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Home My Public Portal About9468 LA ROSA DR_Electrical__ 1 76A663-C`E`0610/72 APPLICATION FOR ELECTRICAL PERMIT �• COUNTY OF LOS ANGELES - DEPARTMENT OF COUNTY ENGINEER JOB �(� 0� C1s'� BUILDING AND SAFETY DIVISIONejkA t LOCALITY - ^ NEAREST J,— y O y , ' FOR APPLICANT TO FILL IN CROSS ST. -�( eef - OUTLETS NO EACH FEE OWNER OR V' / $ $ FIRM NAMEj` RECEPT.! " MAIL S• /1 �• tj FIRST 20 25 ADORES ''i' (G 3 dC f� LIGHT .TOTAL• •' ` OVER 20 CITY �= TEL'. NOg6��SO Zo SWITCH_ 10 PLAN CHECK •� FPRST 20 APPLICANT ' LIGHTING TOTAL 25 " FIXTURES OVER 20 10 ADDRESS S RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_j_WTR. HTR 'APPLICANT= STA. COOK DISP. F.A.U.- ADDRESS SPACE HTR. 'AIR'COND. _ S CITY - TEL. NO. _ CLOTHES WASH. DISHWASH. _ LICENSE OR CLASS. REG. NUMBER FAN OTHER �_ '100 �1 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION (� AND STATE THAT THE-ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES, AND STATE LAWS REGULATING IND HEATERS, ETC HP. KW KVA. ELECTRICAL WIRING 5 SIZE & TYPE OVER TO ' I HEREBY CE RT•IFY THAT I AM PROPERLY REGISTERED ANO/OR O - 1 100 LICENSED AS REQUIRED BY LOS A'NGELES COUNTY AND STATE OF CALIFORNIA_ OR THAI I AM THE LEGA WNER OF THE ABOVE r 1 - 10 300 DESrRIDED RESIDENTIAL PROP CL O PERMITEE V 10 - 50 500 SIGNATURE O 50 - 100 1000 ' DISTRICT N0. PROCES D BY V ` _ W t 00 - 500 i'5 00 /7� Z SIGN, GASSIGN AND ONE CIRCUIT 5.00 APPROVALS v DATE INSPEC SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS I00 TEMP. POWER POLE SERVI CENOT OVER 600 VOLTS OR 200 AMP 300 3 'UNDERSLAB WORK SERVICEOVER 600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT TEMP SERVICE,POLE, &APPURTENANCES 500 WIRING *7Y91 TEMP LIGHT OR RECEPT. SYSTEM 300 FIXTURES POWER AUTHORIZED ' .1 UTILITY CO. NOTIFIED A";-, - 6 FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN'CHECK FEE 'PERMIT ISSUING FEE 300 ' TOTAL FEE PLAN CHECK VALIDATION" CK. M.O CAS PERMIT VALIDATION'. cK. ' M 0 CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 7"663 DSS SA 25M SETS 11-46 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES �� M 1 WILLIAM J: FOX CHIEF ENE31NEER DISTRICT NO. GROUP ZONE _ PERMIT NO. FOR APP ICANT TO FILL IN n ELECTRICIAN RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION _ r ADDRESS _94 CITY TEL. NO.'aOtf�,F76%r, -I Gj LICENSE NO. EXPI RE S/ 0 BUILDINp (� ADD REBS 67- DESCRIPTION DESC IPT ON OF WORK ; FEES LOCALITY - . NUMBER OUTLETS EACH J CROSS LIGHTS 5C $ STREET �jT RECEPTACLES 5 - 12 C/ FIXTURES 5 OWNER I� WALL SWITCHES, 5 MAIL ADDRESS v o o ELEC. RANGES 25 ELEC. HEATERS 25CITY TEL: NO. misc. ' 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LICENSE. LIGHTS RECEPTACLES MOTORS ELECTRICIAN. KIJMBER HORSEPOWER FEE NEW MVD. HP OVER INC. EACH - I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- 1/2 & LESS $ .25 ERTY DESCRIBED ABOVE.' %2 ' 2 .50 2 5 1.00 OWNER. 5 is 1.501INSPECTION RECORD is 50 50 200 5.00 zoo Soo 10.00 SOO 1 OOO 15.00 -I OVER 1000 20.130I Z M.G. SET/FREQ. CHANGER-HP d WELDERS: AC-KVA ' 'Y O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF ORIG.) MISC. SIGNS TYPE: NO.TRANS. TYPE: NO. LAMPS APPROVALS PERMIT FEE DATE INSPECTOR'S NAME FOR ISSUING PERMIT: CONDUIT WITHOUT FIXTURES $1.00 WIRINI3 WITH FIXTURES FIXTURES SUPPLEMENTARY .50 POWER ' TOTAL FEE $ 9 UTILITY CO. NOTIFIED )-n FINAL e WORKERS' COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT I'hereby affirm that I have a certificate of consent to self CE-8066 - 16-... insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY' o �erti ��gy thereSec 3800, Lab C.) a cy a J ompany JAT�T FOR APPLICANT TO FILL IN., JOB Certified co is,hereb furnished. EACH NO FEE ADDRESS PY' Y New Residential Bidgs. & Pools Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY NEAREST ' tion department Multi-family Sq. Ft. ,CROSS ST " _ Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATCOF EXEMPTION FROM ORKERS' � MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw.� 6- Ov ADDRESS 2 This section need not be com leted if the work Involved-by First ti (/ ' ( P Y Total No. 'Additional Q CITY Tel No. the permit is for one hundred dollar's ($100)or less.) Additional Z that in the performance of the work for this PLAN CHECK I certify P APPLICANT Ins permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws Lighting Fixture First 20 ADDRESS Total No. Additional I Date Applicant - i CITY Tel No Fixed A Iplwnces Not ver 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-ihe'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 Tel. No. -LICENSED CONTRACTORS DECLARATION Hood Fan Other_ Disp Room Air Cond 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 PROCESSED BY and,Professions Code,and my license is in full force and effect Power Apparatus& Large Appliances _ d t An Size &Type HP, KW, KVA, or KVAR Q License Numnber�'j�p`w- s 9 Lic Class('' Up to 1 Incl. FINAL V Contractor/9EAUE-1 B0IL1)C�•-C Date �' �� q Over 1 to 10 Incl. DATE �� VA ATION Q ❑ Over 10 to 50 Incl. FINAY U I am exempt under Sec. Over 50 to 100 Inc. BY / L I Over 100 B &P C. for this reason Date- Services, Swbd , MCC & Panelboards - - 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 Sign wrth,One Branch Circuit, _ I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Grcuits 2 6 1..8 A Low for the following reason (Section 7031 5, Business and Professions Code): t # o o e e o 2 / Misc Coriduits& Conductors I, as owner of the property, will do the work and:the �.e e 51L.00 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , , 7044; Business and Professions Code) 5 U O 0Z0 0'P CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for G a O8—8 5 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 017 17 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 jaws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon Q 4 the ove-mentioned rope fo inspection purposes. 4 . 1. ' - SEE `REVERSE FOR•EXPLANATORY LANGUAGE ` Signature of UrrAl to Date