HomeMy Public PortalAbout10702 LA ROSA DR_Electrical__ - COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department OF of CountBUILDING
Engineer ELECTRIC
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Enpineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT/NO.
ELECTRICIAN 7 O yr
0 — RECEIVED BY READY FOR DATE ISSUED
ADDRESSFIRST INSPECTION
CITY I TEL N Q P"9,0760 � t2kr6 /�/�
COUNTY LICENSE NO.199715 EXPIRESIV BUILDING
PERMIT FEES ADDRESS
NUMBFEE gER EACH LOCALITY I
LIGHT OUTLETS 3 NCAREYT
RECEPTACLES CROB9 HT. /
WALL SWITCHESOWNER �f� Mir
TOTAL OUTLETS Sc g� J MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 1TY TEL NO.
FIXTURES S I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
MUMMER OF LIGHT CIRCUITS 7 Al.— AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Or RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE AGOVE VALID LOS
NUMBERHORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEw Mw. HP OVER I.C. EACR OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2 a "as G .25 SIGNATURE OF
I/2 2 .50 PERMITTEC _ .L=L ----
2 S .00 INSPECTION RECORD
_ s is 1.50
_ 15 50 2.50 _
_ 50 200 5.00
_ 200 Sao 10.00 J
1000 15.00 Z
Z
OVER 1000 20.00 Ur
M.G. SET/FRED. CHANGER-HP lC
WELDERB: AC-KVA O
GENERATORS - KW _
TRANSFORMERS - KVA
TEMP. MOTORS (75q OF ORIS.) _
MOVED MOTORS (75% OF ORIS.)
MIBC.
SIGNS
NO. NO.TRANS. APPROVALS
NO. NG. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING 11111.00 { --:0,
ON DUIT z�
0
FIXTURES 81.0JB
WIRINO
i
SUPPLEMENTARY .50 FIXTURES
' POWER
TOTAL FEE G XUTILITCO. NOTIFIED
/ ! Y FINAL
76A663 DBS#5A 4-52 ,/
WORKERS' COMPENSATION cafeDECLARATIONcorse CE-806 10181 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,f. certified copy thereof (Sec. 3800, Lab, C.
P❑oliicy No. Company FOR APPLICANT TO FILL IN JOB -
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS D ()
❑ Certified copy is filed with the county building inspec- I & 2-Family, Sq. Ft. $ — $ LOCALITY M� LE
tion department. Multi-family Sq. Ft. — NEAREST .f
Residential Swimming Pools CROSS ST,
Date Applicant OWNER OR
FIRM NAME /Q
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_LightSw,_ MAIL
COMPENSATION INSURANCE ADDRESS ill1, o-7-f
( P T
This section need not be completed if the work involved b First 20 the permit is for one hundred dollars ($100)or less.) Total No. Additional CITY
Tel. No.
I certify that in the performance of the work for which this A PLLIICANTK
permit is issued, I shall not employ any person in any manner
so as to become subject to the Work rs'Com�ation S. Lighting Fixtures First 20 ADDRESS
Total No. Additional
Applicant CITY Tel. No.
Date
Fixed Appliances Not Over 1 HP
NOTIC TO PLICANT: If, a ma tificate of PERMIT
Exemption, you should be o e ect e Workers' Range_ Heater—D.W. APPLICANT' C Lamer /
th
Compensation provisions of a La Code, you must forth- Oven _ Dryer —W.M._ ADDRESS ' - �-A/a`.
with comply with such provisions or this permit shall be Top — FAU —W.H.
deemed revoked. Hood Fan _ Other_ CITY �� Tel. No. -�
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER " Class -/d'
r,
(commencing.with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS B d
and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances 0
Size &Type HP, KW, KVA, or KVAR' C..1
License Number Lic. Class-
- Up to I Incl. FINAL
Over 1 to 10 Incl, DATE _ ir 6110 VALID ION O
Contractor Date Over 10 to 50 Ind. V
F-1FINA a
am exempt under Sec. Over 50 to 100 Inc. BY Tn
B.&P.C. for this reason Over 100 z
Date: Services, Swbd., MCC& Ponelboards ►
D -200 Amp. Under 600V �44QOA
Signature 201 - 1000 Amp. Under 600 V 54
❑ Over 1000 Amp. or Over 600 V e e e e e 2
Exemption for Reg. Maint. Elect. (
SINGLE FAMILY Temp. Power Pole & Appurtenances e - 2550 255Q
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit • • e 2 5 5 0 5
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code): o4, 1 5-86
❑ I, as owner of the property, will do the work and the Misc. Conduits& Conductors
structure is not intended or offered for sole (Section Other (See Complete Fee Schedule)_
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is o construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) U� r
(Sec. 3097, Civ. C.). '
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I hove read this application and stare that the TOTAL FEE
above information is correct. I agree to comply with all County
ordinanc s and State laws regulating Electrical wiring, and
hereby thorize representatives of this County to enter upon
the a e-men ' tf proper 'for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
RIC
nolo of Perm' e /fate