HomeMy Public PortalAbout9855 LA ROSA DR_Electrical__ 76A663-CEp06 4-68 APPLICATION FOR ELECTRICAL PERM . .
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER /�
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY (� 4
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NO. EACH FEE
RECEPT,_ is $ OWNER
MAIL
LIGHT_ TOTAL FIRST.20 .20 ADDRESS ,$/} lQ ,
SWITCH_ OVER 20 .10 CITY q0 Q 41' TEL. NO.
PLAN CHEC
LIGHTING lTOTAL FIRST 20 .20 APPLICANT
FI%TURES J OVER 20 .10 ADDRESS
RANGE_DRYER—WTR.HTR.— CITY TEL, NO,
STA.COOK_DISP. F.A.U._ CONTRACI-OR l ( p
SPACE HTR,_AIR COND.— ADDRESS
CLOTHES WASH._DISHWASH._ CITY TEL. NO.
FAN—OTHER 1-.00 LICENSE IJO. CLASS.
MOTORS,TRANSFORMERS RATING
IND. HEATEfl S, ETC. HP, KW. KVA. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE 6 TYPE OVER TO AND STATE. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
0 - 1 1.00 ELECTRICAL WIRING.
HEREBY CERTIFY REQUIR THAT AM PROPERLY REGISTERED AHD/OF
1 10 3.00 LICENSED AS REQUIRED EO BY LOS ANGELES COUNTY AND STATE OF
CACIDE NIA OR THAT VE THE LEGAL OWNER OF, AND INTEND T.
10 50 5.00 RESIDE IN, THE ABOVE DESCRIP.ED RESIDENTIAL PROPERTY.
50 - 100 10.00 SIGNATURE d
OF PERMITTEE �� U
100 - soo 15.00 DISTRICT GR P ZO E P D
0
SIGN.GAS SIGN AND ONE CIRCUIT 3.00
TUBE, OR W
MARQUEE ADDITIONAL CIRCUITS 1.000-
NOTES: y
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 z
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE. POLE, 8 APPURTENANCES 3.00 APPROVALS DATE MSPECTW'S SIGNATURE
TEMP. POWER POLE
UNDERSLA B WORK
ROUGH CONDUIT
WIRING �z
PERMIT FEE (SUB TOTAL)
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED /
PERMIT ISSUING FEE 2.00 UTILITY CO.NOTI FIED � .S 1A 'p/'O' //f -A-
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL Pte! � - �'—
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENG R
PLAN CHECK VALIDATION CK. Ni.o. CASK PERMIT VALIDATION CK. M.O. CASM
(AC? 4 4 3- MOV27 2 D
r!} 0
te_•.0.o
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
a"NfORKCOMPENSATION DECLARATION' 76A663 Yaiei APPLICATION FOR ELECTRICAL PERMIT ' {1
CE-808G u
I here
by affirrcf that at I have a certificate of consent to self insure,or a certlficabo of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES IBUILDING AND SAFETY
-copy thereof(Sec. 3800.Lab.C.)
` Policy No. CompanyFOR APPLICANT TO FILL IN JOB -
❑ •Cerhfied,copy is hereby furnished.,' - New Residential Bldgs.& Pools EACH NO. .FEE - ADDRESS'
- 1 8 2-Famil LOCALITY ° -�
Certified'copy is filed with the county building. inspection y,Sq.Ft: $ — $
department..:
Multi-family-Sq,Ft. CROSS'NEAREST
. e5
Date Applicant Residential Swimming Pools OWNER OR -
FIRM NAME. J
i CERTIFICATE'OF EXEMPTION FROM WORKERS Outlets:'Rec� Light _J_ Sw.'�' MAIL
- COMPENSATION INSURANCE " ADDRESS.
(This section need not becompleted if the work involved bey the First 20 �• *"` '
permit is dor one hundred'dollars.($100) or less.). '..Total Nd. '•3 AdditionalCITY - Tel.No.
• PLAN CHECK' ,.� ..
certify that-in the performance of the,work=for which this permit •. - - APPLICANT :•.-
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 - ,ADDRESS e?
Additional +••+ (
7 Total No. - - CITY Tel.No. '•}
Date Ot Lacen4 Fixed Appliances Not Over 1 HP
.NOTICE TO APPLICANT If, after making ,this Certific to of PERMIT
'Exemption,you should become subject to the Workers'.Compensation Range_ Heater_ D.W. APPLICANT
provisions of the Labor Code, you must forthwith comply'with such Oven Dryer _ W.M._ ADDRESS
-.provisions a,l this permit shall be deemed revoked. "., •' ,Top FAU _'W.H. .
LICENSED CONTRACTORS DECLARATION. - CITY Tel, No. -
p Hood'_ Fan Other_
. Thereby. affirm that f am licensed under provisions'of,Chapter 9 LICENSE OR
Disp. Room Air Cond. REG.NUMBER - Class:.
_ (commencing with Section 7000) of Division`3 ot;the'•Business and - -
Professions Code,and my license is in full force and effect. DISTRICT NO PROCESSED BY
.:Power Apparatus.& Large Appliances- .. . ;� � � -
- - Size& Type HP,KW,KVA,or KVAR J O
License Number tic.Class ' Up to 1 Incl. FINAL "" U
i Over 1 to 10 Ind. - DATE t-I VALIDATION O
Contractor
Date' Over 10 to 50 Inc.' FINAL 1 ,/ `-/ f IF
IF
❑ am exempt::under Sec. Over 50 to 100 Inc. gy v �' _ {V
t + %� ti 0'
'B&PC Over 100 far this reason N.
.Services SWbdi,:MCC&Panelboards - Z
Date: 0 200 Amp.Under 600 V
Signature 201 - 1000 Amp.'Under 600 V' �I O II�`✓{�1112 /11
❑ .`•
over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Else YYY
SINGLE FAMILY ' ' Temp.Power'Pole& Appurtenances. ` i'in, ��•^ '
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ' r
I hereby affirm that I am exempt from the Contractor's License Law _ '3 9 Grl]
for the following reason (Section 7031.5, Business and Professions`" ' Additional Sign Branch Circuits'. _
Code): - .Tl]f Il 12 n 7-5
Misc. Conduits &Conductors - .1?a�q
❑ I,asowner of the property,will do the work and the structure Other(See Com tete Fee Schedule)
Z
is not intended or offered for. sale'(Section 7044, Business ,, ... p .. .-. ..
[: in}
and Professions Code). �
CONSTRUCTION LENDING AGENCY ' * -
I hereby affirm that there is a construction lending agency for the ' i''{'"1-�¢' 7V •1r` ,E
performance.of the work for which'this;permit is issued(Sec.3097, 'PERMIT FEE ' (Sub-Total) I' } (i 4,'5Z�•y
PLAN CHECKING FEE. - . --
Lender's Name I I -
• . PERMIT ISSUING FEE.. - V
Lender's Address � ... '
I certify that.h 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 inspection purposes. -
'-SEE REVERSE FOR EXPLANATORY'LANGUAGE. -.
Igna ure of Permittee - - Date ,