HomeMy Public PortalAbout9612 LA ROSA DR_Electrical__ 79A6E3.CE806 ,D-B= APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES '
DEPARTMENT OF COUNTY ENGINEER BUILDING . .. ,
BUILDING AND SAFETY DIVISION . . ADDRESS
JOHN A. LAMBIE,-COUNTY ENGINEER ,
WILLIAM A.JENSEN, SUPT of BUILDING " LOCALITY _ C
NEAREST, -
FOR APPLICANT TO FILL IN CROSS ST. — C _
RECEPT. TOTAL NO. EACH FEE
OUTLETS FIRST 20 8 20 S 0 OWNER
uGHT. MAIL
s WITCH. T T ADD L ADDRESS
OVER 20 .1G
1 TOTAL CITY TEL
NO. [J
LIGHTING. I rlRsr20 . .20 _ —
FIXTURES 11 J. OVER
•'
ovER 20 .lo ELECTRICIAN
,RANGES CLO.DRYERS WTR.HTRS. 1'.00 ADDRESS
GARB.OISP.'' ETA.COOK
CITY O TEL.NO. -7 6
OISHWASX: AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(9a H.P..MAX.) .50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT G Z P D B _
r
01.00 .r
+ 3 1.50 J INSPECTION RECORD
3 a 2.00
1 s 2.50 %!f!LJG�.
B ` /thf" ,�� ) -� O
�. .�'LLlA� iL' �!i�. •I V.
iS so 3.00cd
- _v �- �-- ✓- _ _ O
.50 foo 5.00 - -. i t- 0
SIGNS: NO.TRANS.
NO,LAMPS /V -y +\ •_f� y
SERVICE O.60OV-NOT OVER 200A 1.00 - /
r
SERVICE 0600V-OVER 200 A. 2.001 y
SERVICE OVER 600V 5.001 -
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 ..
TOTAL.FEE - $
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE I NSPECTOR'S'SIGNATURE
'AND STATE THAT,THE ABOVE IS CORRECT ANDAGREE.TO COMPLY CONDUIT � _f�
WITH ALL'COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING., - _ -
'y WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -
LICENSEO AS REQUIRED BY LOS.ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LE WNER OF T_XE ABOVE
DESCRIBED RESIDENTIAL PRO RT POWER
POWERSIGNATUR -
OF PEI r E UTILITY CO.NOTIFIED'
FINAL I�3
VAUDAT ARTHUR C VETT
SUPERVISING.ELECTRICAL ENGINEER:.
CK MID CASH -
ltlty 9 7`4 21G SEP 4 2 0 5.8'0-
hN . WORKERS' COMPENSATION DECLARATION :W.WI9DPW3/97 APPLICATION FOR ELECTRICAL PERMIT 0
eby affirm that I."have a certificate of consent to self 'CE 806G
inspire, or a certificate of Workers' Compensation Insurance,. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
aro certified F6py thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN - TOB
r-1S f
Cetaified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS b
_
❑Certified copy is filed with the county building inspec- 1 82-Family, Sq. FL $ $ 1 1,1LOCALITY
tion department. Multi-family Sq, Ft. CROSS NEAREST
T \
'Residential Swimming Pools
Date—Applicant - .OWNER OR (T
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re< MAR
II., Light_ Sw.�2-
COMPENSATION,INSURANCE ® /J' Q ADDRESS
(This section need not be completed if the work Involved b First 20
Additional . b(J / CITY' ,.� Tel. NSS1 I
Y Total No. -I
the permit is for one hundred dollars ($100)or less.) -
certify that in the performance of the rPLAN CHECK
r which this APPLICANT
permit is issued, shall not employ any person son in in any manner -
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 Q `00 ADDRESS
Date—Applicant
?� Additional
Total No. 9/11) CITY Tel. No.
I
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over I 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 sholl be
deemed revoked. Top — FAU �O;He`
Hood.— Fan = CITY Tel.'No.
LICENSED CONTRACTORS.DECLARATION ' OR
Disp. Room Air Cond. LICENSE
hereby affirm that am licensed under provisions of Chapter 9 - REG. NUM
BER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus B-Large Appliances DISTRICT NO. R ESSED BY >-
and Professions Code, and my license is in full force and effect. .. • Q O_
Size 8 Type HE, KW, KVA, or KVAR p
License Number Llc. Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DATE 9 _(�_ VALIDATION 0-
Contractor Date - Over 10 to 50 Incl. FINAL 7 E-
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
B.BP.C. for this reason Over 100 O_
Date: Services, Swbd., MCC B-Ponelboards CO
- - I 1 0-200 Z
Q Z
Amp. Under 600 V i — '
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg, Main,. Elect.
SINGLE FAMILY Temp.'Power Pole 8 Appurtenances
HOMEOWNER-BUILDER DECLARATION - - -- -
I herebyaffirm that am exempt from the Contractor's License Sign with One Branch Circuit - z
p Additional Sign Branch Circuits ' 1 'a
Law for the following reason (Section 7031.5, Business and g _
Professions Code):viij
I, as awrer of the property, will-do the work and the 'Mise. Conduits 8 Conductors i :)FNS
.structure is not intended or offeredfor sale(Section 7044, Other (See Complete Fee Schedule)_ , t _ „�
Business and Professions Code). •• TOTAL AL 100 = 20
CONSTRUCTION LENDING AGENCY,
1 hereby affirm that there is a constructionlending 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 Nome 1_Ljk lij-I_tG,t ,
PERMIT ISSUING FEE �3 p D ry r -,
Lender's Address - fGr!'D i Hr's 6=:fir
I certify that I have read this application and state that the I TOTAL FEE
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-mentioned perty for inspection pu� Y SEE,REVERSE FOR EXPLANATORY LANGUAGE '
Signature of Permittee Dote $I