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HomeMy Public PortalAbout9469 LA ROSA DR_Electrical__ 76A663C- CE8069 12/75' APPLICA ON FOR ELECT ICAL PERMIT. + BUILDING D SAFETY DIVISION ` �. FOR APPLICANT TO FILL IN JOB - N ewResidential Bldgs.& Pools EACH NO. FEE ADDRESS 2 Finaily Sq. Ft. $ — LOCALITY lti-family Sq: Ft. — NEAR'EST CROSS ST. (,Q ntial Swimming Pools OWNER OR c IoAn'N&t`nG € ' Outlets: Light, Switch & Receptacle' MAI L �[1 First 20' } �o6 ADDRESS �c,6 'i-' ' Additiorial CITY Tel' No PLAN CHECK Lighting Fixtures APPLICANT 20` � ADDRESS First Additional CITY- Tel No PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range Heater D.W. ADDRESS Oven Dryer VV.M. Top FAU VV.H. CITY Tel No �- ,Hood ✓ Fan LICENSE OR° d O Disp. A.C. O V REG NUMBER Class. C_') . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY C-3 - Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING W Size&Type HP, KW, KVA,or•KVAR ELECTRICAL WIRING, _ cn UpU' to 1 Incl. Z 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTER EO AND/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER. OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDENT L PR .1 Over,50 to 100 Incl. PERMITEE Over 1OO SIGNATURE r DISTRICT NO. ROC SED BY Services _ �^ 0-200 Amp, Under 600'V �J� 201 - 1000 Amp. Under 600 V' APPROVALS DATE INSPECTOR'S Over"1000 Amp.or Over 600 V - SIGNATURE TEMP. POWER POLE Temp. Power'Pole&Appurtenances UNI7E9SLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign Branch Circuits (Other)' - WIRING - FIXTURES POWER ALTHORIZED PERMIT FEE (Sub-Total) UTILITY CO:NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL- 7-27-7 PERMIT ISSUING FEE NOTES TOTAL FEE PLAN CHECK VALIDATION CK. M.o C SH PERMIT VALIDATION CK. M.O. C 5`5 7 r MAYS .27 2 0 1,920 I r •r WORiIERS' COMPENSATION DECLARATION DPW 3/87 76AW APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec 3800, Lab. C.) Policy No- Company FOR APPLICANT TO FILL IN JOB ^ Certified copy is hereby furnished. New Residential Bldgs & Pools EACH NO FEE ADDRESS 1 /C Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. -- NEAREST Residential Swimming Pools CROSSST OR Date Applicant //��]] FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets- Rec�Light T Sw 2 L _COMPENSATION INSURANCE ' First 20 7 ADDRESS (This section need not be completed if the work involved by Total No. Additional �a CITY- ` Tel No -I g'17 the'permit is for one hundred dollars ($100)or less.) PLAN'CHECK 1 certify that in the performance of-the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 3 ADDRESS so as to become subject to the Workers'Compensation Laws g g �a Additional Date Applicant � Total Ni . CITY Tel. No. NOTICE TO APPLICANT If, after making this Certificate of Fixed Applian es Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater—D.W. — APPLICATION 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. 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. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances / DISTRIC ED B O. PROCE Y >- and Professions Code,and my license is in full force and effect ai d -Size&Type HP, KW, KVA, or KVAR c7 t u O License Number Lic. Class V Up to 1 Incl. FINAL r Date Over 1 to 10 Incl. DATE i-�Q VALID ION cr Contracto Over 10 to 50 Incl. FINA vv CL O I am exempt under Sec Over 50 to 100 Inc. BY LU B&P.0 for this reason / U Over 100 7� � Services, Swbd., MCC& Panelboards ZZ Date: 0-200 Amp. Under 600 V Signature 201-- 1000 Amp. Under 600 V QExemption for Reg. Maint. Elect Over 1000 Amp. or Over 600 V SINGLE FAMILY •07 Q4 A HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances x I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit '#.o 0 o m o 2 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits A -"o 2 6 2 5 Professions Code): 1, as owner of the property, will do'the work and the Misc. Conduits &Conductors ` Q 9,1 9- structure structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ 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 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 L f 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 the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ± I I g? gnature of Permittee Date ©s I