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Home My Public Portal About9035 HERMOSA DR_Electrical__ "wB °°"°"' APPLICATION OR ELKIRICAL PERMIT `G COUNTY OF LOS ANGELES 7�f DEPARTMENT OF COUNTY ENGINEER gooREss ��. , /ZBUILDING AND SAFETY DIVISION LOCALITY - �j,e `G- � NEAREST FOR APPLICANT TO FILL IN CROSS ST. _>�� z OUTLETS N0, EACH FEE OWNER OR /s FIRM NAMERECEPf L LIGHT ( � $ S MAIL- LIGHT TQT FIRST 20 23 ADDRESS OVER 20 CITY TEL. N0. SWITCH` .10 PLAN CHECK LIGHTING 1TAL FIRST 20 25 APPLICANT FX /} TOS— OVER 20 10 ADDRESS TURES RESIDENTIAL APPLIANCES CITY TEL, NO. PERMIT ,S Ll 1ijk RANGE_DRYER_WTR. HTR._ APPLICANT, -�ll '� J)t� /� sFf✓ STA. COOK_DISP._F.A.U._ ADDRESS C/ ;;) SPACE HTR. AIR GOND. CITY ?w�-4ff TEL, CLOTHES WASH. DISHWASH._ 'LICENSE OR /I S REG. NUMBER.23 9 U.6 CLASS FAN OTHER - / 100 0 1 HEREBY ACKNOWL OGCfHAT I M14THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I_ND, HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. 512E 6 TT PE OVER TO ' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 — I .100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 7. CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE d I — IO 3.00 DESCPIP.ED RESIDE LPROP RTT. CQ P E R M TEE .LZ 10 — 50 5.00 SIGNATURE U 50 - 100 10.00 DISTRICT NO. R SED BY y 100 - 500 1500 S. O 6' ^ Z SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVAL5 DATE iNSFfCiO .SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVI CENOT OVER 600 VOLTSOR 200AMP 3.00 UNDERSLAB WORK S ERVI CE OVER 600 VOLTS OR 200 AM P 10.00 ROUGH CONDUIT TEMP SERVICE, POLE, B:APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED AFINAL 7J PERMIT FEE ISLE! TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 3-19 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASK PERMIT VALIDATION cK. M.D. GSH 9' 6rt 1 2 .'o 1 6.9 0 Age SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76AG63-CE006101'A APPLICATION FORLILECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER AooREss BUILDING AND SAFETY DIVISION s LOCALITY NEAREST - J^ FOR APPLICANT TO FILL IN CROSS ST. 015 //JJ&75 � ' OUTLETS N0. EAOH E FE OWNER OR /Z FIRM I� FIRM NAME R ECEPT. / 1 5 5 MAIL 11` AOGRESS T 25 c� LIGHTOTAL FIRST 20 ?? OVER 20 CITY TEL. N0. SWITCH .10 PLAN CHECK GHTING TOTAL LFIRST 20 '25 APPLICANT Il FIXTURES I OVER 20 10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE_ORYER WTR. HTR._ APPLICANTDow 4 // STA. COOK_DISP._F.A.U._ ADDRESS L<51�7 SPACE HTR. AIR CONO. CITY 'vEz' TEL. NO. 7,E OR CLOTHES WASH. 01 SHWASH._ 1 R G CENSE UMBER CLASS. FAN OTHER 100 j O 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION l 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. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO HEREBY CEOTIFY THAT I AM PROPERLY REGISTERED AND/OR D — 1 IDD LICENSED AS flEOUIREO BY l05 ANGELES COUNTY AND STATE OF y F L MI NIA OR Iql AM TH G OWNER OF 0.. 1 — 1O 3.00 OALIF IF.EO RESID L Pfl OPE T V FERMI CD 10 — 50 5.00SIGNATURE CDV 60 — 100 1000 DISTRICTNO. Cl_ OCE EO BY W O O Z 100 — 500 15.00 0 F SIGN,'GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR' IGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE SERVICENOTOVER60OVOL7SOR200AMP 3.00 GV UNDERSLAB WORK SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR'RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED /J FINAL PERMIT FEE (SUB TOTAL) NOTES: 7, S PLAN CHECK FEE eN� �, �� .9••fA/ PERMIT ISSUING FEE GS TOTAL FEE a � PLAN CHECK VALIDATION CK. M.O. cAsw) , - PERMIT VALIDATION cK. M.O. CASH - 3 /%nAUG 27 2 0 1 1.0 0 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WORKERS'COMPENSATIONDECLARATION 76A663 (280) APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.) FOR APPLICANT TO FILL IN JOB ' Policy No. 4495R6 Company State Fund ' - New Residential Bldgs.&POOIS EACH NO. FEE ADDRESS 9035 HermosaDrive Certified copy is hereby furnished. 1 &2-Family,Sq, Ft. $ — S LOCA LITV ple City ® Certified co y g P Multi-family Sq. Ft. — NEAREST copy is filed with the count building inspection CROSS ST • Rosemead department. Residential Swimming Pools OWNER OR I FI RM NAME Mr. and Mrs. Miller Date 611 Applicants fmid, AIX, Tnn_ Outlets: Rec.—Light—Sw. MAIL First 20 ADDRESS Onzr Drive CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. COMPENSATION INSURANCE } 3347 PLAN CH EC d APPLICANT O (This section need not be completed if the work involved Lighting by the permit is for one hundred dollars ($100) or less.) Fixtures First ADDRESS CJ Total No. Additional 1 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 U so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT AAA ConditionedW Oven _ Dryer_W.M. CL ADDRESS 10160 Valley Blvd. In Date Applicant Top _ FAU _W.H. _ Hood _ Fan _Other_ CITY171 Monte Tel No. 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 293529 Class 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 deemed revoked. Size&Type HP, KW, KVA,or KVAR Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Inc GATE VALIDATION Over 10 to 50 Incl. �Iv I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 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 , License Number 293529 Lie.Class C20 0-200 Amp. Under 600 V '7p 201-1000 Amp. Under 600 V Of Contractor AAA ConA- Ai rDate 6/15/82 Over 1000 Amp.or Over 600 V HOME OWNERBUILDERDECLARATION 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 ;9'4'4 5 9 A F1 I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section # e�e•e e e `L 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 1 4,50 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit isr issued (Sea 3097.Civ.C.). PERMIT'F EE (Sub-Total) ° ° O t 4 5 O Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) O (,1.0.0_O S Lender's Address V PERMIT ISSUING FEE 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-mentioned op try for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE na17id Crass 6/15/82 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 63 CE 8O6G (2-801 APPLICATION FOR ELECTRICAL PERMIT y^' ' CE 806G I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES / Cl BUILDING AND SAFETY ILII insure, or a certificate of Workers'Compensation Insurance,or / a certified copy thereof(Sec. 3800, Lab.C.) FOR APPLICANT TO FILL IN JOB Policy No. Company EACH NO. FEE ADDRESS QgQ,s�- • New Residential Bldgs.8, Pools Certified copy is hereby furnished. 1 & 2-Family,Sq. Ft. S — $ LOCALITY .-r e /7/4/ ❑ — ! Certified copy is filed with the county building inspection Multi-family Sq. Ft. NEAREST Swimming Pools CROSS ST department. FO RM NAME ../Q Q, p a Date Applicant _ Outlets: Rec.12Light_�L_l Sw.. �(� �Q l MAIL 03S SG1J.U/: CERTIFICATE OF EXEMPTION FROM WORKERS' ark Additional t) >Z Total No. CITY Tel No. S_335�7 i COMPENSATION INSURANCE ' - PLAN CHECK �v7 �j , O _ APPLICANT IC j V (This section need not be completed if the work involved Lighting Fixtures First 20 U by the permit is for one hundred dollars ($100) or less.) ADDRESS Additional I certify that in the performance of the work for which this Total No.� CITY Tel No. permit is issued, 1 shall not employ an person in an manner Fixed Appliances Not Over 1 HP P P Y Y P Y PERMIT so as to become subject to t Wor s' Compensation Laws. Range_ Heater_D.W. APPLICANT Oven _ Dryer_W.M._ N ADDRESS SMB Z ...,.`!ate 6�2 plic t Top FAU _W.H., _ \ Hood _ Fan _Other_ CITY el No. 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 Class RIT Compensation provisions of the Labor Code, you,must forth- Power Apparatus& Large Appliances DISTCNO. PROCESSED•BY with comply with such provisions or this permit shall be ' deemed revoked. Size&Type HP, KW, KVA,or KVAR O f/ - Up to 1 Incl. � FINAL rJ ^� Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- BY Over 100 ness and Professions,Code, and my license is in full force and effect. Services License Number Lia Class ' 0400 Amp. Under 600 V .. 201.1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V - HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances I hereby affirm that 1 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 - 4.40 1 A ® 1, as owner of the property, will the work and the Other(See Complete Fee Schedule)— r structure is not intended or offered for sale (Section _ •# ere o e e '2 7044, Business and Professions Code).- - CONSTRUCTION LENDING AGENCY 2 eke 4 Q 1. 0 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) //.�� ° ° °,4 Q issued(Sec. 3092 Civ..CJ. 3 vU j Lender's Name.L4nm,a)reder,,C0 _-- lUIr1RS PLAN CHECKING FEE (One Fourth Permit Fee) 19'6 17;82 Lender's Address ✓P-94dc �sY'zat�i a., PERMIT ISSUING FEE . SU i I certify that I have read this application and state that the TOTAL FEE !a 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE %Signature of Permittee Date