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Home My Public Portal About10403 LA ROSA DR_Electrical__ DEC TION WORKERS't I have a certificate cafe of corse 76-663 10,81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a cedificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDI�G AND SAFETY or a certified copy thereof(Sec. 3800, Lab, C.) P❑ollcy Na. Company FOR APPLICANT TO FILL IN ADDRESS %�- s Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ,rr 1 8 2-Famil $ — $ LOCALITY ,'� ✓f 0� i:.•Certified copy is filed with the county building inspec- y, Sq. FL — v. tion department. Multi-family Sq. Ft. 'NEAREST ! %.' Residential Swimming Pools CROSS SL '?6' `Dote ' Applicant / i r OWNER OR ' PP FIRM NAME/ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight_Sw. MAIL ( COMPENSATION INSURANCE ADDRESS, _ This see tion neenot be completed if the work involved b ( tid P Y First 20CITYry;,,} Tel. No: . - - the permit is for one hundred dollars ($100)or less.) Total No. Additional ,r that in the performance of the work for which this PLAN CHECK I certify P APPLICANT permit is issued, I shall not employ ain any manner so os to become subject to the Workers'ers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant FixedAppliances Not Over I HP PERMIT NOTICE TO APPLICANT: If; after making this Certificate of - APPLICANT ,.. Exemption, you should become subject to the Workers' Range_ Heater—D.W. — Compeosation 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. — CITY Tel. No. deemed revoked. - Hood Fan _ Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR _ I hereby,offirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG- NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY a Power Apparatus 8 Large Appliances and.Professions Code,and my license is in full force and effect. .q .✓/' ..�+�.k. ' O Size & Type HP, KW, KVA, or KVAR ..`,e/5 ,fo j'�d; U 'r License Number Lic% . Class Up to 1 Incl. FINAL Over I to 10 Incl. DATE VALIDATION W Contractor - Date Over 10 to 50 Incl. ^ ❑ FINAL 1 am exempt under Sec. Over 50 to 100 Inc. BY Q B.BP.C. for this reason Over 100 - 0 O Date: Services, Swbd., MCC & Panelboards 1101. a 0 - 200 Amp, Under 600 V Signature 201 - 1000 Amp. Under 600 V - E- Over 1000 Amp. or Over 600 V ElExemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances A'fir- i"F., ' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit hereby affirm that I g r exempt from the Contr31.5, ctor'sBusiness License Additional Sign Branch Circuits p�� Law for the following reason (Section 7031.5, Business and g Alu , v Professions Code): ' �e tk' - I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors I ,:tie;s i I, structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— ► 7044, Business and Professions Code). ;J r t� -.3 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 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 PERMIT ISSUING FEE Lender's Address ' 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 property for mspectioon purposes. SEE"REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS' COMPENSATION DECLARATION 76A663 10,81 APPLICATION .FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY ( or a certified copy thereof (Sec. 3800, Lab. C:) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS 10403 La Rosa Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE E] Certifiedcopy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. 1916 $ — 8 LOCALITY Templ City tion deportment, Multi-family Sq. Ft. — 'NEAREST Residential Swimming Pools CROS$ST. Arden OWNER OR Date Applicant FIRM NAME Fairhaven D evelopmprit CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_Li ht_Sw.— MAIL COMPENSATION INSURANCE g ADDRESS 9088 Las Tunas This section need not be completed if the work involved b First 20 ( cticoP y Total No. Additional CITY Temple City Tek Na.286-3636 the permit is for one hundred dollars ($100)or less.) 1 certify that in the performance of the work for which this PIAN CHECKMartinMartin Electric permit is issued, 1 shad not employ any person in any manner — so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 1560 N. Lassen C? Total No. CITY Ontario Tel. No. 982-7880 Dat c"—.FApplicant Additional Fixed Appliances Not Over I HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Martin Electric Exemption, you should become subject a the War kers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M._ ADDRESS 1560 N, Lassen with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. CITY Ontario Tel. No X982=7880 LICENSED CONTRACTORS DECLARATION Hood — Fan _Other— . _ Room Air Card. LICENSE 304982 Class. I hereby affirm that I a ,licensed under provisions of Chapter 9 REG. NUMBER mDisp BER C-10 (commencing with Section 7000) of Division 3 of the Business DISTRICT NOPR ESSED BY `5 and Professions Code, and m .license is in full force and effect. Power Apparatus 8 Large Appliances y p6-4,10Size 8 Type HP, KW, KVA, or KVAR' .Or Q License Number LLi�c Class l• Up to 1 Incl. FINAL V Contract Ove09 r 7 a79r' i , Over 1 to 10 Incl. DATE �d q ' VALIDATION ❑ Over TO to 50 Incl. G It— FINAL 1 am exempt under Sec. Over 50 to 100 Inc. BY d B.BP.C. for this reason Over 100 N Date: Services, Swbd., MCC 8 Panelboards , Z 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Mainz. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License .A[( Law for the followAdditional Sign Branch Circuits following reason (Section 7031.5, Business and 0 8.8 A Professions Code): ' - 4 e e o o e Z I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 2 e - 77,56 7044, Business and Professions Code). a o 0 7'7,5 6� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for O a 01 —87, the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 04 (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 1 Lender's Address I certify that I have read this application and state that the TOTAL FEE ?r sr 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 in ection proposes. 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date KERS'COMPENSATION DECLARATION CE-W ,D,B, APPLICATION FOR ELECTRICAL PERMIT 11Wur. .f�1eIrtif that I have a certificate of consent to self CE-806G icate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a,ertified copy thereof (Sec. 3800, Lab. C. Policy No. Company FOR APPLICANT TO FILL IN JOB Certi ied copy is hereby furnished. New Residential Bldgs. 8 Pools EACH' NO. FEE ADDRESS Certified copy is filed with the county building inspec- 18 2-Family, Sq Ft $ — 8 LOCALITY tion department. Multi-family Sq. Ft. — -NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR � �/�� pp,,,, FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec-UL_Light-1-0 MAIL b O �` COMPENSATION INSURANCE �/' 7 /S ADORES This section need not be completed if the work involved b First 20 u ( p Y Total No.� Additional CITY Tel. No. tS'7 Q the permit is for one hundred dollars ($100)or less.) �✓ I certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, shall not employ any person in any manner so as to become subject to the Workers'Co pensss��ttton La s. Lighting Fixtures First 20 ADDRESS Z Additional Total No. CITY Tel. No. DateApplicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption, you should become subject to the Workers' Range_ Heater_D.W. 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. - CITY e. o. LICENSED CONTRACTORS DECLARATION Hood — Fan _Other— Disp. _ Room Air Cone. LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 .. REG. NUMBER (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO SED BY and Professions Code,and my license is in full force and effect, Power Apporafus8 Large Appliances �� 6 Size 8 Type HP, KW, KVA, or KVAR' I O License Number Lic. Class U to 1 Incl. FINAL p V Over 1 to 10 Incl. DATE /,,! —3-p A DATION Q Contractor Date Over 10 to 50 Incl. FINAL / p Ulu I am exempt under Sec Over 50 to 100 Inc. BY /X /.�/� _ B.BP.C. for this reason Over 100 ---(/ CL ut Services, Swbd., MCC 8 Pdnelboards nn ? Date: 0 - 200 Amp. Under 600 V ► Signature 201 - 1000 Amp. Under 600 V q 6 4 B'A ❑ Exemption for RegMainz. Elect. Over 1000 Amp. or Over 600 V ,*t a e a rnye� rPe�'Sq. . SINGLE FAMILY Temp. Power Pole 8 Appurtenances O 2'O 2_8 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the fallowing reason (Section 7031.5, Business and sions Code): P as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructionlending agency for the performance of the work for which this permit is issued PERMIT FEE 129"64�p P (Sub-Total)(Sec. 3097, Civ. C.). PLAN CHECKING FEELender's NamePERMIT ISSUING FEELender's AddressI certify that I hoveread 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-me flop d')Lr`2.0 y or inspection purposes. !/ SEE REVERSE FOR EXPLANATORY LANGUAGE ZtZ /Z-�u ignature o Permittee Date WORKERS'COMPENSATIONa certificate DECLARATION 76-863 ,D,e, APPLICATION FOR ELECTRICAL PERMIT {� u I�Fyratip affin have rm that I a of consent to self insure, CE-BOBG or a certificate of WorkersCompensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800.Lab. C.) Policy NO. - FEE Company FOR APPLICANT.TO FILL IN JOB NO. ADDRESS' ❑ CertifieQ copy is hereby furnished. New Residential Bldgs.&Pools EACH T ' F1 Certified Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ — $ / 1 C ' department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools - OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rae Light 2L gw;. \ N MAIL COMPENSATION INSURANCE - / ADURESS This section need not be completed if the work involved.by the First 20 l P - CITY• C Tel.No. permit is for one hundred dollars ($100) or less.) Total No. Additional r I certify that in the performance of the work for which this permit PLAN CHECK is issued, I shall not empl0 an APPLICANT y y person in any manner so as to become subject to the Workers'Compensation La . Lighting Fixtures First 20 ADDRESS //[ ( Additional e. Total No. CITY No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: It, after making this Certificate of AFPUCAN7 Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Oisp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license Is in full force and effect., Power Apparatus& Large Appliances DISTRICT NO. ! PROC 5 ED BY d Size& Type HP,KW,KVA,or KVAR Sr (/ O License Number Lic.Class Up to 1 Incl. FINALU Over 1 to 10 Incl. DATE VALIDATION 0 iv Contractor Date Over 10 to 501nd. BIN / F- E] I am exempt under Sec. Oven 50 to 100 Inc. Over 100 BE B.&RC.for this reason fn Services,Swbd.,MCC & Panelboards �5!6 7 9.6 A Z Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp. Under 600 V # - 2250 ❑ 9 2 Exemption for Reg. Maint.Elect, Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp.Power Pole& Appurtenances . J HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits for the following reason(Section 703 1.5,Business and Professions - Code): P124 Misc.Condu6&Conductors UI I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business , and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE (/ Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of thounty to enter upon the above-mentioned pr arty for ins c'bn�orpose � ^ � f SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Veftittee Date