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HomeMy Public PortalAbout9861 VAL ST_Electrical__ DE 5-A I 28L APPLICATION FOR PERMIT DEPARRTMENT OF BUILDING AND ,SAFETY COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP I zONF //PPEr:MIT NO. WIRING I FIXTURES SERVICE V y RCCEIVCD BY READY FOR DATE ISSUED RANGE HEATER -I POWER FIRST INSPECTION SIGNS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAME JOB r,. ADDRESS U ADDRESS C LOCALITY WF NEAREST CITY '� TEL.NO. ^"�' CROS, ST. yJj COUNTY _ CERT. NO. EXPIRES �D �` ¢ NAMEMAIL --�'�� DESCRIPTION OF WOR 3 ADDRESS NUMBER OF OUTLETS ON CIRCUITS 0 LOCATION BY ROOMS I CITY �' TEL.NO. LIGHT OUTLETS SW. PLUGS FIX, I AM THE LEGAL POSS SSOR OF THE ABOVE LOS A B C D E F G H ANGELES COUNTY CERTI I.AT• OF QUALIFICATION. CIRCUIT L /F�°'� '41 - ------ ` T� ELECTRICIAN. LIVING ROOM wL. T 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED DINING ROOMrY_ ABOVE. BRFST.RM. T _�-_-- OWNER. BATH _ _ _ _ CORRECTIONS ENT.HALL HALL NO. -_-- -_`�_ ---- FRONTPORCH OUTSIDE + KITCHEN ____� __� SERV.PCH. / Q BDRM.NO. CLOSET j BDRM.NO.1 CLOSET OL TOTAL I'I ��. NO. OF OUTLETS APPROVALS _. NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING y. NO. OF RANGES OR xi=ATERS $ FIXTURES M iSCELLANEOUS $ POWER PERMIT FEE $ 1 UTILITY CO.NOTIFIED f TOTAL FEE $ 7 FINAL `! DEPARTMENT OF BUILDING AND SAFETY Alrri.xaavrn rvac rria:►nar COUNTY OF LOS ANGELES T ` M. J. FOX CHIEF ENGINEER ELT �ECTRI -. + FRO UP DISTRICT N0. —R�j�'U�P ZONE. PERMITNO. U ADDRESS /1 ` I� F 'RECEIVED BY READY FOR DATB ISSUED CITY n TEL.NO. FIRST INSPECTION CCEERT.NO. .EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLYJoill _ DESCRIPTION OF WORK ADDRESS 2 7 7 � '7,4 11�J NUMBER OF OUTLETS ON CIRCUITS LOCALITY �Ye��P/liJili. ' L LOCATION BY ROOMS NEAREST LIGHT OUTLETS' SW. PLUGS ROT CROW ST CIRCUIT A B C D E . F G JH N NAME .Pir�� S, z MAIL S .= ADDRESS 9� O CITY `J1 /� TEL.NO. @- 1 AM THE LEGAL/;POSSESSOR OF THE A13OVE LOS ANGJ.EB COUNTY C P1CA76� gU�ICATION.. i ELECTRICIAN. I AM THE LWAL OWN OF TFJE PROP/FJM DESCRIBED ABOVE OWNER. CORRECTIONS — Q .Z . L7 OTA NO. OF.OUTLETS $ S APPROVALS I NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. WIRING- 0 IRING_ NO. OF RANGES OR HEATERS E FIXTURES M ISCELLANEOUS ig POWER PERMIT FEE Ili UTILITY CO.NOTIFIED , TOTAL FEE FINALL 76A66i-CH80O.4. 68 APPLICATION FOR ELECTRICAL RMIT/- *COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �� BUILDING AND SAFETY DIVISION ADDRESS / h+ JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NO. AC FEE RE.CEPI. $ $ OWNER C MAIL 1 /Z 7 � LIGHT TOTAL FIRST 20 .20 ADDRESS /� p7/ SWITC OVER 20 .10 CITY/i /'Lc Cf% TEL. NO. PLAN CHECK LIGHTING �TCITAL FIRST 20 .20 APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE—DRYER—WTR.HTR.— CITY TEL. NO.den) 9 STA.COOK_DISP.—F.A.U._ CONTRACTORt /7Af7,f X117 `� SPACE HTR. AIR COND. ADDRESS ' 7^ 9 dli 10;41<16 ' Iit CLOTHES WASH._DISHWASH.— CITY 4eC 09 TEL. N0.7"�f//6&6 FAN—OTHER 1.00 LICENSE 1-40. >V–�9,3CLASS. C-16 MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 – 1 1.00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 — 10 3.00 - LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEG OWNER OF, AND INTEND TO 10 — 50 5.00 RESIDE IN, THE ASO DE DESCRI D R E S �IDE yNTIAL PROPERTY. O 50 – 100 10.00 SIGNATURE CJL C^�'`•"'•/� � U OF PERMITTEE too - 500 15.00 D1STR1 Tpp.1 GRO1 P I Z PR •Cp B TUBE, A SIGN AND ONE CIRCUIT 3.00 MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE QST TEMP. POWER POLE ��L• UNDERSLAB WORK I ROUGH CONDUIT PERMIT FEE (SUB TOTAL) QQ WIRING .�I � FIXTURES PLAN CHECK FEE (.50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.00 UTILITYCO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELEC CAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH ° L tip, w4 681.23 SEE?18 03.20- %-It EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE / i 76AG63-CE606.9-64 APPLICATION FOR ELECTRIC PERMIT ti :COUNTY OF LOS ANGELES BUILDINp DEPARTMENT BUILD NG AND SAFETY DIV DIVISION ADDRNo BU'LDESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY p. (.Lzy NEAREST FOR APPLICANT TO FILL IN CROSS ST. a� �W RECEPT. TOTAL NO. EACH FEE �r- OUTLETS FIRST 20 $.20 $ OWNER�Jr. Qii ,�O71n�I� LIGHT 60 MAIL •9 S AOD'L ADDRESS SWITCH. Y �J OVER 20 •IO ��rr /�/ •-� LIGHTING TOTAL I FIRST 20 .20 CITY Y+^ ti `t TEL.NO.Icrb—Ifs/ FIXTURES _ ADD'L .IC ELECTRICIAN Bf✓ OVER 20 RANGES CLO.DRYERS WTR.HTRG. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL.NO. DISHWASH. AUTO.-WASH. STATE PACE NTRS. BTA.APP.(yA H.P.MAX:) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DIST) CTO GR U ONE PR R O 1 11.001 1 s 1.50 / INSPECTION RECORD A S 6 2.00 4 Fh C o s is 2.50 V 1s so 3,00 p. s0 100 5.00 SIGNS: NO.TRANS• W NO.LAMPS d _ N Z SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0-600V-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 1 UPP MENTARY PERMIT ISSUING FEE 1.00 ® TAL FEE• 3© 66- 1 HEREBY ACKNOWLEDGE TH T 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Q' / ELECTRICAL WIRING. WIRING AMC'1 HEREBY.CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES (]�.i`H �^+i/•.I�i•/ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO t F RESIDE IN, THE ABOVE BED REST ENT L PROPERTY _ POWERe OF SIGNATURE. UTILITY CO.NOTIFIEDPERMI v oo��Vl� a1 �y ss FINAL eL• �Q. �` r •, F � �FT VALIDATI JOSEPH Cv ROOHAN7 CK MO CASH SUPERVISING ELECTRICAL ENGINEER --LQ 1 9 7 9G MAY 2 cJ 2 D 3.10cm w FOA663-CHOOB-0-57 APPLICATION FOR ELECTRIC PER-MITi 1 COUNTY OF LOS ANGELES DEPARTNIENT OF COUNTY ENGINEER BUILDING q $� BUILDING AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE,COUNTY ENGINEER CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. PEMT FEE$ OWNER e ' LIGHTS RECEPTACLES SWITCHES MAIL l� ' 1 NUMBER ITEM EACH FEE ADDRESS D �/ TOTAL OUTLETS $ .10 $ `{ y ELEC. RANGES, WATER HEATERS, CITY 1e _ TEL.NO. -aLS6 CLOTHES DRYERS 'S0 ELECT IAN ELEC. SPACE HEATERS,STAT-Y. COOK- I_ ��//A ING UNITS, GARBAGE DISPOSERS,. ADDRESS YJ VGL. AUTO WASHERS, DISHWASHER .2s' LIGHTING FIXTURES .10 CITY G. ` \ TEL NO. MOTORS STATE LICENSE NO. HORSEPOWER H.Po OVER INC. D$TRIC N GR 'ON READY FOR 1N$PFCTION . +�8 teas .25 + — 2 .s0 s i.00 INSPECTION RECORD S s IS LOU is s0 2.50 sa 200 s.00 MISC. SIGNSI NO.TRANG NO.LAMPS SERVICE O-GOOV 1.00 SERVICE OVER GOOV 0.00 WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT s0 APPROVALS TOTAL FEE $ DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE .ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 'SO I HEREBY CERTIFY THAT I AM'PROPERLY REGISTERED AND/OR FIXTURES IAf ✓,Il ; LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF E. CALIFORNIA_OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESID IAL PROP SIGNATURE a UTILITY CO.NOTIFIED �� OF PERMITTE 'MA FINAL MJ F;.A IOHN A.LAMBIE. VA A ARTHUR C.VEIT. 'OUNTY ENGINEER SUPERVISING ELECTRICAL ENGINEER CK M CASH ®F 78A888-L'1 . g-6". APPLICATION FOR ELECTRIC L PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDINGOCALITY BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING L NEAREST / FOR APPLICANT TO FILL IN CROSS ST. f Q a T �Q7 Gv i�^+ ✓ , RECEPT. OTAL i NO. EACH FEE LIGHT OUTLETS FIRST 20 Z $20 $ MWL ER C Q `oe tie ADO'L 10 ADDRESS 1 SWITCH. OVER 20 LIGHTING TOTAL FIRST 20 .20 CITY GL-w TEL.NO. (' 2r 1 FIXTURES 1 _ OVR 20 ADO'L 10 ELECTRICIAN RANGES CLO.DRYERS WT.R.HTRS. 1.00 ADDRESS yNl CARD.D18P. STA.COOK CITY p TEL.NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(Va X.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DIST�ICI N OU ZONE PR D O f14 1 1.00 / / Lc) 1 8 1.50 INSPECTION RECORD s s 2.00 �c�4i �� _ � O s 1s 2.50 ° —1 ;i/ U is so 5.00 I�, pA � V "` Ad s0 100 5.00 r SIGNS: NO.TRANS• q A NO.LAMPS ✓ r �Z SERVICE O-GOOV-NoT OVER 200A 1.00 SERVICE O-SOOV-OVER 200 A. 2.00 SERVICE OVER GOOV 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTO 188116 E AND STATE THAT THE ABOVE 18.CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ ELECTRICAL WIRING. WIRING 1 HEREBY.CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA E TWIAHELEGAL OWNER OND TO RESIDE IN;THE TBED RESIDENTIAL PR POWER SIGNATUREol UTILITY CO.NOTIFIED ! OF PERMITTE FINAL ALIDATI JOSEPH C. ROOHAN " CK MO ASM SUPERVISING ELECTRICAL ENGINEER LAC017 3 5Q MAY18 2 D 3.8 0010 s 1 1 A _ - _; 7BA663-CESOB 9-64 APPLICATION FOR E.L TRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING /J J BUILDING AND SAFETY DIVISION ADDRESS - (/ JOHN A. LAMBIE. COUNTY ENGINEER . COLEMAN W. JEINKINS, SUPT. OF BUILDING LOCALITY.. qe4 C4= NEAREST FOR APPLICANT TO FILL IN CROSS ST. RECEPT, , TOTAL NO. EACH FEE OUTLETS FIRST 20. S.20 $ R $ OWNE LIGHT G ' MAIL ADD'L ADDRESS .10 SWITCH. � OVER 20 / LIGHTING TOTAL 1 FIRST 20 .20 CITY TEL.NO. FIXTURES } '.l A.DO'L .1O ELECTRI IAN OV R 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY le, TEL.NO. .DISHWASH. AUTO.-WASH. STATE SPACE HTRS. BTA.APP.(yy H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTR O. GRQL�p NE P ESSED Y O 1 1.00 ! U 1 s 1.50 INSPECTION RECORD a S 2.00. 0 S 1 S 2.50 1s • so 3.00 O so 100 5.00 U W SIGNS: NO.TRANS. h NO.LAMPS Z SERVICE 0.500V-NOT OVER 200A 1.00 SERVICE O-SOOV-OVER 200 A. 2.00 SERVICE OVER SOOV 5.00 MISC. PERMIT ISSUING FEE 12.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 - TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL•COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY.CERTIFY THAT I PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REp UIRED BY LOSS ANGELES_ COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN,'THE ABO E D,ESCRfAI B,E,D RESIDENTIAL.P OPERTY. POWER d OF PERM17'IEE / ' 'vJ SIONATUIUTILITY CO.NOTIFIED g� FINAL �U �k] 4`(1• 'i VP (DATION JOSEPH CY ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER Lnuo 0 �. s o ���3 0 2 D 4.6 0- V :- �, ,::.1 APPLICATION FOR ELECTRICAL. PE:RMIT __ __ COUNTY OF LOS ANGELES BUILDING-AND SAFETY " FOR APPLICANT TO FILL IN JOB New Residential Bldgs.&Pools EACH NO, FEE ADDRESS �.. 1:&2-Family,Sq.Ft. $ .025 — $ LOCALITY, „/"��L � L/ ). Multi-family Sq.Of. •02 — NEAREST l'y Residential Swimmin Fools 25.00 -CROSS'ST. g OWNER OR q �, FIRM NAME�7/V Outlets;,Rec Light J_Sw. ' r _ MAIL. 5.� _ ` _ First 20 -50 ADDRESS Total No. •• • Additional 30 CITY j �f � _fJ•/Tel.No. y PLAN CHECK APPLICANT Lighting Fixtures First 20 •50 ADDRESS Atfditional' .30. CITY Totol No. CITY -Tel.No Fixed Appliances Not Over 1 HR PERMIT l - APPLICANT Range.Heater—D.W. Oven`—Dryer—W.M. ADDRESS Top _FAUW.H._ CITY _ Tel,No,. Hood_Fan �Other_ f'] LICENSE OR.. Pis Room Air Cond: 2.50 v REG.NUMBER i Clgss: I HEREBY ACKNOWLEDGE THAT!HAVE READ THIS APPLICA• Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH-ALLCOUNTY-ORDINANCES-AND'STATE LAWS Size&Type HP,KW,KVA,or KVAR REGULATING ELECTRICAL WIRING: Up to 1 Incl. 2'50I•HEREBY.CERTIFY'THAT I1AM PROPERLY REGISTERED AND/OR (Oy Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 119 Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL,OWNER OF THE ABOVE O Over 50 to 100 Irlc. 25.00 DESCRIBED RESIDENTIAL PRQPERTY. . Over,100 40.00 P,ERMIIEE L f, /1�� � , 9r,.9_� I SIGNATURE Gam(. y Services - DISTRICT-NO.. PROC ED'BY Z 0-200 Amp.Under 600'V 12.50 �— 201-Y000 Amp. Under 600 V 25.00-• - - •, - - Over 1000 Amp.or Over 600 V 50.00 Z Temp.Power.Pole&.Appurtenances 10.00 Q Sign with One Branch Circuit 10.00 Additional Sign Branch Circuits 2.00 INSPECTION ._ > ' t� C' 11 Misc.Conduits&.Conductors INFORMATION u :; o o a o 0 1.0.00 ON REVERSE z Other(See Complete Fee.Schedule) ti o SIDE Z [ 4 C. 4C, PERMIT FEE ISub=Tofall r r PLAN CHECKING FEE 10ne-Fourth Permit Feei Y O PERMIT ISSUING FEE $7.00 TOTAL FEE d Sd INSPECTION FINALE IL date: '/���// By ��•��5��, - � fes' ®s 17 76M" 781 APPL,ICATI FOR ECT_ RICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND: AFETY FOR APPLICANT TO FILL IN JOB New Residential Bldgs.'&Pools EACH NO. FEE ADDRESS JAI /,_ 1 &2-Family,Sq.Ft. $ ' .025 $ LOCALITY 'L af� �LG t/ Multi-tamily'Sq.Ft, .02.• — NEAREST Residential Swimming Pools. 25.00 CROSS ST. OWNER .pp-- FIRM NAME Ou-tlets;Rec �•�•'Light.JZSw. MAIL ��11 � q-, First 20 •50 & ADDRESS f#00/ 4�L(w6 rr- Total.NoazSQ__ Additional 30 CITY—reP4 �/Tel.No.Gf.L/�, S _ ' PLAN CHECK _ . APPLICANT Lighting Fixtures First 20 •50 ADDRESS Additional .30 Total No. CITY Tel,No. Fixed Appliances Not Over 1 HP PERMIT ~���- /- ' •. _=' ' APPLICANT,/?/✓/,.1 ,-` ` %�� Range_Heater_D.W.._ « ', .(lam/ (!�Y S ­ ?.4 ' . _ Oven_- Dryer—' W.M.—. -- ADDRE$S � ^ �«-�-•.--••- -- Top _FAU _W.H._ CITYel.Nb;- Hood_F.ari —Other I y�rfo 50 LICENSE OR' - ' Gloss. Disp.—Room Air Cond. 2. REG.NUMBER . I HEREBY-ACKNOWLEDGE-THAT I,HAVE READ THIS APPLICA• 'Power Apparatus&Large Appliances TION AND STATE THAT THDABOVE IS,CORRECT,AND rAGREE TO .Size&Type.HP,KW,,KVA,,or KVAR COMPLY WITH. ALL COUNTY ORDINANCES AND STATE LAWS. 2..50 REGULATING ELECTRICAL WIRING: ` Up to 1 1k). ' V .00 I HEREBYCERTI Y THAT I-AM-PROPERLY REGISTERED-AND/OR 5 Over 1 to 10 Inc]. LICE%ED AS,REQUIRED-BY -,tOS;ANGELES -COUNTY AND STATE OF pe Over 10 to.50.Ind. •12.50 CAL•IFORNTA OR THAT I*-AM-THE-•LEG7AL-'.OWNER-O,F THE•.ABOVE 25.00 DESCRIBED RESIDENTIAL PROPERTY. Over 50 to 100 Inc. PERMI.TEE Over 100' 40.00 k. SIGNATURE. N .ServicesDISTRICT NO. CESS -BY _ 0-200 Amp.Under 600 V 12.50 201-1000 Amp.Under 600 V 25.00' Over 1000 Amp.or Over 600 V- 50.00 Z Temp.Power Pole&Appurtenances 10.00. - • =a Sign with One Branch Circuit 1.0.00' O Additional Sign Branch Circuits 2.00 ' INSPECTION_ > Misc..Conduits&Conductors 10:00 INFORMATION ON REVERSE z Other(See Complete Fee Schedule) SIDE v -'41 7 2 t It A Z g' #; o Oa -o ") 2 C C 2-L ', PERMIT FEE (Sub:Total): PLAN CHECKING FEE (One-Fourth Permit Feel O PERMIT ISSUING FEE $7:00- J TOTAL FEE > e > - INSPECTION FINALE. . W date: (By es WORKERS'COMPENSATION DECLARATION 20-001MAW9 DPW PP`IC A TION FOELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self .212-80613APPLICATION /� R 80.212-80613 /"9 9� i4ure, Qr ecertificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ori 0.ertified copy thereof(Sec. 3800, Lab. C.) I �� Policy N"O. Company 'tli[li� 1 FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ _ $ LOCALITY iamu� WHO Ndepartment. - Multi-family Sq. Ft. NEAREST ST. Date Applicanteytm!E-1Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE-OF EXEMPTION FROM WORKERS' �' MAIL COMPENSATION INSURANCE Outlets: Re""Light Sw Apw ADDRESS J (This section need not be completed if the work Involved bye First 20 ° CITY Tel. No the permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this ' PLAN CHECKAPPLICANT 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 Additional Total No. CITY Tel. No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT 9 � Exemption, you should become subject to the Workers' Range..._ Heater—D.W. APPLICATION 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 7—:Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION / LICENSE OR Disp. •-i'•- Room Air Cond. — Class. I hereby affirm that t am licensed under provisions of Chapter 9 REG.NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. P SED BY d and Professions Code,and my Ii nse is in full force and effect. � Size&Type HP, KW, KVA, or KVAR d ' License Number Lic. Class_ Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE �� VALIDATION � Contractee �e Dat Over 10 to 50 Incl. FINAL U ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100 K&4 CL co Services, Swbd., MCC&Panelboards Z Date: 0-200 Amp. Under 600 V too Signature i 201 - 1000 Amp. Under 600 V ❑ I Exemption for.Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I I hereby affirm that I am exempt from the Contractor's License Sign with One Branch.Circuit s $ Law for-the following.reason (Section 7031.5, Business.and Additional Sign Branch Circuits Professions Code): _uj's 74.!5,11., ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 's 1 T E N 3 structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ _ .. .7, ' Business and Professions Code). _ , i CONSTRUCTION LENDING AGENCY 'tit iL=.11a I�CCL I hereby affirm that there is a construction lending agency for i r�.�iHA_E a 1 jij 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 p�RMIT ISSUING FEE -4 t, _l f t�JL :li i Lender's Address TIC,TAL FEE �)L. I certify that I have read this application and state that the , above information is correct. I agree to comply with all County 16 ordinances.and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned roperty for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE ®s ignature o ermitteey Date' i