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Home My Public Portal About9816 LA ROSA DR_Electrical__ ... °°°'-°° APPLICATION FOR ELECTRIC/PERMIT �. COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING' C/ BUILDING AND SAFETY DIVISION ADDRESS G JOHN A. LAMSIE. COUNTY ENGINEER. CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES ceoss sr. /(J ITEM NUMBER EACH FEE OWNER 1(," OUTLET �) S S MAIL LIGHTS RECEPT.� SW. (/ .10 90 ADDRESS LIGHTING FIXTURES 3 .10 / 3d CITY TEL NO ELEC.RANGES CLO.DRYERS ELECTRICIAN WATER HEATERS .50 ADDRES ELEC.SPACE HTRS. DISHWASHERS CITY TEL. NO. GARBAGE DISPOSERS AUTO. _ / STATNE / / WASHERS STA.COOKING UNITS .2$ .[.S LICESE NO. zic MOTORS OVER INC. H.P. DIST ICT NO. I GRQUP I ZONE PRO ESSED BY O— l/. .25 V! �� v— 2 .50 INSPECTION RECORD 2— 5 1.06 5— 1s 1.5o -T 15— so 2.50 so—zoo 5.00 (^ _ SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-600V 1.00 ` 15 rZ-Y' vP.. SERVICE OVER 600V 5.00 MISC. 4Y- X2.2. �v�l�7J LYs� WIRINGPERMIT 1.00 FIXTURE PERMIT Loo Q� D -�'CO I,N Q SUPPLEMENTARY PERMIT TOTAL FEE 1HEREBY ACKNOWLEDGE THAT I HAVE .READ THIS APPLICATION APPROVALS DATE INSPw.. OR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/ORWIRING LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER O THE ABOVE DESCRIBED RESIDENTIAL O ERTY. POWER 'I SIGNATURE � UTILITY CO.NOTIFIED AL OF PERMITT ! / �b 4� FIN OF DATION - ARTHUR.C.+VETT,.: ` CK MD CASH SUPERVISING ELECTRICAL ENGINEER 1C0 9 1 1 7 2 I'W 1 2 A9.5 w e ,m hA.t I'hCOMPENSATION DECLARATION 7BA669OPW„2-9„ APPLICATION FOR ELECTRICAL PERMIT IJ 60663 I hereby atTirm that I have a certificate of consent to sell insure, or a certificate of Worker's Compensation Insurance. or a certified COUNTY OF LOS ANGELES °D�PI',�F PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800090 pLab.C.) ,yJ,/� POMC DJO/ Company "I' FOR APPLICANT TO FILL IN JOB p ADDRESSLT certified copy is hereby furnished. �—/—�7 New Residential Bldgs.&Pools NO. EACH FEE ❑ $ $ LOCALITY Certified copy Is filed with the county building ins _ 1&2-Family,Sq.Ft. NEAREST depa/rtment. - Multi-family Sq.Ft. CROSS ST. Data o _ Applicant �/ Rmclimtial,Swimming Pools ASSESSOR _ '.( MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' — OWNER OR COMPENSATION INSURANCE Outlets:R.D.RLightSw. �� G FIRM NAME First io O MAIL (This section need not be completed it the work Involved by the ADDRESS O permit is for one hundred dollars($100)or less.) Total No. Atlditional I certify that in the performance of the work for which this permit CITY TeI.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK 11 become subject to the Workers' Compensation Laws. . Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY TeI.No. Exemption,you should become subject to the Workers''Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT Appliances APPLICANTe A Apparatus&Large pp provisions orchis permit shall be deemed revoked. Power AppT 5 LICENSED CONTRACTORS DECLARATION Size 8 Type HP.KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9CITY Tel No. iy (commencing with Section 7000) of Division 3 of the Business and Over 3 to 10 Incl. �G�,«Js Professions Code,and my license i5 in full force and effect. Over 10 to 50 Ind. LICENSE OR J�jp L, Over 50 t0 100 Ind. REG.NUMBER✓i/ V/U Class. a Over 100 DISTRICT NO. SSED BV �v O License Number Lia Class �D V Services,Swbd.,MCC&Panelboards cc ContractorOAn .Date +� 0-399 Amp.Under 600 V FINAL^ ❑ DATE / I am exempt under Sec. 400- 1000 Amp. Under 600 V ( VALIDATION U Over 1000 Amp.or Over 600 VFINAL d B.&P.C.for this reason - BRANCH CIRCUIT FEES BY Date: 150,or 200, 120V, Lighting or Recept. Z 1 To 10 Branch Circuits _ Signature 11 To 40 Branch Circuits 41 Or More Branch Circuits ❑ Exemption for Reg.Maine Elect. 15A,20A,208V To 27TV Lighting Br.Circuits 2 SINGLE FAMILY Temp.Power Pole&Appurtenances AC:C:T.i HOME OWNERBUILDERDECLARATION with One Branch hereby affirm that I am exempt from the Contractor's License Law Sign h Circuit 3,503 35.75 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 1 ITEMS ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 35 e 75 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) r c and Professions Code). ® NECK 355.75 CONSTRUCTION LENDING AGENCY CHANGE '00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Y'k Civ. C) 000a-000i 7i ab PLAN CHECKING FEE Lender's Name L 1273 1 Ah 9°75 PERMIT ISSUING FEE d Lender's Address / I certify that I have read this application and under penalty of purjury state TOTAL FEE 3'.�• 5 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 he a o -mentioned property for ins on Pur e5 s. / SEE REVERSE FOR EXPLANATORY LANGUAGE "'�'�Ln SIGI Tn FPERMDFrEE DATE e WORKER'Shave a certificate of consent to 260019DPW 9/99 APPLICATION FOR ELECTRICAL PERMIT 20A001 I herey w:eff irm 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(Sec.3800 Lab.C.) - - - Policy No. Company FOR APPLICANT TO FILL IN - JOB ❑ ADDRESS /O "Certified copy is hereby furnished. New Residential Bldgs.&Pools I - EACH NO. FEE LOCALITY E] Certified copy is filed with the county building inspection - 1&2-Family,Sq.Ft. $ — $ - department. Multi-family — NEAREST - Sq Ft NEARS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE, Outlets:Rec._Light_Sw._ ,� FIRM NAME First 20 _ (This section need not be completed it the work Involved by the l +� .+ :` ADDRESS permit Is for ane hundred dollars($100)or lees.) Total No. Additional t- - I certify that in the performance of the work for which this permit I -. _ CI t is issued, I shall not employ any person'in any manner'so as to become subject to the Workers'Compensation Laws. - Lighting Fixtures First 20 PLANILANT r. . - Toial No. Additional ADDRESS Date Applicant NOTICE TO APPLICANT: If,-after making this Certificate of —'15 OR 20A,120V BRANCH CIRCUITS - -' _ CITY Tei.Nod Exemption,you should become subject.lo the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Cade, you,must forthwith comply with such --11 TO 40 INCLUSIVE EACH - - - PERMIT APPLICANT provisions or this permit shall be deemed revoked. , 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS I hereby affirm th2t'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 3HP LICENSE OR Class Power Apparatus&Large Appliances _ _ REG.NUMBER O License Number Lia Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. yp PROOEESSv�Ep�B�Y Up to 3 Incl. .._ - -' �oO �! ez mi W Contractor Over 3 to 10 Ind. FINAL Dale d ❑ _ DATE Over 10 to501nc1."I am exempt under Sec_ Over 50 to 100 Incl. FINAL VALIDATION B.&P.C.for this reason - '- Over 100 _ BY Services,SwbO,MCC&Pa o s _ _ Date: 0-200 Amp.Under 6 V�00 O Signature -201--1000.Amp..Under 600 V ❑ - Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. _ _ _ I SINGLE FAMILY1 HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances - �'fi,f.i oy with O Sign wOne Branch I hereby affirm that I exempt from the Contractor's License Law Sigh Circuit •1-r `j��_�'P' for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits �Code): A} SMC LO} I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors _ .. _ - - -. �)f�l•1p .LR�- 1 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ L - 90 and Professions Code). -- _ _ _- f:i 117pv` 417.9111 _e_ v_ 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 (Sec. 3097, PERMIT FEE._ _,. - _ (Sub-,Total) Civ.C.) PLAN CHECKING FE_E J-iIj�'/ry Lender's Name - _ - - - PERMIT ISSUING.FEE �, .F.ju7 L fad' 1=! ' Lender's Address - - I certify that I have read this application and state that the above TOTAL FEE io7e 9 information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize epresentatives of thi ounty to enter upon the above-mentionetl - ope rinspe pu s. SEE REVERSE FOR EXPLANATORY LANGUAGE U E01FAFONLICA;5ollc5NT DATE