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Home My Public Portal About9812 LA ROSA DR_Electrical__ 76A663-'En610/72 APPLICATION F R ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB CCf 12 ! �0 y� BUILDING AND SAFETY DIVISION ADDRESS d 1, L CPl LOCALITY ' � TCNEAREST YC T FOR APPLICANT TO FILL IN CROSS ST. FT1L-b LV i Imo/ OUTLETS NO. EACH FEE OWNER OR + $ $ FIRM NAME W is/, P�IGHT DDRESS ) n T. Ll A � L^ RV s� " LIGHT_11\ TOTAL FIRST 20 .25 Z � CITY y.�GG F (y �2 („ Ci TEL. NO. T-U�Z7 / OVER 20 SWITCH_ .10 PLAN CHECK GHTING TOTAL LFIRST 20 25 APPLICANT FI%TURES .10 I OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGEDRYER_WTR. HTR._ APPLICANT r �FT�/w All. STA. COOK_OISP. F.A.U. 1� ADDRESS "LO Q- N. PeL�L p(/ SPACE HTR. AIR GOND. CITY J (,�«��/ (�J}'� TEL. NO.571-7/d CLOTHES WASH. DISXWAS H._ LICENSE EG NNUMBER `b J O CLASSC-Z0 FAN_OTHER / 1.00 % O I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION NO 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. SIZE & TYPE OVER TO /, HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR D - 1 1 1 OO 1 V O LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIF 0 RNIA OR THAI I AM THE L OWNER OF THE ABOVE ].. 3' 1 - 10 3.00 `.� " OESCPIPEO RESIDENTIAL ROPER Y. O 1. V PERAl FIE V 10 - 50 500 SIGNATURE CO 50 - 100 10.00 U DISTRICT NO. P CES D BY Ly [L 100 - 500 15.00 SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'SISIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICENOT OVER 600 VOLTS OR 200 AMP / 3.00 J �� UNDERSLAB WORK SERVICE OVER 600 VOLTS OR 200AMP IGOD ROUGH CONDUIT TEMPSERVICE, POLE. &APPURTENANCES 5.00 WIRING _/ ' ' TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL 7'7' ` PERMIT FEE (SUB TOTAL) O ZJ NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 300 o TOTAL .FEE 1 F Z' PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION r C�; M.O. CASH 3 9 6 3'3 DEC 4 � 0 1 1 .25n SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE L.� ` r ff-m that I have a COMPENSATION of con RATION. CE-863 APPLICATION FOR ELECTRICAL PERMIT {� I hereby.affirm that I have a certificate of consent to self insure, CE-806G LJ or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof (Sec.3800,Lab, C.)'. PO IGY No- ' .Company; FOR APPLICANT'TO,FILL.IN - JOB'' �-Certified,copy is hereby furnished. ., New ResidentiahBldgs.8 Pools- .EACH NO, FEE.: ADDRESS' ' - Certified copy is filed withillcounty building inspection 1 & 2-Family,.Sq.FL S — S LOCALITK �dg`partment " Multi family Sq. Ft — 'f NEAREST . `J .li^ Resdenhal.Swimming Pools CROSS ST Date Applicant OMER OR t, •„ y�' 23" FIRM.NAME CERTIFICATE OF EXEMPTION FROM WORKERS' 't., MAIL ". Outlets:Red— Light Sw - COMPENSATION INSURANCE : ADDRESS First 20 (This'section need not be completed if the work involved by the / _ ' -' p-,. -� .CITY Tel.No permit is for one hundred'dollars($100);or.less.) a Total No. Additional 7 C• ) I certify that in the,performance•of thework for whichthis•permit -APPLAPLICANT CHECK is issued, I shall not employ any person,in a6y manner-so as s become subject to the Workers'Compensation.Laws. Lighting Fixtures First 20 ADDRESS- Total DDRESS". ' ' Additional Total`'Np. - 'CITY -Tel.No.- Date Applicant - Fixed AppliancesNot Over 1 HPPERMIT 7 - ' NOTICE .TO APPLICANT: If, after making this Certificate of - - Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W.._ APPLICANT' �QJ .provisions of the Labor Code(yod must forthwith comply with such Oven _ Dryer _ WM._ - ADDRESS. ` provisions or this permit shall be deemed revoked. Topp — FAU _ WH. _ LICENSED'CONTRACTORS DECLARATION - Hood — Fan Other_ CITY-'�L Tel Ni . I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of DMgion'3 of the Business and Disp.�— Room Air Gond. -- - REG.NUMBER .� - Class. Professions;Code,and my license is in full force and effect. Apparatus 8 Large Appliances DISTRICT NO. PROCESSE - Power - _ - Size&Type HP,KW,KVA,pr KVAR License Number Z 1 b ) /C-1 Lic.Class '" '-- "', `>' FINAL ver 1 to 101nc1. D U Up to 11nc1. (� Oi d' ContractorQ) L' �1'1\�-t'F Date .. ✓(/.(/ _ p' ATE VALIDATION - Over 10 to 50 Incl FI ` , am exempt under Sec.- Over 50 to 100 Inc. B -U i e&P.C. for this reason Over 100 -. Services, Swbd.,MCC& Panelboards' ;U) Date: 0-200 Amp.Under 600 V Signature. 201 --1000 Amp.Under 600 V, - "" 9 Q 6 2 4 A. , ❑ -' .'- Over 1000 Amp. or Over 600 V ^- , Exemption for Reg.Maint.Elect - ., 1r # �'�'-� 2', SINGLE-FAMILY ' Temp.Power°Pole&'Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit - 'l 5'0 I hereby affirm that I am exempt from the Contractor's License Law .�'�• for the following reason(Section 7031.5, Business and Professions Additional Sign.Branch Circuits Code): Misc.Conduits & Conductors -- - - UEl I,as owner of the property,will do the work and the structure Other(See Complete Fee.Schedule) is not intended or offered for sale (Section 7044, Business - , ` and Professions Code). CONSTRUCTION LENDING AGENCY - -- - -- - - --,' '- - - ' 'I hereby affirm that there is a construction landing agency for the _ performance of the work for which this permit is issued(Sec.3097, PERMIT FEE - (Sub-Total)' Civ:C.). _ a,. . _ PLAN CHECKING.FEE Lender's Name ' - ' ` PER ISSUINGFEE (/ _ 'Lender's Address' � 1 �'j ,I certify that I have read this application and state that the above - TOTAL FEE r- �Q(J ' information is correct. I agree to comply with'all County ordinances and State laws regulating Electrical wiring,and hereby authorize r esentatives of this County to enter upon the above-mentioned erty}o ins ed ion purpose - SEE REVERSE FOR.EXPLANATORY LANGUAGE _. C1lz�- ' Signature of Permittee Date WORKER'S haveCOMPENSATIONcertificate DECLARATION 76AB690PW 9189 APPLICATION FOR ELECTRICAL PERMIT 0-001 I hereby affirm that I have a certificate of consent to self insure, of_a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy.thereof(Sec. 3800 Lab.C.), -- - / I Policy NO Company FOR APPLICANT TO FILL IN - pDOREB3 OB /}(�/2 /-.O_ goe ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH - NO. FEE - ❑ $ — $ LOCALITY k Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. NEARESTde department. Multi-family Sq Ft. CROSS STWecLsP Date Applicant Residential Swimming Pools 'ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rea Light Sw. /7O OW / ,r__ / COMPENSATION INSURANCE FIRMM NAME NAME MYIGIb( First 20 MAIL o(Y '7� p per(Thmit is for need not be domes ted($1 if the work involved by the Total No. Additional ADDRESS /p! IN /9/1✓'l.. permit is for one hundred dollars($100)or,less:) � p I certify that in the performance of the work for which this permit - - CITY Tel.No. 3a9-�/0J3 is issued, I shall not employ any person in any manner so as to _ 7 become subject to the Workers'Compensation Laws. Lighting Fixtures / First 20 0 PLAN CHECK APPLICANT ' Total No. Additional ,. ADDRESS Date Applicant NOTICE-TO APPLICANT: if, after making This Certificate of 1508 20A{120V BRANCH CIRCUITSCITY 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 such11 TO 40 INCLUSIVE EACH PERMIT provisions,or this permit shall be deemed revoked. APPLICANT 41 OR MORE BRANCH CIRCUITS } LICENSED CONTRACTORS DECLARATION - - 'ADDRESS hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH d. (commencing with Section 7000) of Division 3 of the Business and /— CITY Tel.No._ 0 Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO SHP LICENSE OR Class. cc Power Apparatus&Large Appliances REG.NUMBER O License Number Lie.Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. p PRQCESSED BY F.. UP td 3 Incl. W Over 3 to 10 Incl. FINAL d COgtfaCler Date - DATE W Over 10 to 51)Incl. _ Z ❑ I am exempt under Sec. _ Over 50 to 1_00 Incl ` I VALIDATION GVef 100 FINAL B.&P.C.for this reason BY Services,.Swbd.,MCC&Panelboards Date: ,, 0-200 Amp.Under 600 V Signature 201 -1000 Amp. Under 600 V - - - ❑ - _ - Over 1000 Amp,or Over 600 V Exemptiod for Reg.Mains.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances }1'� HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit i'fLl•t.'r I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits � f; Code): ® I,as owner of the property, will do the work and the structure Misc.Conduits BConductors is not intended or offered for sale Section 7044, Business Other See Complete Fee Schedule).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 (Seo. 3097, .PERMIT.FEE - - .._ (Sub-Total) /G - Civ. C.) PLAN CHECKING FEE_ 4/ 1!9_; Lender's Name PERMIT ISSUING FEE � �!Pr�•'.`= 1 (ai''1 `' 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 ection purpose, SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT PATE