBBESB THE ABOVE VALID LOB
NUMe[aMGM POWER FEE ANGELER COUNTLICENSE. OR 1 AM THE LEGAL OWNER
N[w Mvo HP COUNTY LICENSE.
INC1NO [AGN OF THE RESIDENTIAL PR PE [RCRISE ABOVE.
I Y2
_ %500
SIGNATURE O
F
-PRMT [
0 OV
VER
N REC�O"[R
DINSPE
J Q
Z
1
G
NO SET/fRrq CHANGER-HP
WELDERS AC-KVA O
-GENERATORB - KW
TRANSFORMERS - KVA
TEMP MOTORS (76 OF 01110) I
MOVED MOTORS (76 or Gam)
M
SIGNS �•
NNO LAMPSTRANSAPPROVALS
NOo LAMPS
NO
FOR EACH P[RMITIDAT[ INSPEOTDRIB NAM[
WIRING G1 m • d d CONDUIT
FIXTURES slao WIRING
8L4PPLKMKNTAfff BO FIXTUR[B
POWER
TOTAL FEE •�{ 0 O UTILITY CO NOTIFIER
L FINAL
COUNTY OF LOB ANGELES APPLICATION FOR PERMIT
Department of County Engineer ELECTRICV����
DIVISION
OFFBUILDING & SAFETY
on
WILLIAM J FOX. CDty EnNnMr
FOR APPLICANT TO FILL IN OISTR!Fr NO. GROUP ZONE PERMIT NO.
ELECTRICIAN A/ Ca S z 3947-
AGGRESS Z 4I y L/ ♦ R[ [I D BY READY FOR DAT[ ISSUED
FIR INSPECTION
CITY
/vow
COUNTY LIO[MB[ NO G S EXPIRES MIT ADDRESS
PERFEES -
rc[
NUMBER EACH LOOALTrY
LIGHT OUTLETS M[AR[ST V �•� ,
RECEPTACLES CROSS ST L.
WALL 13WITCHEB OWNER ma A+.4Q /•
TOTAL OUTLETS 6D S MAIL G�
ELEC RANGES 9S ADOREBR
[LEC H[ATERB 16 CITY TEL. NO
FIXTURES B
- ENEMY ACKNOWLEDGE THAT 1 HAVE RGD THIS
MISC. APPLICATION AND STAT[ THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Or RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER NORBEPOW[R FE[ ANGELES COUNTY LIO 1 AM THE LEGAL OWNER
N[w MVD H P 1A Or THE RESIDENT. P[RTY ie[D ABOVE
• �[ S EBSIGNATURE Or
R 6D P[RNITTIOC
SB IDD INSPECTION RECORD
B to 1 BD
is BD a.BD y
BO 200 SDG D /
200 SOO 1000 J
SOO IOOO 13 00 Z
OVER 1DOO 20 00
MG BET FRED CHANGER-HP
WELDERS AC-KVA O
GENERATORS - KW
TRANBFORMERB - KVA
TCMP MOTORS (79 or ORIa)
MOVED MOTORS (7S% Or DRIa)
milic
EiIONB
NO NO TRANS APPROVALS
NO NO LAMPS
FOR EACH PERMITS DAT[ INSPECTOR'S NAM[
WIRING 1.00 OONOUIT
rI1(TIIRER Sl 00 WIRING
SUPPLEMENTARY 6 PICTURES
POWER
TOTAL FEE a {g� v�7/ ( UTILITY DO NOTIrIED
I FINAL
TEAEES DB8#SA 4-0E
APPLICATION FOR PERMIT
DEPART OF BUILDING AND SAFETY ��������
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF EROIHEERA_
,/ FOR APPLICANT TO FILL IN, Qdz DISTRICT NO. I GROUP ZONE PERMIT NO
ELECTRICIANr�e (,- 6
ADDRESS R[OE VED BY FIRSTINSPECTION
/IDY ranDA E IaBUeD
CITY , TEL N O AZ;�
COUNTY LIDCHEE NO. t EXPIRES ADDRESS 3 T-?
PERMIT FEES 7
FEE '
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
oRUBB aT
RECEPTACLES oQ
WALL SWITCHES OWNER %//jj� _� QTy (�
TOTAL OUTLETS 60 B MAIL dr
ELEC RANGES 25 ADDRESS
ELEC HEATERS 25 CITY TEL. NO
FIXTURES S I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MIBO APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER or LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT I PCSSFAB THE ABOVE VALID LDS
NYNQn HORBEPOMRR ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
F[[
Ntw MVa NP av[q IMS GaN OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
S/ a Lft a 23 .SO 813HATURE Or
B SO SO PERMITTEE • LLH�R(///
B a 1 GD 00 INSPECTION RECORD
_ 6 16 ISO 0
16 SO 250
60 200 Sao
200 Sao 1000
Sop 1000 1500 Q
0-0.
OVER IDOO 2000
NO SET/rREQ CHANGER-HP
WELD[RS1 AC-KVA O
GENERATORS - KW
TRANsrURM[RS - KVA
TEMP MOTORS (769 aE onto)
MOVED MOTORS (75% or anlB)
misc
SIGNS
NO NO TRAM& �� n
NO NO LAMPS APPROVALS
FOR EACH PERMIT DAT[ INBPECTORM NAM[
WIRING 11111313 oD CONDUIT
rIXTUR[a a100 WIRING
SUPPLEMENTARY60 FIXTURES
POWER
TOTAL FEE �0 UTI LITE co NOT1rlcD
FINAL
E
� A
II 'SA E3*CEBDS`I1,]° APPLICATION FOR ELECTRICArPERMIT
COUNTY OF-LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER �noRess
BUILDING AND SAFETY DIVISION
COLEMAN W JENKINS N BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OUTLETS ° A FE
S S OWNERilLobLav) N
RELEPT MAIL
FIRST 20 Zy ADDRESS
LIGHT TOT L P6 Gtr TEL NO SO O
SWITCH OVER 20 CITY
10 _ PLAN HECK �- - - - - -
FIRST 20 ZS APPLICANT
LIGHTING TOTAL
OVER 20 ADDRESS
FI%TURES 10
APPLIANCES CITY TEL NO
PERMIT
RANGE_pRVER_WTR HTR_ APPLICANT r
STA COOKDISP_F A U _ ADDR SS
SPACE MTP AIR GOND C4viITY 0
CLOTHES WASH DISHWASH_ LICENSE NO at of
j,j CLASS
FAN-OTHER 100 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APOIC TION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATIN[ WITH ALL COUNTY ORDINANCE! AND STATE LAWS REGULATING
IND HEATERS ETC HP KW KVA ELECTRICAL WIRING
SIZE B TYPE OVER TO
HEREBY CERTIFY THAT AM PROPERLY REGISTERED ANO/OR
Q - 1 IOO O D LACI LASED A9 REQUIRED BY LO! ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO }
1 - 10 30° RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY d
O
10 - 50 SGG SIGNATURE U
OF PERMITTEE
K
50 - 100 1000 OICLA99 ONE Pq C ID Y O
100 — S00 1500 STRICTN
a
SIGN GAS SIGN AND ONE CIRCUIT 500 NOTES
TUBE OR I ?
MARQUEE ADDITIONAL CIRCUITS 1 D
SERVI CENOT OVER 600 VOLTS OR 200 AMP 300
APPROVAL! OAT[ INSPECIOHl 9101MNRE
SERVICEOVER 600 VOLTS OR 200 AMP 1000
TEMP POWER POLE
TEMP SERVICE POLE 9 APPURTENANCES 5DO
UNDERSLAB WORK
TEMP LIGHT OR RELEPT SYSTEM 300
ROUGH CONOIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO NOTIFIED
PLAN CHECK FEE
FINAL L
PERMIT ISSUING FEE 3°° JOSEPH C ROOHAN ,
TOTAL FEE SUPERVISING ELECMUCAL ENGINEER
l
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATIO CK M O CAI"
j C06311;3 mu30 � 2 D 5.00-
SEE SACK OF APPLICATION FOR COMPLETE SCH[DULE ,
K •
COUNT' OF LOS ANGELES APPLICATION FOR PERMIT '
Department of County Engineer ELECTRIC DIVISION OFF BIIILDING 8c SAFETY
WILLIAM J FOX, County EDFIFar
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN - F
ADDREBB /(/1 D BY FIRST INSPECTION �7DAT[ ISSUED
CITY TEL NO - / C[IV[
COUNTY LIOENBE NO [%FIRER ADDRESSD UUI /.' ' /
PERS dA V —
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS ":r
&1A
WALLRECEPTACLES /�
WALL SWITCHES OWNER OSS J' .R OF
TOTAL OUTLETS so •S MAIL
[LEC RANGES SIs ADDRESS
ELEC HEATERS as CITY TEL. HO
FIXTURES S
Ming 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TRIO
APPLICATION AND BTATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGR[[ TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITB AND STATE LAWS REGULATING ELECTRICAL WIRIND
MOTORS I CERTIFY THAT 1 POSSES➢ THE ABOVE VALID LOB
NUMBER HORSCPOWER FEE ANGELES COUNTY LICENSE. OR 1 AM THE LEGAOWNER
NEW MVD HP DvER L INo EACH OF THE RESIDENTIAL OP[RTY DESCRIBED ABOVE
1/ • "as IN SIS SIGNATURE OF
9 s0 PERMITTER
SI 9 1 DD INSPECT192ffI&ORD
s is 1 50
is so SI 50
s0 SIDE Soo
200 500 1000 J
SED IEEE 1500 =
OVER IGOO J 2000 B
M B BET/MEQ CHANGER-HP D:
WELDERS AO-KVA D
GENERATOR➢ - KW
TRANSFORMERB - KVA
TEMP MOTORS (75or oRIG)
MOVED MOTORB (76 DF GRID)
Mie
SIGNS
NO NO TRANS. APPROVALS
No NO LAMPS
FOR EAOH PERMITI DAT[ INSPECTOR'S NAM[
WIRING 01.00 ped CONDUIT
FIXTURES ei.00 WIRING
NUPPLEMENTARM 60 FIXTURES
POMT.R
TOTAL FEE e / S UTILITY CE NOTIFIED
FINAL t
76w1N DBD#M a•aa It
1
7" 3 Dee""'M eJTe II-w INAPPLICATION FOR PERMIT
" DEPARTMENT OFNG AND SAFETY ELECTRIC i
COUNTY OFF LOS LOS ANGELES
WILLIAM .1 X CHIEF ENGINEER
1 DIST DR P ZONE PERMIT NO.
FOR APPLICANT TO FILL IN
ELECTRICIAN naf Usof, RECEIVED BY READY FOR DAT[ ISSUED
AODR[SS �'� FIRST INSPECTION
CITY � JJ
TEL NO
AD
LICE ENO BUILDING
DRESS
DESCRIPTION OF WORK
FE[B - - - - '-
NuwecR ourLEre EACHLOCALITY- -
CROBB
LIGHTS 9a STREET tP
RECEPTACLES B J •t
FIXTURES B p OWNER . T
WALL SWITCHES B MAIL
ADDRESS / 4"ljy »,57, I
ELEC RANGES
ELFC
. HEATERS 96 CITY (�(f /'D. TEL NO J
O
P
ER C
1 CERTIFY THAT I SSESS THE VALID LOS, J
NUMBER Of CIRCUITS INSTALLED. ANI CCOUNTY LI CENSL
LIGHTSPTACLES
MOTORS
REO IRMN
mum HORSEPOWER FE[ ♦ -
mm Mw HP I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP•
I� i L[Ri B 9B ERTY DESCRIBED ABOVL
va 9 60 ,
9 S loo DWH[R ?;
B is I SO INSPECTION RECORD
16 BO 250
BD 90O Boo
90O B00 loco '
BOO I 1DOD IBM J
t
OVER lOOO
2000 =_
No ser/meg CHANGER-HP 0
WELDERS AC-KVA D
GENERATORS - XW
TRANSFORMERS - KVA
TEMP MOTORB (7e or MRIG)
MOVED MOTORS (75% Or DRIB)
MISC
SIGNS
TYPE NO TRANS
TYPE No LAMPS APPROVALS
PERMIT FEE DAT[ INSPECTOR'S NAM[
FDR ISSUING PERMIT CONDUIT
WITHOUT FIXTURES MI.Da ev WIRING
JmzMA FIXTURES FIXTURES
SUPPLEMENTARY BO
POWER /�
TOTAL FEE s / UTILITY eo NOTIVIED r Iy/J / r -,/r
FINALS~�-
COUNTY OF LOB ANGELES APPLICATION FOR PIOUCT
DSof County Engineer ELECTRIC
������� a
g
DIVISIONION OF OF BUILDING & SAFETY
WILLIAM i Fox, oBaeeY EPEIMPr
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN /=
S^ -2 - 220
R[0 READY FOR DA 1
ADOR68B FIRST INSPECTION
CITY .Y
TEL. NO S
COUNTY LICENSE N0. EXPIRES 9; BUILDING
PERMIT FEES
NUMBER EACH FEE LOCALITY OSE E
LIGHT OUTLETS O-4 OROSBST / E.� !/ ✓�/
RECEPTACLES
WALL SWITCHES OWNER OSJ S A/T U'
TOTAL OUTLETS 6o B MAIL
[LEO RANGES 10 ADDRESS
[LEO HEATERS IUs CITY S A 9/Z,#'ATEL NO
FIXTURES S '-
1 H
E
REBY ACKNOWLEDGE THAT 1 HAVE READ THIS
HimAPPLICATION AND STAT[ THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
q.� NP
HORSEPOWER FEE ANOELW COUNTY LICENSE, OR I AM THE LEGAL OWNER
oV[P IHa [ADH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
mP111 IIS
SIGNATURE OF
va B SO PERMITTE
2 S 100 INSPECTION RD
S IS 1 SO _
15 SO 250 O L
SC 200 Sao
200 SGG 10 GO �-
500 1000 15 00 =
OVER 1000 20 OC
M O SET/FRL9 SET/FRCHANGER-HPIr
WELDERS'AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS (76 OF OPTS)
MOVILP MOTORS (76 of onto)
MISC
SIGNS
NO NO TRANS.
NG N MPB APPROVALS
FOR EACH PERMITI DAT[ IHSP[CTOR•B NAM[
WIRING *Ica 0.OCONDUIT
FIxTUR[S Sl OG GO WIRING SK.
SUPPLEMENTARYSO FIXTURES
POWER
TOTAL FEE B � UTILITYCO NOTIFIED
O�
FINAL
7"A DBS#eA 9-N
,' • COUNTY OF LOS ANOELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUn.DING & SAFETY ELECTRIC WILUAIN J FOX. County Esclaw
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN — _�S_
ADDRESS R[O[IV[G aY FIRB7INBPFECTION DAT[ IWUm
' CITY w1Z NO
COUNTY LICENSE N0. ¢%PORES - AUUILDIN /J/ �(�
PERMIT FEES
NUMBER EACH FEE LOCALITYlz
LIGHT OUTLETS NEAREST
RECEPTACLES ROBS BT OW u.S
WALL SWITCHES OWNER
TOTAL OUTLETS so MAIL
[LEG RANGES 75 ADDRESS
[LEC HEATERS IIB CITY P c TEL. NO
FIXTURES 6
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MIBQ
APPLIQATION AND STAT[ THAT THE ASOV[ IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Of RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUM�[wL HORSEPOWER FCE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
N[w Mw HP ovEn IHC ua11 OF THE RESIDENTIAL PROPERTY DEBORIBED ABOVE
• �s SS6C SIGNATURE or
S 60 PERMITTE
a B lool I INSPECTION CORD
s IB I Sol 1
15 BO 250
so zoo B DD
3010 BW 10 DO J
saD IDDG Is DD Z
DYER IOOD 20 DQ 'p
M G BET FRE CHANOCR-HP
WELDERS AC-KVA V D
GENERATORS - KW or
TRANSFORMERS - "A
TEMP MOTORS (73 or omG)
MOVED MOTDRB (76 or o[IR
MIBC
SIGNS
NO NO TRANS APPROVALS
NO NO LAMPS
FOR [AOR PERMITI DAT[ INSPECTOR'S NAM[
WIRING 6 DD CONDUIT
FIXTURES SI OO Q WIRING
113UPPLEMENTARY BO FIXTURES
POWER
TOTAL FEE •G 9 UTILITY CD NOTIFIED
FINAL
7eww o® w ¢-ea
' COUNTY OF LOB ANGELES APPLICATION FOR PERMIT
Departmentof County Engineer ������1�
DIVLSION OFOF BIIII.DINa & SAFSAFETY
WILLIAM 1 FOX. County EEEIe�e
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT
NO.
ELECTRICIAN [FN Af E p. FL -L
ADDRESS ON // ✓r R[6 Iv[O FIRST INSPECTION DATE
crrvT ' LBE T Tel No /4� GP : 67
COUNTY LIQ[NNa./3 EXPIRES BUILDIND
PERMIT FEES _ ADDREee--ry TS—� �EMPLL BCi ✓L
NUMBER EACH FEE L TY S W B ztta
LIOHT OUTLETS [BT N
R[CEPTACLLS C BB BT
WALL SWITCHES WNER R OS .�j5� 7/?/A//CLE
AL
EL C�RANOLSTL[TB 1SD S AIL
ADDRESS J .1
[LEC HEATERS as cm TONIII015 /nI TEL. NO • ✓. V X !.6
FIXTURES 6
1 N[REBY AQKIDWYXOSIC THAT 1 HAV[ READ THIS
MIBC APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT I POBBESS THE ABOVE VALID LOS
NuweEq HORSEPOWERCL AN0[L[0 COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
N[vl Mw HP DVEq IHC [SOH OF THE RESIDENTIAL PRbP[RTY D IBED ABOVE
A "as 111 aB • SIGNATURE OF
i V2 a 60 7 D PERMITT
451 a e 1013GU INSPECTION
B IB ISO
is BD 250 9g
_ SO 20O Boo p�
200600 1000 J
600 I= 1500 Z
OVfiR 1000
2000
M O BCF lR CHANG[R-HP (C
W[LD[RB AC-RVA D
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS (76 DF 01110)
MOVILD MOTORS (76 DF DeID)
MIBC
SIGNS
NO. NO TRANS. APPROVALS
ND N LAM
FOR [AOM P[RNITI DATE IN ECTOR• NAM[
WIRING SI OD L949CONDUIT
FIXTURES •I GO WIRING
SUPPLEMIINTARY 50 FIXTURES
POWER
TOTAL FEE • UTILITY CO NOTIFIED �Y �
FINAL
'lAA{Ll DDe#eA
2-Ea
APPLICATION FOR PERMIT
DEPARTMENT OFLOS NG AND SAFETY ������I�
COUNTY OFF LOS ANGELES t
WILLIAM J FOX, CHIEF ENGINEER 1
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN '6— — 9A396
RECEIVED BY . READY FOR OAT[ 15BUED
ADDRESS 1 FIRST INSPECTION
CITY TEL. N
COUNTY LICENSE NO 57 EXPIRES BUILDING
ADDRES5
PERMIT FEES - _-FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS I NEAREST
RECEPTACLES CROSS ST
WALL SWITCHES
OWNER
TOTAL OUTLETS 6e • Q
MAIL
CLEO RANGES 25 ADDRESS
CLEO HATERS 75
FO CITY TEL NO
FIXTURES 5
1 HERESY ACKNOWLEDGE THAT 14pVE READ THIS °
MIBD
APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
NUNe¢R HORSEPOWER r[c ANGELES COUNTY LICENSE. ON 1 AM THE LEGAL OWNER
NEW MVD HP DYER INC [ADH DF THE RESIDENTIAL PROPQR/T�' �DCDCRIs[D ABOVE
A L[ee S 25 O SIGNATURE OF
I a SO I PERMITTEE
' S 1DO INSPECTION RECORD
5 Is 1 so
1s so 150
50 700 Soo
100 Soo 10 GO J
500 1000 1500 Q
- Z
OVER 1000 2000
M 0 BET/rREG CHANGER-HP
I WELCERS AC-KVA .Z Q O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS (76 aF ORIG)
MOVED MOTORS (75% OE CRm)
BC
SIGNS
NO NO TRANS.
NO NO LAMPS APPROVALS
FOR EACH PERMIT: DATE INSPEOTOR'B NAME
WIRING 91 Do D CONDUIT
FIXTURES *Ica oo WIRING )�
SUPPLEMENTARY50 FIXTURES
POWER
TOTAL FEE • '3 Cd UTILITYCO NOTIFIED /
44 FINAL �y�
711AS40 BOB a 7-51 APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY ��������
COUNTY OFF LOS LOS ANGELES
WILLIAM J FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN
RECEIVED BY READY FOR DAT[ ISSUED
ADDRESS rIRST INBPECTIoN
CITY TEL NO [
COUNTY LICENSE NO EXPIRES ABUILDDDRESS 7/ 01
PERMIT FEES —_
NUMBER EACH c LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST
WALL SWITCHES
TOTAL OUTLETS So MAIL
ELEC RANGES 25 ADDRESS
ELED HEATERS 25 CITY TEL. NO
FIXTURES S 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC APPLICATION AND'STAT[ THAT THE ABOVE 18 CORRECT
NUMBER Or LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Or RECEPTACLE CIRCUITS AND STAT[ "" REGULATING ELECTRICAL WIRING
MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOH
NUMB 11 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
Nm MVR NP OVER INC E
ACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
I/ A L[[e SIGNATURE OFva %2PERMITTEE
2 aINSPECTION RECORD
e 1e1S SoSO 200200 Boo W
fQ
SOD 10001 1500 - D
OVER 1000 2000 J
M 0 BET/FREo CHANGER-HP G
7
WELDERS AC-KVA O
GENERATORS - KW
TRANSFOR14ERB - KVA
TEMP MOTORS (76 or amm)
MOVED MOTORS (75% Rv aPla)
Mina
SIGNS
NO. NO TRANS APPROVALS
S
NO NO LAMPS
FOR EACH PERMIT DAT[ INSPECTOR'S NAME
WIRING S1 OD CONDUIT
r1XTURE9 •1 00 WIRING
SUPPLEMENTARY SD FIXTURES
POWER
TOTAL FEE a un LITYCO NOTIFIED
FINAL
Te•se!'cEeoe i 1 "r , s ( ' -, w 5,(}5 —)/ �'�� %
APPLICATION FOR ELECTRICAL P IT (�1,[JL�Ji�
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING C
BUILDING AND SAFETY DIVISION
ADDRESS
JOHN A LAMBIE COUNTY ENOINGER
ITYCOLEMAN JENKINS, SUPERINTENosNT CM BUILDING LOCALITY G
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
C
RECEPT
S OWNER
MAIL
LIGHT_ TOTAL FIRST 20 20 ADDRESSI-EN
SWITCH— OVER 20 10 CITY TEL NO _
PLAN CHECK
LIGHTING iTOTAL FIRST 20 20 APPLICANT
FIXTURES TL
OVER 20 10 ADDRESS
RANGE_DRYER—WTR HTR — CITY TEL NO
STA COOK_DISP _F A U — CONTRAC rOR C
SPACE HTR —AIR COND _ ADDRESS • g
CLOTHES WASH _DISHWASH CITY 6ATFTEL NO IT
FAN—OTHER 1 00 LICENSE NO CLASS
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
SIZE IN TYPE OVER TO AND !TATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE! AMO STATE LAWS REGULATING
I LECTRICAL WIRING
O - 00
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
1 - 10 5 00 CALIFORNIALICENSEDA9 REQUIRED BY LOS ANGELS! COUNTY AND BTATE OF
CALIFOq MOR THAT I AM THE LEGAL OWNER OF AND INTEND TO s
10 $O O 00 RESIDE IN THE ABOVE DESCPIiEO RE910 NTIAL PROPERTY O
SIGNATURE {J
50 - 100 10 00 OF PERMITTEE cc
too — 600 1600 D.O' ICT�1_O GBpUP N SE BY t'
TUBE SIGN GAS OR SIGN AND ONE CIRCUIT 3 00 J U ZS y I6L
MARQUEE ADDITIONAL CIRCUITS 1 00
NOTES 70 _
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 r
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE1NBPECTGi'!BIGHATME
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) fill
WIRING
FI%TURES
PLAN CHECK FEE 150% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 200 UTILITY CO NOTIFIED
J 11
SUPPLEMENTARY PERMIT ISSUING PEE1.1 00 FINAL d
TOTAL FEE JOSEPH C ROOHAN
SUPERVISING ELECT AL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M 0 CASH
1a('_ 3448� M423 2 D 3.00
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
�lA//✓I vsv/'
TeAeea-cEeoea aG APPLICATION FOR ELECTR�AL MI
COUNTY OF LOS ANGELES
✓ DEPARTMENT OF COUNTY ENGINEER BUILDING GI� G
BUILDING AND SAFETY DIVISION ADDRESScl
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY (�
NEAREST
FXTURES
APPLICANT TO FILL IN CROSS ST t—
NO EACH ICE
> > OWNER
MAIL
FIRST 20 20 ADDRESS- OVER 20= - -' f0 - - - __ CITY CTEL NO
PLANCNE K FIRST 20 20 APPLICANT
OVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR CITY TEL NO
STA COOK_DISP _F A U CONTRACTOR Q,
SPACE HTR _AIR COND ADDRESS S O Of rI ` AJ
CLOTHES WASH _DISHWASH _ CITY/,a C A,,je,,C-7_H(,- TEL NO 77 6
FAN OTHER 1 00 LICENSE NO 2 3 /-�
Q J CLASS C
MOTORS TRANSFORMERS RATING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
IND HEATERS ETC HP KW KVA AND STATE THAT THE ABOVE m CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO OT
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
TRICAL WIRING
D — 1 1 DDHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED MO/OR
SED AS REQUIRED EY LOB ANOELLS COUNTY AND STATEOF }
1 — 1D 3 DD ORNIA OR THAT 1 THE LEGAL OWNER OF AM INTEND TO Q_
E IN THE AEOY RIBEO RESIO TIAL PROARTY Q
10 — 50 500 U
I- 9rMyA 50 — 100 10 DO ATURE D<
ERMITTEE � Q
2, — `/ 100 — 500 500 RN/o� GROUP oNE PRO E O
SIGN,GAS SIGN AND ONE CIRCUIT 3 00 n V TUBE, OAZ
MARQUEE ADDITIONAL CIRCUITS 1 00 S � QSERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE, POLE, &APPURTENANCES 3 00APPROVALS DATE nuPECTORI SIGNATURE
P POWER POLE
RSLAB WORK
� /J4H CONDUIT
ING
PERMIT FEE (SUBTOTAL) FIXTURES
POWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
PERMIT ISSUING FEE 2 00 aO UTILITY CO NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 100 FINAL ,
TOTAL FEE 2 JOSEPH C ROOHAN
SUPERVISING ELECT L ENGINEER
PLAN CHECK VALIDATION CN M O DASH PERMIT VALIDATION EK M o CASH
( Rr. 3 9 4 3 VAR 4 2D 2 7.0 0^s a
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULED /J
i t
'ebWorm that
COMPENSATION DECLARATION 863 ID,BI APPLICATION FOR ELECTRICAL PERMIT t
I hey affirm that I have a certificate of consent to self ��6G
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 RLL IN ADDRESS /G
Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE
❑ Certified copy is filed with the county building mspec 1 & 2 Family Sq Ft 3 — f LOCALITY
hon deportment Multifamily Sq Ft — NEAREST
Residential Swimming Pools CROSS ST
Date Applicant OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERSOutleh Rec_Light_Sw_ MAIL
COMPENSATION INSURANCE ADDRESS
to _ --
(This section need not be completed If the"rk ImFirst 20 _
nelved by - Total No Additional - , CITU Tel No
the Permit Is for one hundred dollen($100)or toss) PIAN 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
Date cant
Total No Additional
CITY Tel No
AppliFired Appliances Not Over 1 HP PERMIT
the Workers
NOTICE TO APPLICANT If, after making this e rs Range_ Heater_D W — APPUCANT
Exemption you should become subject to the Workers
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 _WH _
deemed revoked Hood _ Fan _Other_ CIN Tel No
LICENSED CONTRACTORS DECLARATION Dup _ Room Au Cond LICENSE OR Class
I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER — r
(commencing with Section 7000) of Division 3 of the Business power Apparatus&Large Appliances DISTRICT NO L 0 r� P V a
and Professions,Code and my license is in full force and effect ar 8
T9y�z Size 8 Type HP KW KVA, or KVAR
License Number r Lic Class,y,_G(,— Up to 1 incl FINAL K
VAIVALIDp �— Over I to 10 Incl DATE O
Conhocto,A Aerae rrie_ C/ems to `5� .Q.2- li Over 10 to 50 Incl FINAL W
ElI am exempt under Sec Over 50 to 100 Inc BV /
B 8P C for this reason Over 100 Z
Date Services, Swbd MCC 8 Ponelboords polo
-,200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑ Exemption for Reg Mmnt Eject Over 1000 Amp or Over 600 V ,
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit '
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits f 4 8 .3 A
Law for the following reason (Section 7031 5 Business and
Professions Code)
❑ 1 as owner of the r Mix Conduits 8 Conductor t� e e e e e 2
property o off do the work and the
structure is not intended Prof or offered for sole (Section Other (See Complete Fee Schedule)— ► 'I,- e 7 5 O
t
7044 Business and Professions Code) �
CONSTRUCTION LENDING AGENCY t• •�• 7 3 5 0 6
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) 6,3 O 0617-86
(Sec 3097 Cv C )
PLAN CHECKING FEE
Lender s Name
PERMIT ISSUING FEE
Lender s Address
I cenify that I have read this application and state that the TOTAL FEE
above mformahon is correct I agree to comply with all County
ordinances and State laws regulating Elecrrrcal wiring and
hereby authorize representatives of this County to enter upon
the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
y-z It-fc
S�n . ermittee Date
W04KERS COMPENSATION DECLARATION 7eA663 10/8t
I he*8by affirm that I have a certificate of consent to self CE 8066 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 38M Lab C )
Pot icy No Company FOR APFUCAM TO FILL IN � ss TeT
Cenified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEEkqlvl
❑ Certified copy ,s filed with the county budding mspec- 1 8 2-Family Sci Ft f — S LOCALITY
bon department Multi family Sq Ft I NEAREST
Residential Swimming Pools i CROSS ST
Dote Applicant OWNER OR
CERTIFICATE OF EXEMPTION FROM WORKERS — FIRM NAME
COMPENSATION INSURANCE Outlets Rec_Light_Sw_ MAIL
(This section need not be completed If the work Involved by First 20 ADDRESS y ,
the permit is for one hundred dollars ($100)or leu ) Total No Additional CITY Tel No
I certify that in the performance of the work for which this RAN CHECK
permit is issued I shall not employ any person in any manner
APPLKANT
so as to become wblect to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS
Date Applicant -
Total No Additional
CITU Tel No NOTICE TO APPLICANT If after making Fixed Appliances Not Over 1 HPg this Certificate of PERMIT
Ra Heater—D W — APPLICANT s
Exemption you should become subject to the Workers ^90— -
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 LICENSE
I hereby affirm that I am licensed under provisions of Chapter 9 Diap — Room Au Cond OR
REG NUMBER Clan
(commencing with Section 7000) of Division 3 of the Business _ Y'
and Professions Code and my license is in full force and effect Power Apparatus 8 Large Appliances DISTRICT NO S Y
T 5,�y1 z �F—'^ Size 8 Type HP KW KVA or KVAR v„J s D�
License Number + Lic Class e-fin Up to 1 Incl FINAL D:
ContraClWA Aer,j" Le C/ee cto S C. .'�'xQ�i Over 1 to IO Incl DATE " 7� _ D N
❑ Over 10 to 50 Incl FINAL t
Iam exempt under Sec Over 50 to 100 Inc BV W
B 8P C for this roman
Over 100 / Z
Dote Services, Swbd , MCC 8 Ponelboards ►
0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600V
❑ ,
Exemption for Reg Moint Elect Over 1000 Amp or Over 600 V
i.
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor s License 3 4 8 3 3 A
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 Mac Conduits 8 Conductor i� • is e a e 2
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , +),• • 7350
70" Business and Professions Code)
CONSTRUCTION LENDING AGENCY to -,- 73505
1 hereby affirm that there is a construction lending agency far _ _
the performance of the work for which this permit is issued PERMIT FEE (Sub Total) 63 Q 0617-86
(Sec 3097 Civ C )
PLAN CHECKING FEE
Lender s Name
PERMIT ISSUING FEE
Lender s Address
I certify that I have rood this application and state that the TOTAL FEE
above information ,s coned 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 properly for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signory of Permittee Date
Wm that I havea COMPENSATION DECLARATION 76-663 ,D,Bi APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-906G
or a certificate of Workers' Compensation Insurance, or a certifi§d COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof See, 0,Lab.C.) /
ss:
POIIC Np. '� - '� Company •� 7'
FOR APPLICANT TO FILL IN JOB
Certified copy is herebyfurnished. EACH NO. FEE ADDRESS
New Residential Bldgs.8 Pools ,
❑ 1 & 2-Family, $ I—Is LOCALITY
Certified Copy is filed with the county building spection Y,Sq.Ft.
department, _ j/Jf 1('' Multi-family Sq.Ft. NEARECROSSSTr' a r1y
f �. ,:�.Y,�, \/i Residential Swimming Pools
Date / "/ ''�"�Applicant ! /F• FIRM NAME ®r' +% e
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
COMPENSATION INSURANCE Outlets:Rec— Light ,Sw. — ADDRESS
(This section need not be completed R the work involved by the First 20
permit is for one hundred dollars($100) or less.)
Total No. Additional CITY Tel.No.
I certify that in the performance of the work for which this permit PLAN CHECK `
is issued, I shall not employ any person in any manner so as to APPLICANT f / •?(7 f _
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
Total No. CITY �� X17 Te Nye .��//
Date Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT
i
provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top _ FAU W.H. _
CITY 7e1.No.
LICENSED CONTRACTORS DECLARATION Hod Fan Other
Hood a
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR class.
(commencing with Section 70001 of Division 3 of the Business and REG.NUMBER //
/41
Professions Code,andmy license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY O
/ r-, Size 8 Type HP,KW,KVA,or KVAR �, t'.. ,�,� LLI
License NumberLic.Class Up to 1 Incl. FINAL J_
ContractorDate I^ f-. ',NfX� Over 1 to 10 Incl. DATE VALIDATION
Over 10 to 50 Incl.
❑ FINAL <
I am exempt under Sec. Over 50 to 100 Inc.
BY Q
100 M
B.&P.C.for this reason Over 0
Services,Swbd.,MCC& Panelboards , d.
Date: 0- 200 Amp.Under 600 V
W
Signature 201 - 1000 Amp.Under 800 V
❑
Exemption for Reg.MaiOver 1000 Amp.or Over 600 V -Maim.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5,Business and Professions Additional Sign Branch Circuits
Code):
Misc.Conduits& Conductors
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
1 certify that I have read this application and state that the above TOTAL FEE i
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 bove-mentioned
property for inspection purpo s;.�• ,,^
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
WORKERS COMPENSATION DECLARATION CE 806 ,D.Bt APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE B06C
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a citified copy thereof (Sec 3800 Lob C )
Policy No " Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnishedNew Residential Bldgs 8 Pools EACH 1J0 FEE ADDRESS
❑ —
Certified copy a filed with the county budding mspec � 1 8 2 Family $q Ft $ $ LOCALITY
hon department Multi-family Sci Ft — NEAREST
CROSS ST
Residential Swimming Pools
Dote Applicant OWNER Cii Ii r J w \
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_Light_Sw_ MAIL T
COMPENSATION INSURANCE ADDRE N-ll
Is stolon need not be completed N the work Invohred --First 20_� --
-� P
by —Total No Additional I� — — — Tsl No y �7
the permit Is for ono hundred dollars ($100)or lass ) ,
PAN CHECK
I certify that in the performance of the work for which this APPLICANT MR+
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
Fixed Appliances Not Over I HP PERMIT
Date Applicant
NOTICE TO APPLICANT If offer mokmg this e of
Exemption you should become subject to the Workers Range_ Heater_D W APPLICAM
the 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 — F
deemed revoked Hood — Fan _Other_ CITY Tel No
• LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp . Room Air Cond REG NUMBER Clots
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large fiances DISTRICT NO P BY f1"
and Professions Code and my license is in full face and effect PPa 9 APP (�D U
Size 8 Type HP KW KVA or KVAR c/
License Number Lic Class Up to I Incl FINAL 11:
Over 1 to 10 Incl DATE — VA ATION 0
❑
Contractor Date Over 10 to 50 Incl FINAL W
I am exempt under Sec Over 50 to 100 Inc BY 4.
N
B 8P C for this reason Over 100 Z
Dote Services, Swbd MCC 8 Ponelbo irds ►"
0 -200 Amp Under 600 V
Signature 201 1000 Amp Under 600V
Exemption for,Reg Momt Elect Over 1000 Amp or Over 600 V
SINGLE FAMILY Temp Power Pole 8 Appurtenances 26661 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits a e ie�e a 2
Law for the following reason (Section 7031 5, Business and
Professions Code) 1 • s, 2550
• a
as owner of the property will do the work and Mist Conduits 8 Conductors
the
structure a not intended or offered for sole (Section Other (See Complete Fee Schedule)— a 2 5 5 0,
7044 Business and Professions Code) O a , 2 8 7
CONSTRUCTION LENDING AGENCY L x
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 Name F-to PERMIT ISSUING FEE
Lender s Address r '
I certify that 1 have read this application and state that the TOTAL FEE J
above information is correct I agree to comply with all County
ordinances an to ows regu laking Electrical wiring and
eby out ori a ntatives of this County to enter upon
the above- en on pr party for inspection purposes -
- SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of ermitiee Date
1 t