HomeMy Public PortalAbout9842 LA ROSA DR_Electrical__ 7GA663-CES06 4-64 APPLICATION FOR ELECTRI. AL ER T-
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILD)NG
BUILDING AND SAFETY DIVISION ADDRESS �-
JOHN A. LAMBIE„COUNTY ENGINEER
COLEMANW. JENKINS.'SUPT. OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPTACLES// TOTAL NO, EACH FEEJL'ourLET6
LIGHT FIRST OWNER
20� S.20 0
MAIL
SWITCH
r �h l OVADD L
ER 20 .10 ADDRESS
TOTAL I FIRST 20 20 CITY TEL. NO.
LIGHTING 1y FIXTURES
FXTURES J ADD LA CONTRACTOR
OVER 20 qq
RANGES CLO.ORYER4 WTR.HTR4. 1.00 ADDRESS ✓
GARB.DISP. STA.COOK CITY �J Off.
DISHWASH. AUTO.-WASH. TEL. NO.
STATE, � A �j
SPACE HTRS. � STA.APP.(gy H.P.TIAX.) .50 �� LICENSE NO. V V�b
MOTORS: OVER NOT OVER H.P. DIST T 7. GIJJP N P 00 BY
O 1 11.00 �f ��
911
1 — 3 1.50 INSPECTION RECORD
3 8 12.00 1
8 , 15 12.50 1
15 50 3.00 1 O
50 100 5.00 L.1
09
SIGNS: NO.TRANS. O
NO.LAMPS . I�
SERVICE 0.600V.NOT OVER 200AA 1.001 oV - d
N
SERVICE 0-SOON-OVER 200 A. 2.00 Z
SERVICE OVER 600V 5.001 -
OTHER )SEE COMPLETE FEE SCHEDULE)
j I
PERMIT ISSUING FEE 1
SU PPLEM ENTAgY PERMIT I66UWG FEE TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE
1HEREBY ACKNOWLEDGE THAT I HAVE READ IICgTION UNDERSLAS WORKAND STATE THAT THE ABOVE 15 CORRECT AND O COMPLY ROUGH CONDUITWITH ALL COUNTY ORDINANCES AND STATE LGULATINGELECTRICAL WIRING. WIRING ��/ ZOO
1 HEREBY CERTIFY THAT 1 AM PROPERLY RED ANO/OR FIXTU REBLICENSED AS REOUIREO BY LOS ANGELES COUSTATE OFCALIFORNIA OR THAT AM THE LEGAL OWNER ONTEND TO POWERRESIDE IN,THE ABOVE ESCRIBED RESIDENTIgLTY.
61GNATURE UTILITY CO.NOTIFIED
OF PERMITTEE li,•
FINAL 1Y
LIDATION JOSEPH C. ROOHA4L/
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
L c4 0 8 9�S AUG 11 2 D 1 0.80 v
J '
WORKER S'COMPENS ATION DECLARATION 63
CE806G (2 80) APPLICATION
FOR
ELECTRICAL
PCRM1T
,
I herebyl3ffirm that I have a certificate of consent to self COUNTY OF LOS ANGELES ��.:�, BUILDING AND SAFETY
ibsure, or a certificate of Workers'Compensation Insurance,or '
a certified copy thereof(Sec. 3800, Lab. C.)
FOR APPLICANT TO FILL IN JOg �jI,//
Policy No. CompanCertifiy ADDRESS 2 /•) /7
' New Residential Bldgs.&Pools EACH NO. FEE
r%7
sed cop 1 &2-Family,5q. Ft.
, $ — $ LOCALITY
y is hereby furnished.
Multi-family.Sq. Ft. — NEAREST qq
Certified.copy is filed with the county building inspection CROSS ST r7 LL)
departments _ Residential Swimming Pools OWNER OR n�
FIRM NAME
Date Applicant Outlets: Rec. L Light_ Sw._ �. AMA DRESS
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY - Tel No. �
COMPENSATIONINSURANCE }
PLAN CHECK CL
(This section need not be completed if the work involved APPLICANT O
by the permit is for one hundred dollars ($100) of less.) Lighting Fixtures First 20, _ ADDRESS
Total No. Additional O .
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. F
permit is issued, Ishall not employ any person in any manner - PERMIT n�romf• /,. W
5o as to become subject to the \Vorkers' Com pen anon Laws. Range_ Heater_D.W. ' APPLICANT /P=21/ �Y=/t"7 a
Oven _ Dryer_W.M. ADDRESS / U)
Z
7 Top FAU _W.H.' CITY �� Tel N0. - 7
Date= pelican[ —
Hood _ Fan —Other—
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._ LICENSE OR
Exemption, you should become 'subject to the Workers' REG. NUMBER G Class 14
Compensation provisions of the Labor Code;:you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCE SED BY
with comply with such provisions or this permit shall be Size& ype HP,KW, KVA,or KVAR c (/
deemed revoked. // 5' J i 6
Up to 1 Incl..
FINAL
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 50 In7 _da, VALIDATION
Ind.
I herebv affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL ! '
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY �or F—!-
ness and Professions'.Code, and my license'is in full force and
effect. /J Services
License Numbe Lie. Class 17 0-200 Amp. Under 600 V r��Cl�/ �
(',� 201-1000 Amp. Under 600 V r 7 :21 '4:1•'6 A
Contractor Date �—>Z5—ll Over 1000 Amp.or Over 600 V �2 e e `Z
HOME OWNER BUILDER DECLARATION Temp. Power Pole&Appurtenances .. 2 e e 1 0.00
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit _
License Law for the following reason.(Section 7031.5. Busi- Additional Sign Branch Circuits ' e o e 1 Q 0
D 0
ness and.Professions Code): - o.T 2 5.—$O
Misc.Conduits&Conductors v
L as owner of the property, will do the work and the Other (See Complete Fee Schedulel``
structure is not intended or offered for sale (Section
7044, Business and Professions Code).• -
CONSTRUCTION LENDING AGENCY t
1 hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
issued (See. 3097,Civ.C.). PERMIT FEE (Sub-Total) J,
'Lender's Name PLAN CHECKING FEE (One�Fourth Permit Feel
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE _ / V 010
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
here) authorize representatives of this County to enter upon '
the i ve-mentione 'op y fo upection purposes.
7� cX/ SEE'REVERSE FOR EXPLANATORY LANGUAGE
O
$rgnature of Permittee Date '
COUNTY OF SAS ANGELES TEMPLE CITY k 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS £L 0508 1205300023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
JTR: 9481 LT: 16 9842 LA ROSA DR
1FEE DESCRIPTION: QUANTITY: DOM: AMOUNT 1 TEMP CA 917803920
(ASSESSOR INFORMATION NUMBER: I - I NEAREST CROSS STREET: AGNES
18589-022-015 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
I 1LB 200 AMP PANELS, MCC . 1.00 PAN 38.90 1 I
ITENANT: I TOTAL FEES 66.70 TISSUED ON: PROCESSED BY: PLAN BY:
105/30/12 SR
OWNER: TEL. NO: IFI TE FIN B') CODE:
19842ALMACEL
LA RO VI CTQR;NANGY (626) 286-7791-
119892 LA 8039 DR OF
TEMP 917803920 1 R PT ION OF WORK I
REPLACE 100 AMP SERVICE WITH A 200 AMP SERVICE REWORK EXIST1
ING A/C WITH PROPER SIZE WIRE
APPLICANT: - TEL. NO:
IPUTZIER, GARY (818) 692-6980-
15932 ALDEA AVE ISPECIAL CONDITIONS:
111
ENCINO, CA 91316
CONTRACTOR: TEL, NO: IAPFROVALS DATE INSPECTOR SIGNATURE
IG P ELECTRICAL INC. (818) 692-6900-
15932 ALDEA AVENUE LIC. NO (TEMPORARY POWER POLE
1ENCINO CA 91316 506184C-10 '
UNDERGROUND CONDUIT
I 1 11 I I I
1ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND "}'
LIC. NO: (ROUGH CONDUIT
IROUGH WIRING
IMAIN WATER LINE
PLASTIC YIN METAL YIN
1UTILITY COMPANY NOTIFIED( (
I 1 1 1 111 I
11111 a � �_ � 11111
111 ADDITIONAL DATA ON FILE 111 111
i REPORT ID: DPR265 ROUTE TO: BS0508