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APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CASBATT D GRIFFIN,SUPT or Su1Lm NG LOCALITY
FOR APPLICANT TO FILL W ti
PEEM PEES ROSS ST X�1.64 J
of
ITEM HUMEen Ewcx Fu 1<
OUTLETS t t
LIGHTS RCCIPT SW f0
LIGHTING FIXTURES to CITY TEL NO
osc RANOl/ "0 DRYERS ELECTRICIAN
WATER HEATERS BO ADDRESS
4EG SPACE HT DISHWAeHOtS CITY TELN
QANBAGE DISPOSENB AVTG
BrATE —� C—/d
WASHERS STA COOKING UNITS on LICENSE NO
MOTORS OVER INC Hp 0 IGROUP ZONE
O— / / /•JIt- 00
3ItA 7,
't 3 V / so o 04SPECTION RECO
E— s loo
IB— BO 250
so-900 500 H .s
SIGNS NO TRANS
NO LAN"
SERVICE O-BOOV 100 /y _ A p
SERVICE OVER BOOV Boo
MISC.
WIRINGPERMIT ADD
FIXTURE PERMIT 100
SUPPLEMENTARY PERMIT SO
TOTAL FEE t/ 10'0
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AFPLIGTIGNkFI)
EA BIpBGTOR S MONATURs
AND STATE THAT THE ABOVE W CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ICAL WIRING
sI HEERE" CERTIFY THAT I AM TRORRLT REGISTERED ANDIOR
LICENSED All, REQUIRED BY LOS ANGELES OUNTY AND STATE OFI I T I
DDQ IBBEO OR ut AM THE L[ OF THE ABOVEIr /f I �.. j
SIGNATURE D /A
OF PERMI _I 1 y I /
FINAL
a. v /"MAMN OUPERVISINO ELECVEITTRICAL ENGINEER
Ila�y' ro OABH
[�_a1 9 1 5 `2 ;-KY 1 2 4 12.5 0
APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGIN.
CASSATTD GRIFFIN,11111PT OF BUILDING LOCALITY
FOR APPLICANT TO FILL W NEAREST
PERM FEES CROHS ST
IT[M NuN[sR [ACIIFE[ OWNER
OUTLETS MAIL
LIGHTS 1D RECEFT GW ADDRE88
LIGHTING FIXTURES to CITYTEL-NO
. Corti"I.^ RANQ= CLO Corti" ELECTRICIAN
WAT[R HEATERG 30 ADDRESS
<L.[C SPA=HTRE. DHOIWAQHBtD
GARSAGQ DIIPOEQfIH AVTO-
ffi
� L J N CrI
WAEHOD QA COOIONGUNTTQ Ea ST
EO
MOTORS OVER ING HP / aO 1 _
o— .0 Oe
v.— s ao RTE�rN b
s— a IOD 67
a— to tgo IT(
r
/9/r
1a— so 200
ao-200 goo
SIGNS No TRAN6
No LVIPQ
S®tVICEO-000V 100 O
SERVICE OVER GOOV goo
MISC
WIRING PERMIT '.LOO Q
FIXTURE PERMIT 1 00
SUPPLEMENTARY PERMIT g0
TOTAL FEE Is Z100
1 HERESY ACXNOWL GE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATA INEPECTOREEIONATURQ
AND STAT[ THAT THU "0" 1E CORR[CT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND WATt LAWS REGULATING CONDUIT
ELELT111CAL WIRING
1 HRLY ERTD LE ELES CERTIFY THAT 1 AM •ROPERLY RQOIffEm RANO/OR WIRING
LIRNE[D " REQUIRE [Y OANGCOUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGALOWbIKR OF THE ASOVE
DEQCRI[ED RESIDENT FIDRT POWER
SIGNATURE UTI LITY CO NOTIFIED / 1
OFPERMITTE
NAL
pp �/� 1
�r /VPCSDATION SUP RV181NG FI vGTRICALENGINEER
L." WO YO CASH
1 6 ;.'.7 1 2D 7.0 0
TION
TION
WORKERS CI have certificate
of corse cc 006' taut APPLICATION FOR ELECTRICAL PERMIT
�� CE 006G
I$ereby affirm that I have a certilimte of consent to self
insure or o 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 JOB T
Certified copy ,s hereby furnished New Residential Bldgs 8 Pools �� NO FEE ADDRESS \ t-
❑ Certified copy is filed with the county budding mspec 18 2-Family, Sq Ft = — $ LOCALITY l
tion department Multi-family Sq F — NEAREST 1 Residential Swimming Pools OWNER CROSS ST OR
Dote Apphcont FIRM NAME Q
CERTIFICATE OF EXEMPTION FROM WORKERSMAIL Q
COMPENSATION INSURANCE Outlets Rec_Light_Sw_ ADDRESS It '� I
(This Faction reed not be completed If the work Involved by First 20 '
Tot
the permit Is for ono hundred dollars ($100)or leu ) al Na Additional CITY rL Tel
PIAN CHECK
I certify that in the performance of the work for ch this APPLICANT
permit,s issued I shell not employ any person in ny rarer
so as to become subject to the era Camps no L ws- Lighting Fixtures Fmt 20 ADDRESS
s- Total No Additional
Date 2-`a-� 1 Appl,ca CITY Tel No
Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If after mak, t s Cernh of Range Heater_D W APPLICANT c'NW
Exemption you should become sublet the o an, 9
Compensation provisions of the Labor Coda you m at th Oven _ Dryer _W M — ADDRESS
with comply with such provisions or thn permit II be Top _ FAU __WH — �t WS12
deemed revoked Hood _ Fon _Other_ CITU 1e - Tel No
LICENSED CONTRACTORS DECLARATION LICENSE OR
I herebyaffirm that I am licensed under p D,sp Room Air Cond Class
provisions of Chapter 9 REG NUMBER
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO P BY
and Professions Code and my liters,s,n full force and effect Power Apparatus 8 Large Appliances 0
2 A�J gg Size 8 Type HP KW KVA a KVAR
License Numbs, ^-L O 3 Lc Class -,� Up to 1 Incl FINAL / /J 0:
��1L r^,���-- Over 1 to 10 Incl DATE (///" L/7/ VAUDA N 0
Contractor A4914
�e Date 2 NA Over 10 to SO Incl t
❑ I am exempt u Sec FINAL LLI
p Over 50 to 100 Inc BY N
B 8P C for this reason Over 100 Z
Date Services Swbd, MCC 8 Panelboards , 8 6 5 2 2 A
0 -200 Amp Under 600 V # a a a a e 2
Signature 201 - 1000 Amp Under 600 V
Exemption for Reg Maint Elect
Over I DO()Amp or Over 600 V l o 939.50
❑ xG rM�
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's LSign
¢ense Additional with Sign Branch Circuits
Low for the following reason (Section 7031 5 Business and
Professions Code) '
❑ I as owner of the property will do the work and the Mac Conduits 8 Conductors
structure is not intended or offered for sole (Section Other (See Complete Fee Schedule)— Pilo
Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there iso construction lending agency for 0
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec 3097 Gv C )
PLAN CHECKING FEE ,
Lenders Name
PERMIT ISSUING FEE
Lender s Address
I certify that I have read this application and state that the TOTAL FEE
above information is correct I agree to comply with all County
ordinances and St a laws regulating Electrical wiring and
rittereby authorize r ti
r sentaves of this County to enter upon
abtio ro M r m
ove man
spectwn purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signet ZY
f Perminee _ 2 —