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►BA CEB08_B-B7 APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERa' NEA
LDING -
BUILDING AND SAFETY DIVISIONRESSJOHN A.LAMBIE,COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF BUILDINGALITY
FOR APPLICANT TO FILL IN
NEAREST
PEBMT FEES
Mzz
LIGHTS RECEPTACLES SWITCHES OWNER
NUMBER ITEM EACH FEE MAIL
ADDRESS
TOTAL OUTLETS $ .10 $
i ELEC. RANGES, WATER HEATERS, 'CITY Ad&jVZ TEL.NO.
CLOTHES DRYERS .SO ELECTRICIAN
ELEC.SPACE HEATERS,STAT•Y. COOK- -
ING UNITS, GARBAGE DISPOSERS, ADDRESS
UTO WASHERS, DISHWASHER .25' Cf
kCITY EL NO.
LIGHTING FIXTURES .10
MOTORS STATE
LICENSE NO.
HORSEPOWER
H.Pj OVER INC. DISTRICT NO.' GRO P O READY FOR INSPECTION
V.&LESS .25
— 2 .50 INSPECTION RECORD
a s 1.00
s 1s 1.Sd
IS s0 2.50
50 200 S.00
MiSC.
SIGN90 I NO.TRANS
NO.LAMPS
SERVICE O-600V 1.00
SERVICE OVER 600V 5.00
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50 APPROVALS'
TOTAL FEE g
I HEREBY ACXNDWLED6E THAT I HAVE READ THISPLIC TION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING I r '`/ tL� •'t,.;%"/j 9•,
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY OS ANGELES COUNTY D OF
CALIFORNIA OR THAT 1 T LEGAL HER VE POWER 1 ,
DESCRIBED RESIDENTIAL P P
SIGNATURE UTILITY CO.NOTIFIED iy -e.��
OF PERMMry
FINAL . ✓ 'f
JOHN A.LAMB1E. VALIDATION ARTHUR C.VETT,
:OUNTY ENGINEER CK MO CASH SUPERVISING ELECTRICAL ENGINEER
i 4 1 0 3 NOV 7 2 1 0.10 .9
CE-806G (2-SO)6'RKERS'COMPENSATIONDECLARATION C
W' ' APPLICATION FOR ELECTRICAL PERMIT
CE-806
I hereby affirm that I have a certificateof consent to self y COUNTY OF'LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.) n
Policy No. Compan r A ND FOR APPLICANT TO N 306
New Residential Bldgs.&Pools ! ADDRESS ®IA
f
EACH NO. FEE
Certified copyis.hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. NEAREST
Certified copy is filed with the county building inspection CROSS ST
dep rtme t. Residential Swimming Pools OWNER OR
�;.. �,IR �R&_1 FIRM NAME
Date AL N
� � pplicant r w Outlets:-Rec.—Light Sw. MAIL Q �I L EL O��
First 20 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No.
COMPENSATION INSURANCE PLAN CHECK CL}
(This section need not be completed if the work involved APPLICANT 0
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS U
Total No. Additional
I certify that in the performance of the work for which this Fixed Appliances Not Over 1'HP CITY Tel No. 0
permit is issued, I shall•not employ any person in any manner PERMIT
so as to become subject to the Workers'Compensation Laws. Range_Heater D.W._ APPLICANT D W
Oven _ Dryer_W.M._ ADDRESSfa/I
Date Applicant
Top _ FAU _W.H.,_ Z
Hood _ Fan _Other_ CITY MON Im IA el No. a �,
NOTICE TO APPLICANT: If, after making this Certificate of D'sp. _Room Air Condom LICENSE OR qg��
Exemption, REG.NUMBER 'LZ&Iass _��
p you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- Power Apparatus&.Large Appliances DISTRICT NO. PROLE ED BY
witli .comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW,KVA,or KVAR
Up to 1 Incl.
FINAL
Over 1 to 10 Incl. DATE .7y.el�
LICENSED CONTRACTORS DECLARATIONVALI DATION
I Over 10 to 50 Incl. (
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
oe
9 (commencing with'Section 7000)of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force and
effect. Services
0 0-200 Amp.Under 600 V
License Number Lic.Class-
AX U O
p 201-1000 Amp.Under 600 V ,
Contractor A0E.fiRaDate o 1 Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARA•ION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch.Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors
I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— woe 0 2 2 8.'A
structure is not•intended or offered for sale (Section
7044,Business and Professions Code). I
CONSTRUCTION LENDING AGENCYf o 0 0 0'0 2
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is 'PERMIT FEE (Sub-Total) 2 -,- 2.4,50
issued(Sec.3097,Civ.C.).
Lender's Name PLN CHECKING FEE (One-Fourth Permit Fee) 0
A 0 0 2 11 5 0
Lender's Address PERMIT ISSUING FEE -707-81
•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 State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-menti e r yor inspection pur as SEE REVERSE FOR EXPLANATORY LANGUAGE
Si ature of Perm' tee Da e