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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. b7 7 7� 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