HomeMy Public PortalAbout10105 LA ROSA DR_Electrical__ 76A663C- CE806813,16 APPLICATION FOR ELECTRICAL PERMIT
BUILDING AN SAFETY DIVISION
FOR APPLICANT TO FILL IN
New Residential Bldgs.& Pools EACH NO. ApD REBS
FEE
1 &2 Finaily Sq. Ft. S — S LOCALITY
Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSSST.
OWNER OR
FIRM ME
NAq !�
Outlets: Light,Switch& Receptacle o MAIL h' `T2A��
First 20Xry ADO RESS / J/
Additional ,J v CITY Tel. No.
PLAN CHECK
Lighting Fixtures O APPLICANT
First 20 i- I — ADDRESS
Additional '
CITY Tel, No.
PERFixed Appliances Not Over 1 HP APPLICANT 00
Range_ Heater_ D.W. ADDRESS ,Zz/O �0/�r/V�✓ITL
Oven _ Dryer W.M. _ `1
Top FAU W.H. - CITY 4'90,V r� Te I. No. Ti `
Hood Fan LICENSE OR �I >
Disp. A.C. REG. NUMBER 2� Class. U
z
HERESY
THIS APPLICATION
THAT
E ABOVE IS
AGREE TO COMPLY
Power Apparatus& Large Appliances LCOUNTYN ORDINA"CES AND STATE D
STATEAND LAWS REGULATING S-
Size&Type HP, KW, KVA,or KVAR ELECTRICAL W.R."` d
Up to 1 Incl. I HEREa OPERL NDroR r�
��✓ . Over 1 to 10 Incl -� LICENSED AS NEGURRCG By LOS ANGELES COUNTY AREa
GALIFORNIAOR THAT 1/41 THEAL ow E AEDv
Over 10 to 50 Incl. DESCRIBED RES BE ROPERT
Over 50 to 100 Incl. PERMITEE
Over 100 SIGNATURE
DISTRICT NO. SED BY
Services
0-200 Amp. Under 600 V
201 - 1000 Amp. Under 600 V APPROVALS DATE INSP. TOR'S
Over 1000 Amp.or Over 600 V SIGNATURE
TEMP. POWER POLE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits CONDUITts
(Oth¢r) WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) UTI LITY CO.NOTI FI ED
PLAN CHECKING FEE (One-Fourth Permit Fee)) FINAL
PERMIT ISSUING FEE /
TOTAL FEE NOTES
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
212�NOV 17 2 D 50 °t;'
p _C�
76A663 CE-606 NF 6/76 APPLICATION R ELEC �CAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS S
New Residential Bldgs.&Pools EACH NO. FEE
I &2-Family,Sq.Ft. b — $ LOCALITY
Multi family Sq.Ft. — NEAREST
Residential Swimming Pools ROSS ST.
OWNER
FIRM NAME L.p
Outlets:Rec—Light_Sw._ MAIL
ADDRESS O �.� S
First 20
tg
Total No. Additional CITY � Tel Na •„��
PLAN CHECK'
APPLICANT
Lighting Fixtures First 20 ADDRESS
Total Na. Additional CITY Tel.No.
Fixed Appliances Not Over 1 HP PERMIT
APPLICANT b /c, rL
Range—Healer— D.W.
Oven—Dryer_ W.M.— ADDRESS
Top _FAU — W.H._ CITY 2 T .No.
Hood_Fon —Other— LICENSE OR
Disp.—Room Air Cond. REG.NUMBER Class.��
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCA
Power Apparatus•&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP, KW, KVA,ar KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING ELECTRICAL WIRING. 6
Up to 1 Incl. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0
Over 1 to 10 Ind. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF V
Over 10 to 501ncl. CALIFORNIA OR TH T I AM THE LEGAL OWNE OF THE ABOVE 09O
DESCRIBED IE IA PROPERTY. 0
Over 50 to 100 Inc.
PERMIT
Over 100 EE
SIGNATOR
VI
Services DISTRICT NO OCESS D BY ?
0-200 Amp.Under 600 V 15 O (f
201 1000 Amp. Under 600 V �T !l
Over 1000 Amp.or Over 600 Vw..�ZO
Temp. Power Pole&Appurtenances
Sign with One Branch Circuit j
Additional Sign Branch Circuits INSPECTION >
Misc.Conduits 8 Conductors INFORMATION
ON REVERSE x
Other(See Complete Fee Schedulel_ SIDE u
g �5138A
6
p . . . . . 2
PERMIT FEE (Sub-Total) 2 • • 3200
Z
PLAN CHECKING FEE lone-Fourth Permit Feel O
a • • • 3200
PERMIT ISSUING FEE _ ' 0 b 2 5-7 9
TOTAL FEE J L >
r
INSPECTION FINALEEDD
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