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Home My Public Portal About10425 LA ROSA DR_Electrical__ DEC TION WORKERS't I have a certificate cafe of corse CE-806 10,61 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm Choi I have o certificate of consent to self CE-8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES 7 C / BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C,) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS 10425 La Rosa Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. 1644 $ — $ LOCALITY Temple City tion department. Multi-family Sq. Ft. — NEAREST Date Applicant Residential Swimming Pools CROSS ST. Arden OWNER OR FIRM NAME airhaven Development CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight_Sw._ 'MAIL COMPENSATION INSURANCE ADDRESS 9088 Las Tunas This section need not be completed if the work Involved b First 20 ( ctiR T Total No. Additional CITY Temple Cit t Tel. No 286-3636 the permit is for one hundred dollars($100)or less.) - I certify that in the performance of the work for which this PLAN CHECK P APPLICANT Martin- Electric 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 1560 N. Lassen q `'��f�� Total No. Additional�� /—�Applicon�X�-<-- aTv Ontario rel. No.982-7880 Date NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT APPLICANT Martin Electric 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 156n N_ T,aqqpn with comply with such provisions or this permit shall be Top -- FAU —W.H. — deemed revoked. Hood _ Fan _ Other_ CITY Ontario Tel, No.982-7880- LICENSED CONTRACTORS DECLARATION Hoo — Room Air Cord. LICENSE OR Class. I hereby affirm that 7 am li<ertsed under provisions of Chapter 9DisREG. NUMBER _ (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROC SED BY } and Professions Code, and my license is in full force and effect. d Size & Type HP, KW, KVA, or KVAR' �!1 O License Number '-^-' ( �/� Lic. Class '�yv Up to I Incl. FINAL ^ V Over 1 to 10 Incl. DATE H2 —;?6 VALIDATION Q Contractor Date X Over 10 to 50 Incl. ' I G `/` F ❑ FINAL I am exempt under Sec Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 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&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License ;?4 0 85 A Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits - - Professions Code): # 0 0 0 o e 2 ❑ I, as owner of the property, will do the work and the Misc. Conduits& Conductors - structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— BooZ'o o6 B 0 2 7044, Business and Professions Code). o a o 6 8.0 2 6 CONSTRUCTION LENDING AGENCY - £3 0 1 —83 I hereby affirm that(here 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 IC50 Lender's Address I certify that I have read thisapplication and state that the TOTAL FEE G.Y/0 above information is correct. I agree to comply with all County ordinances and State laws regulating Elecvical wiring, and hereby authorize representatives of this County to enter upon the above-mentoned property for ins tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signdture of Permittee Date DEC TION "WORKERS't I have a certificate cafe of corse 7MW DPW 3157 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have q certificate of consent to self 'CE�G insure, or c certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, b. C.) - F,y No.{I(�Company /� FOR APPLICANT TO FILL IN JOB Certified copy ,s hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS Y 4�'s.� .. /✓) �rCertified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY Q 1 T ti deP ortm a nt. Multi-family Sq.-Ft. — NEAREST If I CROSS ST. )31 Y I d Residential Swimming Pools OWNER OR Date Applicant p� Outlets: Re< LightFIRM NAME CERTIFICATE OF EXEMPTIO FRO WORKERS'N � 3 MAIL L COMPENSATION INSURANCE _Sw._ , 0 �' d GQ ADDRESS ( completed if the work involved b This section need not be corn j First 20 O Y r�� the permit is for one hundred dollars ($100)or less.) Total No. IAdditional CITY Tel, No. I certify performance oe workor wthat in the erff the for this PLAN CHECK permit is issued, I shall not employ any person iAPPLICANT n any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Date Applicant Total No. CITY Tel. No. Fined Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: IF, cher making this Certificate of APPLICATIOr 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 Z with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY i 'f,�`�el. No �/T( . LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Cond. — LICE EUOR �^It 7. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NMBER Jr/4! (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROPRO ESSE� } and Professions Code,and my license is in full force and effect. ` G. any Size 8 Type HP, KW, KVA, or KVAR d• Q License Number �,T Lit. Class . V 2 C Up to 1 Incl. FINAL Controctc - Q Dat �J-/ Over I to 10 Incl. DATE VALIDATION 0 Q � / Over 10 to 50 Inc]. FINAL r am exe t under Sec. WAV •_ Over 50 to 100 Inc. gy W B.BP.C. for this reason Over 100 d Z Services, Swbd.,'MCC 8 Panelboords ED Date: 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances OWNER-BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits llu. ) ,'a Professions Code): -47137 ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors `u dJ f structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ j t I Ct'IJ Business and Professions Code). ' ')'j 11=L 2 CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lending agency for "hl.` ' the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) / (.YaHN--3t (Sec. 3097, Civ. C.). LAlJ/[41t PLAN CHECKING FEE Lender's Name � PERMIT ISSUING FEE !1[t[fl i-t'_!;aVi ;_rj�j�',�rii Lender's Address 1 certify that I have read this application and state that the TOTAL FEE �. S=r'! f hin above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and herebyouthorize representatives of this County to enter upon the a fie-mentionedr rty for.inspe tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dote Os