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Home My Public Portal About9159 LA ROSA DR_Electrical__ 76A663-CE806 !-68 APPLICATION LECTR`rCk PERMIT �. G�OUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER UILDING r I BUILDING AND SAFETY DIVISION ADDRESS r� hI� GSA LTR B , JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY ITC-/7nj''e L//!7-1 NEAREST C FOR APPLICANT TO FILL IN CROSS ST eYCiIVIT'Ff 7EP NO. EAC FEE $ $ OWNER Yn/►-1 i.//T� 5; 65"14 ML Co TOTAL FIRST 20 20 ADDRESS /Y7'E OVER 20 .10CITY TEL. NO. PLAN CHECK TOTAL FIRST 20 �C 20 00 APPLICANT FIXTURES OVER 20 10 5U ADDRESS RANGE—DRYERWT R.HTR._ CITY TEL. NO STA COOK_OISP. F.A U._ CONTRACTOR SPACE HTR. AIR COND. ADDRESS 3.z5 SeplhxtN IRVe CLOTHES WASH._DISHWASH._ CITY, hfT_e_ TEL. N0G130`TZZ FAN—OTHER 1 00 LICENSE NO�jQ j CLASS6-40 MOTORS.TRANSFORMERS RATING IND. HEATERS, ETC HP. KW. KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE &,TYPE OVER TO AND STATE •THAT THE ABOVE IS CORRECT AND-AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. O - 1 1 00 ",/, I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR A T(�A/ /R N 1 - 10 3 00 'y� r LICENSED AS RED U]RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM E LEGAL OWNER OF, AND INTEND TO O�. 1 O - 50 5 00 RESIDE IN, ABOVE D SCRIP•ED RESIDENTIAL PROPERTY O 50 - 100 10 00 SIGNATURE V OF PERMITTE pd 100 - 500 15 00 0 DIST CT O. GROUP ZONE PROCESSED BY SIGN,GAS , TUBE, A SIGN AND ONE CIRCUIT 3 00 d a MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES. Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 Q SERVICE OVER 600 VOLTS OR 200 AMP 5.00 ' TEMP SERVICE, POLE, &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE + UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED - PERMIT ISSUING FEE' 2 00 a UTILITYCO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL j V11, TOTAL FEE 3Q JOSEPH C. .ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION M.o CASH _. .. �. 5 6; 1 2-- Ji;l. �. 2 D 3 4.3 Q^' - ttw., ;EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 76A663-CE806 1_68 APPLICATION FOR ELECTR A PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS a JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING tLOCALITY � I NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. EACHI FEE $ S OWNER RECEPT._ MAIL LIGHT TOTAL FIRST 20 20 ADDRESS SWITCH_ OVER 20 10 CITY / C r - TEL._N0, —33 4le PLAN CHECK LIGHTING . �TOTAL FIRST 20 20 APPLICANTFIXTURES OVER 20 101 ADDRESS RANGE—DRYER—WTR.HTR._ CITY TEL NO STA.COOK_OISP F.A.U._ CONTRACTO SPACE HTR.• AIR COND. ADDRESS _ CLOTHES WASH._DISHWASH._ CITY TEL. NO _FAN_ OTHER 1.00 /�j LICENSE W `O. �' CLASS. MOTORS,TRANSFORMERS RATING , IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING 0 - 1 1 00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO 10 - 50, 5 00 RESIDE IN, THE ABOVE DESCRIP.ED RESIDENTIAL PROPERTY O SIGNATURE V 50 — 100 10 00 OF PERMITTEE CC 100 — 500 15 00DISTRICT NO. G OUP ZONE PROCESSED BY O SIGN,GAS Is AND ONE CIRCUIT 3 00 J /d l TUBE, OR d MARQUEE ' N ADDITIONAL CIRCUITS 1 00. NOTES: Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 v SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE, POLE, & APPURTENANCES .00 V n APPROVALS DATE INSPECTOR'S SIGNATURE i TEMP. POWER POLE - UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 200 UTILITY CO NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL 1� TOTAL FEE 00 JOSEPH C. ROOHAN SUPERVISING ELEC CAL ENGINEER PLAN CHECK VALIDATION CK. M.0 CASH PERMIT VALIDATION CK M.o CASH Lko:4 4. 5' 3 APR 2 6 T2--D 5,Q Q - 5EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 9woRKER's COMPENSATION DECLARATION 76A663 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT /r` 76A663 hereby affirm that I have a certificate of consent to self Insure, I LI or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Spec':3800 Lab i) �y/) j j�j�C/� Policy No• ' `^� Company�`y ^�" ' r -" FOR APPLICANT.TO FILL IN -' •+ - ADDRESS •�I /`V s • Certified --EACH- i copy is hereby furnished. J New Residential Bldgs.&Pools NO. FEE i.e. i $ _ $ LOCALITY Certified co is filed with the count building Ins ectioNl 1&2-Family,Sq.Ft. PY Y 9 P _ department /�f/ L Multi-family Sq.FL NEAREST t CROSS ST J_ow e-y �'(� SCA MAP Date Applicant's :�JL��L � Residential Swimming Pools ASSESSOR Rc PAGE PARCEL CE_RTIF.ICATE OF,EXEMPTION FROM WORKERS'-; ., �F• i OWNER OR w?Ly �)w COMPENSATION INSURANCE Outlets:Rec._Light Sw. FIRM NAME /V 1 W First 20 e) MAIL (This section need not be completed If tworknvolved by he Ithe ,c -� '' � permit is for one hundied dollars($100)or less.) ) Total No. Additional ADDRESS -a I certify that in the performance of the work for w,hlch this permit - - - CITY `� CIT Tel o 0 0F' is issued, I shall not employ any person In any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures / First 20 APPLICANT' Total No. Additional ' '• - "' ', ADDRESS ' Date Applicant { 15 OR 20A,120V BRANCH CIRCUITS- r - ' NOTICE TO•APPLICANT. If, after'making this--Certificate of ii CITY _ Tel No Exemption,you should become,subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the.Labor Code, you,must forthwith comply with,such 11 TO 40 INCLUSIVE EACH- - --- - - -- --,'i• PERMIT. . . APPLICANT �j ` Wf� provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH } LICENSED CONTRACTORS DECLARATION ' T .. _ _ ADDRESS / S-MAP, (SGC G I hereby affirm that'l am licensed under provisions'of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH- •o O (commencing with Section 7000) of'Division-3 of the Business and CL It'-.d CIT}_ OWIM „ Te A0 �� V Professions Code,and my license is In full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances REG NUMBERS Class �/O Z�8 f O Size&Type HP,KW,KVA,Or KVAR DISTRICT NO PRO C ED BY -F-, License Num�b^er, / L_ic.Class �--Up to 3 Incl Ll ._. _.. __ S �� 'ai-tum-cam' - LU a )- a Over 3 to 10 Incl FINAL j Contractor. Date - - -- -- - DATE - vvu Over 10 to 50'Incl- Z I am exempt under Sec. Over 50 to 100 Incl. VALIDATION — B.&P.C.,for this reason ' ' - --' Over 100 - -' - FINAL - - BY Services,S_wbd.,-MCC&Panelboards 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&Appurtenances HOME OWNER-BUILDER DECLARATION -•- - ` _ _ >,c.- _ _ _ _ I•. - hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ,i for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code) i`_0 ❑ J - - �� Misc.Conduits&•Conductors 9-=-- TOTAL 1 m 3 I, as owner of the property,will do the work and the structure 1 jI _ is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ t; n} and Professions Code) ._ .. .. __ _ _ _ CLIECK 7 CONSTRUCTION LENDING AGENCY .� _ -. _ _ _ CHANGE CIO I hereby affirm that there Is a construction lending agency for then performance of the work for which this permit is Issued (Sec. 3097, PERMIT FEE. _ _ •:(Sub,.Total)_. __ n c 1� -: f Civ.C.) - .,�,- - t i3`tI�3�^�I��I_f�, ''7l L.{/`7 i. Lender's.NamPLAN_CHECKING.FEE -, ' - -•--•- - 561 - -AM i ;20" 561 e _ = 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 this County to enter upon the above-mentioned =- property for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT / ATE T WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT LJ , I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS- BUILDING AND SAFETY DIV. copy thereof-(SeaY3800 Lab �(, a Policy No ` "Itf Co`mllpany FOR APPLICANT TO FILL IN JOB ADDRESS �. F' "'Certifled'co is fIe7 reb furnished' PY _ Y New Residential Bldgs &Pools NO EACH FEE A L - _ $ $ LOCALITY Certified copy Is filed with the county building In 1 &2-Family,Sq.Ft. Ion _ NEAREST department Multi-family Sq. Ft. CROSS ST �/✓(�(�7 Date �`' Applicant' Residential Swimming Pools. ASS SSOK r •- - PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' a OWNER MR Outlets Rec. Light Sw ,�� D'b FIRM NAME d/�J� COMPENSATION INSURANCE` - First 20 (Thls.sectlon need"not be completed If the work involved by the -ADDRESS r Total No Additional pe�mit,is for.one Hundred dollars($100)or less.) , I crL ertify that'In the peFformance of the work for which this permit, CITY Tel No is issued, I shall not employ-any personin any manner,so as to - PLAN C14ECK become,sublect to the Workers':Compensation Laws Lighting Fixtures First 20 APPLICANT Total No. Additional • ,• ADDRESS Date' "- a'- Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP •NOTICE.T,O,AP,PLICANT If; after making this Certificate of CITY Tel"No Exemptien,youu should,,become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. rovlslons'.of the Labor Code, you must forthwith,comply with such PERMIT P Y p y Power Apparatus&Large Appliances APPLICANT provisions or this permit shal'I be deemed revoked LICENSED CONTRACTORS DECLARATION" Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under'Provisions of Chapter 9 Over 3 to 10 Incl CITY f ? Tel No (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect 'Over-10 to,50 Iricl.,' } REGLICEN EOR Class • f ,Over 50 to 100 Incl _ REG NUMBER a Over 100;, DISTRICT NO SED BY License Number / Llc.Class V ` Services,Swbd.,MCC&Panelboards 0-399 Amp.Under 600 V FINAL Q Contractor _ ate DATE ❑ 400-1000 Amp Under 600 V I am exempt under Sec VALIDATION V _Over 1000 Amp or Over 600 VFINAL d B;&P C for this reasonBY BRANCH CIRCUIT FEES ' • Cn Date, 15A,or 20A, 120V,Lighting or Recept - Z_ - '1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits _ 41 Or More Branch Circuits Exemption for Reg Malnt Elect 15A,20A„208V To 277V Lighting Sr Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances -71!1 f r i HOME OWNER-BUILDER DECLARATION' 1=�' I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit T for,t Fie following reason (Section 7031.5, Business arid Professions Additional Sign Branch Circuits i � 3—I = Code. - '- Co ) TOTAL 145 - 80 ' I,as owner of the property, will do the,work and the structure Misc.Conduits&Conductors s Is not intended or offered for sale (Section 7044,'Business Other(See Complete Fee Schedule) ® s:tiE•1. �E' and Professions Code). CHANGE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the i r_r performance of the work for which this permit Is Issued (Sec:3097," PERMIT FEE (Sub=Total) ;3 II��}—! h_ a, r,;+ Civ. C) PLAN ,.CHECKING FEE _ 65 _ AMI1 1 k t Lender's Name // PERMIT ISSUING FEE _6 Val Lender's Address I certify that I have read this,application and under penalty of purfury state TOTAL FEE , that the 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-mentioried property for inspec�,purposes. ! SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE10V-PtJR14"Ze DATE