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MEN cn , s■I. % A■.N ■err ;.�� W!PEIFFIMSEff �� '043 APPLICATION OR ELECTRICAL PERMIT LJ • F COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDREISS klAJ6 BUILDING AND SAFETY DIVISION COLEMAN W JENKINS, SLIPIRRI.T11.01114T OI BUIL1,INQ LOCALITY A GF1 NEAREST FOR APPLICANT TO FILL IN CROSS ST e- OUTLETS NO EACH FE 5 S OWNER RECEPT_ MAIL LIGHT_ TOTAL FIRST 20 25 ADDRESS SWITCH OVER 20CITY TEL NO IG PLAN CHECK FIRST 20 APPLICANT LIGHTING TOTAL 23 OVER 20 FIXTURES 10 ADDRESS APPLIANCES CITY TEL NO PERMIT 3 RANGE _WTR HTR_ APPLICANT C STA COOK_DISP_F A U _ ADDRESS SPACE HTR AIR GOND CITY , TEL NO CLOTHES WASH DISHWASH_ LICENSE NO 2-7v O CLASS FAN_OTHER 100 1HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS ETC HP NW MVA ELECTRICAL WIR INO SIZE B TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CAL'FOR N4 OR THAT I AM THC LEGAL OWNER OF AND INTEND TO } 1 - 10 300 ACSIDC IN THE A C DESCRIBED RESIDENTIAL PROPERTY CL p 10 - SO 3GO SIGNATURE V OF PERMITT OC 50 - 100 1000 DI ICT LADS ROCES rO 100 - SOO 1300 c w a SIGN GAS SIGN AND ONE CIRCUIT `B00 NOTES TUBE OR — _ ? MARQUEE ADDITIONAL CIRCUfTS_ 100 SERVICE NOT OVER 600 VOLT50 OO AMP 300 AP ROYALS DATE INSPECTOR'S SIGNATURE S ERVI CE OV ER 600 VOLTS OR 2100 AM P 1000 TEMP OWER POLE TEMPSERVICE POLE 8 APPU ENANCES EGO TEMP LIGHT OR RECEPT SYSTEM—-300�� UNDERSLAB WORK ROUGH CONDI UT WIRING FIXTURES POWER ALITHORI ZE0 PERMIT FEE (SUB TOTAL) UTILITY CO NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 300 3 p0 JOSEPH C ROOHAN TOTAL FEE QO SUPERVISING ELECTRICAL ENGINE PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION cry M 0 cAeN L& 2 2 9 4;9 SEP 8 . 2 D 6.00~ v SEE SAM OF APPLICATION FOR COMPLETE SCHEDULE - Te;Leee-ce[oa I/To V , APPLICATION FOR ELECTRICAL PERMIT u I rCOUNTY OF LOB ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION JOHN A LAMBIE. COUNTY ENGINEER LOCALITY COLEMAN W. JENKINSBUILDING FOR APPLICANT TO FILL IN NEAREST CROSS ST O&O&E TS L S OWNER 46ly— RECEPT/co / LIGHT TOTAL FIRST 20 20 -717 ADDRESS SWITCH �_ OVER 20 CITY TEL NO 10 PLANCNEC LIGHTING FIRST 20 20 Q APPLICANT FI%TURES TOTAL 10 OVER 20 ADDRESS APPLI LACESACELACES CITY TEL NO RANGE_DRYER_WTR HTR_ PERMIT APPLICANT STA CGOK_OISP_F A U _ ADDRESS 3 SPACE HTR AIR COND CITY TEL NO 2•21 CLOTHES WASH DISHWASH_ LICENSE NO CLASS FAN LUTHER100 �J THIS APPOCATION ANO STATEYTMATH THEEABOVE�5 CORRECTAT I HAVEREAD AND AGREE TO COMPLY MOTOR! TRANSFORMER! RATING WITH ALL COUNTY ORDINANCES AND !TATE LAWS REGULATING IND MEATERD ETC MR RW MVA ELECTRICAL WIRING SIZE B TYPE OVER TO I HERESY CERTIFY THAT I AMANGELES PROPERLY REGISTERED 4AND/ORQ _ 1 1W LICENSED Ap REQUIRED M HEE EGALLOW COUNTY AMOGES'FORRIA 0 T I AM THE LEGAL OWNER OF ANO 1 - 10 900 RESIDEIi; ABOVDESCRIIEDENT 10 - 50 500 SIGNATU ITTF "olt�OF PERK!SO - 100 '000 KISTRICTNO CLASS SROUP zo Oc 100 — Soo 1500 5-0O / SIGN GAS SIGN AND ONE CIRCUIT 900 NOTES �. TUBE OR 2MARQUEE ADDITIONAL CIRCUITS 1 G SERVICENOTOVER 600 VOLTS OR 200 AMP 200 SERVICE OVER 600 VOLTS OR 200 AMP 500JE14 PROVALS DATE INSPECTOWS SIGNATURE POWER POLE TEMPSERVICE POLE 4 APPURTENANCES 3 D LAB WORK TEMP LIGHT OR RECEPT SYSTEM 900 CONDI UT LAE ESPERMIT FEE (SUB TOTAL) AUTHORIZEDPLAN CHECK FEE (50% PERMIT FEE)PERMIT ISSUING FEE 200Y CO NOTIFIEDSUPPLEMENTARY PERMIT ISSUING FEEJOSEPH C ROOTOTAL FEE SUPERVISING ELEC ICAL ENGINEER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M 0 CASH M2405�- SU15 2 D 11.79;- SEE BACK Of APPLICATION FOR COMPLETE SCHEDULE TeneB!-c eeoe I1,TD APPLICATION FOR ELECTRICAL PERMIT" COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER EnoR S BUILDING AND SAFETY DIVISION •COLEMAN W JENKIN$ u r LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST ouTLers FEE OWNER RECEIPT_ S Is MAIL LIGHT_ TOTAL FIRST 20 25 ADDRESS CITY TEL NO SWITCH_ OVER 20 ID PLAN CHECK GHTING 70TAL LFIRST 20 25 APPLICANT FI%TURES 10 I OVER 20 ADDRESS APPLIANCES CITY TEL NO PERMIT RANGE_DRYER_WTR HTR_ APPLICANT STA COOK DISP _F A U _ / �O ADDRESS SPACE HTR AIR GOND CITY TEL NO CLOTHES WASH _DISHWASH _ LICENSE NO CLASS FAN_OTHER / 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND !TATE THAT THE ABOVE 13 CORRECT AND AOR[[ TO COMPLY MOTOR! TRANSFORMER! RATING WIT" ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING IND HEATERS ETC HP KW MVA ELECTRICAL WIRING SIZE A TYPE OVER TO I HEREBY CERTIFYTHAT I AM PROPERLY REGISTERED AND/OR 0 — 1 100 LICENSED AS REQUIRED By LED ANGELES COUNTY AND STATE END OF CALIFORNIA OR THAT I THE LEGAL OWNER OF AND INTEND TO 1 — 10 900 REal0! IN TXf A E pESCPIBED flIOyNTIAL PROPERTY 0 10 — 50 500 1 OF PERU eveOC 50 — 100 10 DO DIS T R I C T NO CLASS ZON! FRO a Y O 100 - 500 1500 p R I G SIGN GAS SIGN AND ONE CIRCUIT 500 NOTES N Z TUBE OR _ MARQUEE ADDITIONAL CIRCUITS 100 SERVI CENOT OVER 600 VOLTS OR 200 AMP 001 1 SERVI CE OVER 600 VOLTS OR 20O AMP 1000 APPROVALS DATE INpccTarl SIGNATURE TEMP POWER POLE TEMPSERVICE,POLE &APPURTENANCES 5 D UNDERSLAS WORK TEMP LIGHT OR RECEPT SYSTEM 300 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO NOTIFIED PLAN CHECK FEE FINAL ` PERMIT ISSUING FEE awl I JOSEPH C ROOHAN TOTAL FEE00 SUPERVISING ELECT Al_ ENGINEER PLAN CHECK VALIDATION CK fm 0 CASH PERMIT VALIDATIO CK 0 CASH .O0-SLAO z 8 7 6N JAN 7 2 D 4.00- SEE EE BACK OF APPLICATION FOR COMPLETE SCHEDULE ITBABea-aBoa_e.eT APPLICATION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGMESS BUILDING BUU.DMQ AND SAFETY DrvmioN ADDRESS JOHN A LAMBIE.Cou NTY ENGINEER 1 CASSATT D GRIFFIN BUTT OP BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST sr PERM FEES OWNER // S LIGHTp R[CR/ ADLRII SWITCH[E NUMBER T MAIL C TOTAL OUTLETS 10 f ADDREHS J ELEC [ANG[. RAT[[ HEATERS, CITY NO aorx[s DRYERS Eo ELECTRICIAN ELCC SPACE MEAT[" STAT Y C00[ IIID UNIT[ GARBAGE DISPOSERS. ADDRESS ? S AUTO RASHERS DISHWASHER 2E ¢ C-- LIGHTING FIXTURES 10 0+0 CITY ) N TEL,N MOTORS LICENSE NO Ly0 > W — 0 ATE HORSEPOWER R RP.HY POR IKIPECTION XP OVER INC DI %aLEBq 2E z Bo INSPECTION SECOND Y S 100 E 1E 1 80 iD DO 250 EO — 200 boo MIBG , 7 cn F4,07 A-Df SIGNS NO TRANS NO LAMPS / B SERVICE O.EOOV Too SERVICE OVER EOOV 500 WIRING PERMIT 100 FIXTURE PERMIT too 6p LELIECTRI'CAL MENTARY PERMIT EO APPEOVALS TOTAL FEE f REBY ACKNOWLEDGE THAT I HAVE READ THIS A PLIj0FFlXYURFS DATE INSPECTORS SIGNATURE ANDATE THAT THE ABOVE IS CORRECT AND AGREE TO ONDUIT LL COUNTY ORDINANCES AND STATE LAWS REGU ICAL WIRING IRING REBT CERTIFY THAT I AM PROPERLT REGISTERED D A3 REQUIRED B ANGELES CO TT AND STNIA OR THAT AY T L ER OF THEED RESIDENTS P P WER RE TILITYCO NOTIFIED E 1 NA 5- f JOHN A LAMBIE. A. ARTHUR C VEIT COUNTY N6INBGR SUPERVISING EL ZMCAL ENGINOM ' &4740/s DEC 2 2 300 R m. 165663-CE31610/72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER .loe / /� �„� 7w BUILDING AND SAFETY DIVISION ADORES$ v LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS FEE OWNER OR IIIFIRM NAME C RECEPT ATP S s MAIL LIGHT� TOTAL FIRST 20 25 �� ADDRESS e W CITY G.L, / EL NO SWITCH_ OVER 20 10 PLAN CHECK LIGHTING l TOTAL FIRST 20 ZR APPLICANT )} OVER 20 IO ADDRESS FIXTURES RESIDENTIAL APPLIANCES CITY TEL NO RANGE_ORYER_WTR HTR_ 6 APPLIICANT 0 1-24 A/ � /C c- Fdc... STA COOK DISP_F A U ERT O ADDRESS /J� 'J fr_ CC SPACE HTR AIR CONE) CITY e'+-N_t 2t TEL NO Z*#YN 26 aorHEs WASH E)ISHwASH_ REG NNUMBER X L 7 9v 6L_ cuss C—/V FAN_OTHER 100 I Hf REDY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORSTRANSFORMERS RATING WITH ALL CWNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS ETC HP KW KVA ELECTRICAL WIRING 31ZE S TYPE OVER TO HEREBY CERTIFY THAT AM PI1 CBCT R OII TI RCD AxOroR 0 - 1 I W LICENSED AS REQUIRED BY LOS AN ff C T AND STATE Of CALIFORNIA OR T AM THE AL O OF THE ABOVE d 1 - 10300 OE5CRIPEO R EMTIAL PROPE PERMITEE 10 - 50 500 SIGNATU O H SO - 100 1000 DISTRICT NO PRO ESSEO BY too - Soo 1500 A = SIGN GAS SIGN AND ONE CI RCIIIT 600 APPROVALS DATE uulrfcT s616NATURE TUBE OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE SERVICENOTOVER 600 VOLTS OR 200AMP ml I UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT TEMPSERVICE POLE h APPURTENANCES 500 WIRING TEMP LIGHT OR RECEPT SYSTEM 3DD FIXTURES POWER AUTHORIZED UTILITY CO NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES PLAN CHECK FEE PERMIT ISSUING FEE 300 TOTAL FEE S PLAN CHECK VALIDATION CK M 0 C HM PERMIT VALIDATION cx M G CASH `tel= 'NOV 9 2 D 4_.7_ 5_ DEE BACK Or APPLICATION FOR COMPLETE SCHEDULE TeweesC- CESe{i 12,78 APPLICATION FOR ELECTRICAL PERMIT BUILDINGAN AFETY DIVISION FOR APPLICANT TO PILL IN New Residential Bldgs & Pools EACH NO FEE ADDRESS Il 1 &2 Finaily Sq Ft $ — S LOCALITY Multifamily Sq Ft — NEAREST Residential Swimming Pools CROSSST OR FIRM NAME C Outlets Light,Switch&Receptacle MAIL ,g-w�G• Fiat 20 ADDRESS Q Additional CITY Tel No /3 PLAN CHECt Lighting Fixtures APPLICANT First 20LIA ADDRESS AdditionalCITY Tel No Fixed Appliances Not Over 1 HP PERMITAPPLICANT Range Heater_ DW V Oven Dryer W M ADDRESS Top FAU W HCITV Tel NO Hood Fan LICENSE O Dnp AC REG NUMBER Clea p I HEREBY ACKNOWLEDGE LEDGE THAT I •wo rnl.• IcwTlox o STAT" THAT THE • coRw It A TOCOMPLYPower Apparatus& Large Appliances L UT C ORDINANCES AND .TAT. LAW. ....LATIN. o3 Size&Type HP KW,KVA,or KVAR ELECTRICAL`Y'"'"G D w UP to 1 Incl LIC 6R C .TFY T D..RLr REm. E D ANOio. cl z Over 1 to 10 Ini«. D A ".OVIR.e . rGELE• COUNTY AND STATE OF CALIro"m.� Y LOS A OR T HAT I LEGAL OWNER or THE A.OVff Over 10 to 50 Incl Oe.cRum RESIDENTIAL r Over 50 to 100 Incl PERMITEE / Q Over 100 SIGNATURE $urvlCea DI TRICT NO ROCE D Y Ss Q® 0 200 Amp Under 600 V 201 1000 Amp Under 600V APPROVALS DATE N TOR S Over 1000 Amp or Over 600 V SIGNATURE TEMP POWER POLE Temp Power Pole&Appurtenances UNDE RSLAS WORK Sign with One Branch Circuit BOUGH CONDUIT Additional Sign Branch Circuits (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE )Sub-Total) UTILITYCO NOTIFIED _72 PLAN CHECKING FEE (One Fourth Permit Fee) FINAL �/ PERMIT ISSUING FEE NOTES TOTAL FEE , PLAN CHECK VALIDATION CK MO CASH '➢ - `PERMIT VOLIVATIUN b M O CASH ,C i+- Co � X ¢2— -.28 -7 7 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELESopgg BUILDING AND SAFETY Al FOR APPLICANT TO FILL IN ADDRESS / New Residential Bldgs &Pools EACH NO FEE / 1 &2 Family Sci Ft E 025 — E LOCALITY Mull, family Scl Ft 02 — NEAREST ST Residential Swimming Pooh 2500 OWNER FIRM NAME Outlets Rec1L—Light_Sw _ ADDRESS Total First 20 50 Total No Additional 30 CIT 0%12Tel No PLAN CHECK APPLICANT Lighting Futures First 20 50 ADDRESS Additional 30 Total No CITY Tel No Fixed Appliances Not Over 1 HP RMIT Rang Heater_D W L A kid, Over ADDRESS APPLICANT LA Dryer_W M— l /lt Top _FAU —W H CITU ZA Aa Tel No Hood_Fan —Other— LICENSE OR �`o Disp _Room Air Cond 2 50 REG NUMBER 3 .7 Z a Class I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO Size&Type HP KW KVA or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS 2 50 REGULATING ELECTRICAL WIRING Up to 1 Incl I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl 12 50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 25 00 DESCRIBED RESIDENTIAL PERT Over 50 to 1 DO Inc Y O 40 DO PERMIT Oyer 100 EE SIGNATURE Services DISTRICT NO BY 0 200 Amp Under 600V 1250 201 1000 Amp Under 600 V 2500 _ Over 1000 Amp or Over 600 V 5000 Z Temp Power Pole&Appurtenances 1000 t Sign with One Branch Circuit 1000 7 Additional Sign Branch Circuits 200 INSPECTION <> Misc Conduits&Conductors 1000 INFORMATION 1'siys Other See Complete Fee SchedulN_ ON REVERSE 3 *3023A SIDE 2 ° ° 1080 PERMIT FEE ISub Totoll . . • 1 Q 6 PLAN CHECKING FEE (One Fourth Permit FeN �7 PERMIT ISSUING FEE $7 00 0302-79 TOTAL FEE S <> INSPECTION FINALED dote G//O —/� 79 By ms GG�� APPLWANr FULIN ;I: A I LY OtFrIJNED POWMN ONLY DESCREMON OF WORK . on �0®■0DUE 7:.•..- - �'r -■■AEM■■■■■ ' y . MWWIIMEMMMM -■MM■M■MEM■ MWWI■■■MM■MEMO MEMS■MME■■■MM■. 1 Y 1 MWIM■MMEM■MEM■ MMOS■EM■MMMWEIMMEMEM ■■■■,■ MMWIM■■■MMM■MIM 7 �■I■■■■■MEM �MMM■MMME■ E i_- SEE�■MMM■MMM■■Mt//m SEE�■MMM■MMMMM■ MMWI■IMMMMMMMM■M AMM■■MMM■■O'M MMWIIMMMMMI SEM■■MMM■MEM !■0 • �■Wd" �� , WORKERS'COMPENSATIONDECLARATION 76A663 11 BO)AOB CEAPPLICATION FOR ELECTRICAL PERMIT L1Ihereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insula or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Seo 3800,Lab C) FOR APPLICANT TO FILL IN JOB Policy No Company ADDRESS I New Residential Bldgs &Pools EACH NO FEE , F1Certifiedcopy i hereby furnished 1 & 2-Famdy,Sq Ft S — $ LOCALITY 0 CertiNEAREST fied co Muly-family Sq Ft CROSS ST py u filed with the county building i9spection Residential Swimming Pools de merit-�-r OWNER M Qb C ( J �`� FIRM NAME Date i try Applicant " �-r� Outlets Rec Light Sw MAIL �� / dist 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No �Ai— Additional CITU i el No 3 COMPENSATION INSURANCE Y PLAN CHECK 1 APPLICANT (Thu section need not be completed if the work involved Lighting Fixtures First U by the permit Is for one hundred dollen ($100) car no Total No Addi less) Additional ADDRESS cc A p 1 certify that in the performance of the work for which this Fixed Appliances Not Oder 1 HP CITY Tel No U permit B issued, I shall not employ any person in any manner PERMIT W so as to become subject to the Woor__k'.erIs' Compensation Laws Range_Heater_D WAPPLICANT a ZS �Ga�1/ Oven — Dryer_W M _ ADDRESS N 2 Date Applicant Top _ FAU _W H CITY Tel No Hood _ Fen _Other 7 — NOTICE TO APPLICANT If after making this Certificate of Disp _ Room Air Cond_ LICENSE OR Exemption you should become subject to the Workers' REG NUMBER Clam Compensation provisions of the Labor Code,you must forth Power Apparatus& Large Appliances DISTRICT NO PROCESSED By with comply with such provisions or this permit shall be Size&T deemed revoked yea HP,KW, KVA or KVA Q Up Incl FINAL Overr 1 1 to 10 Incl DATE LICENSED CONTRACTORS DECLARATION VALIDATION Over 10 to 50 Incl I hereby affirm that 1 am licensed underrovisions of Chapter Over 50 to 1D Inc FINAL 9 (commencing with Section 7000) of Division 3 of the Bust OVer 100 BY nos and Professions Code, and my license is in full force and / effect Services License Number Lie Class D 200 Amp Under 600 V 201 1 ODD Amp Under 6DO V Contractor Date Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pale&Appurtenances 1 hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the followurg reason (Section 7031 S, Busi Additional Sign Branch Circuits - a 4 4 res 8 A ness and Professions Code) r�-,/ Mix Conduits&Conductors # • • • • • 2 Fi I as owner of the property, will do the work and the Other(See Complete Fee i Schedule)— 2 r• • 1 650 structure not intended or offered for sale (Section 7044 Business and Professions Code) ` CONSTRUCTION LLNDING AGENCY • • • 1,�6 S 0� 1 hereby affirm that there is a construction lending agency 69 2 r - 8 4 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued(Sec 3097 Civ C) Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE above information is correct 1 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 entioned property for IpHifction purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ccuec/ 6Z zk A Si lure of Permittee Date , k WORKER I have of consent to 76A6W PW 91e3 APPLICATION FOR ELECTRICAL PERMIT t I hereby affirm that I hove a certificate of consent to self Insure 7�ee3 or a cginlhcete of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 38^000 Lab C) Policy NOW013.�'YJ/1" ` "" FOR APPLICANT T01931 M ZR .0 ❑v r Cerldled copy Is hereby rumlahed New Reeldentlel Bldgs &Path EACH NO FEE E] 1 8 2 family Sq Ft f — S LOCALITY )�✓ Z e 6 departmentth fled with the county Ou"inspection ' Mufti family Sq Ft NEAREST CFKM ST p—� Date �I— 2 , Residential Swimming Pooh ASSESSDR MAP BOOK _("30 P Z2 arnC� CERTIFICATE OF EXEMPTION FR 1 WORI(ER Outlets Rec —&—Ught L�—Sw � q� � G' _ COMPENSATION INSURANCE (This section need not be completed it the work Involved by the permit In for one hundred dollars(3100)or Mae) Tool No Additional Oo E8a L� Te I cenity that In the performance of the work for which this perms CITY �,' No924 Oki 3 is issued I shell not employ any person In any manner so as l0PLAN HECK r become subject to the Workers Compensation Lowe Lighting Fxtu Fust 20 Q APPLtCANr ` — Total No Additional ADDRESS o 0 Date Applicant � L / NOTICE TAPPLICANT If alter making this Certificate 15 OR 20A 120V BRANCH CIRCUITS Compensation of CITY �i..,.— Wo— Tet Exemption you should become auD)ect to the WorkersCompensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Coda you must forthwith comply with such 11 TO w INCLUSIVE EACH MIRI APPL� r provisions or this permit shell be deemed revoked U OR MORE BRANCH CIRCUITS EACH r1 kAW l.� LICENSED CONTRACTORS DECLARATION 15 OR 20A 208V TO 277V LIGHTING EACH ADDRESS I hereby affirm that I am licensed under provisions of Chapter B (commencing with Section 7000)of Division 3 of the Business and CITY Gj Tw w -47 3 �� Profeealons Code and my license is in full force and effect RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR 6 n cie,ui q Q 1/1-139k 1/�� Power Apparatus 8 Lege Appliances REO NUMBER O LicenseNumber Uo Class `3 Size d Type HP KW KVA or KVAR otSTRtCr n0 BY 0 _ Up to 3 Ind LU U r G,�� 7/ —Q 2 Over 3 in 10 Ind NAL O� d Contractor e [ Over 10 to 50 Incl DATE VALIDATION ? I ion en ec under SOver 50 to 100 Ind B BP C for this reason Over 100 By Dew Service Swbd MCC IL Panalboarde 0 200 Amp Under B00 V Signature 201 1000 Amp Under 800 V ❑ Exemption for Rep MAIM Elect Over 1000 Amp or Over 800 V SINGLE FAMILY Temp Power Pole 8 Appurtenance r HOME OWNER BUILDER DECLARATION Sign with One Branch CIrwh ACCT.i I hereby affirm that I em exempt from the Contractor a License Lew for the following reason (Section 7031 5 Business and Profeeelona Additional Sign Branch Cbcuds _ 117 68.43 Code) ❑ I as owner of the property will do the work aM the structure Mho Conduits a Conductors I ITEMT Is net intended or offered for eels (Section 7044 Business Wer(See Complete Fee Schedule)_ ► 11ITHL 68 a IFI and Professions Code) _ CHECK `7�.rr: CONSTRUCTION LENDING AGENCY r1�� I hereby affirm that there Is a construction lending agency for the IPAAWGE 1L�1_ performance of the work for which this permit Is issued(Sac 3087 PERMIT FEE __ _ (Sub-TOW4 Civ C) PLAN CHECKING FEE Lender a Nemo a 4 _ I A PERMIT ISSUING FEE +Sc'J r `1:139 Lander a Address I certify that f have reed this application and state that the above TOTAL FEE Information is correct I agree to comply with All County ortlinancea and State laws regulating Electrical wiring, and hereby authorize _ representatives of this County to enter upon the above mentioned property for inspection purposes BEE REVERSE FOR EXPLANATORY LANGUAGE 1L APPltcunr OR ADEIR DATE