The URL can be used to link to this page

Home My Public Portal About9921 LA ROSA DR_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMT (VISION O EER OF COUNTY ENGINELECTRIC DMSION OF BUILDINGh SAFETY WILLIAM . FOR COUNTY ENGINM FOR APPLICANT TO ILL IN DISTRICT NO. GROUP/ ZONE I PERMIT NO. ELECTRICIA AODRES RECEIVED BY READY FOR DATE SBUE � FIRST INSPECTION N �Q7 /�' COUNTY LICENSE NO. R% BUILDING PERMIT FEE$ ADDRESS FEE NUMBER EACH LOCALITY J LIGHT OUTLETS Z Q NEAR ST RECEPTACLES CROSS ST. WALL SWITCHES OWN � TOTAL OUTLETS 5c $ MAIL ELEC. RANGES 26 ADDRES ELEC. HEATERS 25 �5 FIXTURES '� g 00 TEL N �/IJ MISC. I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LI SE. OR I AM THE LEGAL OWNER NSW MvO. HP OVER INC. EACH OF THE REST DENT( PR PE D C ]BED A V Vp a 1-Ess $ .25 SIGNATURE h 2 .50 PER z s 1.00 RECORD s 1s 1.50 INSPECTION / 15 so 2.50C/�,,,o 50 200 5.00 �,C: ( z- 200 800 10.00 Soo 1000 15.00 s� Q OVER 1000 20.00 �G' g .7za M.G. SET/FRED. CHANGER-HP T� WELDERS: AC-KVA I Z'I O GENERATORS -KW TRANSFORMERS-KVA ,1 TEMP. MOTORS (75% OF ORIG.) �� ! ✓1w//Gh Gig - C'Xwr- .�_. MOVED MOTORS (75% OF o51G.) G O MISC. /- SIGNS AP w� N0. NO. TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: DATE INSPE TOR'S NAME WIRING $1.00 aF.TN CONDUIT FIXTURES $1.00 ./NT SUPPLEMENTARY .50ES TOTAL FEE Y CO, NOTIFIED 1 76A 099 DES# 9A. 4-02 I WORKERS'COMPENSATIONDECLARATION 76 680 63 (2-80) CE- 6 APPLICATION FOR ELECTRICAL PERMIT � I hereby-afffrm.^hal I\have a certificate of consent to self COUNTY OF LOS ANGELES 'BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or // - a certified copy thereof(Sec,. 3800, Lab. C.) - L _ Policy No. FOR APPLICANT TO FILL IN 30B .-r/ Company 'c' EACH NO.1 VFEE ADD S x New Residential Bldgs.&.Po�oly5,.q.�Q - ❑ Certified copy is hereby furnished. 1 & 2-Family,Sq. Pt-F $ — $ LOCALITY •. Multi-family Sq. Ft. — NEAREST- `— El Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST r department. ('7 y� OWNER RM NAME Date Applicant Outlets: Re�Light 8 First 2 MAIL First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.�l Additional ?15 CITY _�') el No. } COMPENSATION INSURANCE PLAN CHECK 1 APPLICANT 0 (This section need not be completed if the.work involved (;/" U by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional O 1 certify that in the performance of the work for which thisFCI Tel No. H ixed Appliances Not Over 1 HP U permit is issued, I shall not employ any person in any manner _ PERMIT /� / W so as to become subject to the Workers' Compensation Laws. Range Heater—L D.W. APPLICANT /L(�/ a Oven Dryer_W.M._ ADDRESS N Date Applicant Top FAU _W.H.. z Hood Fan _Other_ ' CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. ..� Room Air Cond._ V" LICENSE OR Exemption, you should become subject to the Workers' REG.NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR C SED BY with comply with such provisions or this permit shall be deemed.revoked. Size&Type HP, KW, KVA,or KVAR el f/ Up to 1 Incl. FINAL a Over 1 to 10Inc]. DATE 50bu LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. / VALIDATION I hereby 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 ness and Professions Code, and my license is in full force and effect. Services License Number Lic. Class 0-200.Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances 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 ness and Professions Code): Misc.Conduits& Conductors 3 0 3.0 A KI, as owner of the property. will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 7044, Business and Professions Code). - # e 0 0 0 0 2 ,CONSTRUCTION LENDING AGENCY I her affirm that there is a construction lending agency 2'e a 4 1.70 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 741 issued (Sec. 3097.Civ.C.). o e -.4 1:7 0 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Feel _ 11. 1 2-80 Lender's Address PERMIT ISSUING FEE 'I certify that I have read this application and state that the TOTAL FEE / above information is correct.I agree to comply with all County ordinances and State laws' regulating. Electrical wiring, and herebv authorize represe tanves of this County to enter upon the above-menti,, d pro �rdy f r spection purp es.- _ SEE'REV ER SE FOR EXPLANATORY LANGUAGE Sig adore of Permute Dat( - WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT u1 6A663 I hereby affirm 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 JADDO B RESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE ❑ c _ $ $ LOCALIT derartm copy is filed with the county building inspection 1 &i--Family. .Sq. Ft FL r Z 101, department Multi-familyS FL CRONEASS 9� CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR CO o/6 MAP BOOK PAGE ex*7 PARCEL B'O CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.AQ Light Sw/� OWNER OR Cffu�rC /,{GN / p COMPENSATION INSURANCE 9 First 20 AP'4 FIRM NAME 77 ( 4 `, (This section need not be completed If the work involved by the �} P MAIL permit Is for one hundred dollars($100)or less.) Total No.a Additional oZ• ADDRESS I certify that in the performance of the work for which this permit CITY Tel.Ni is issued. I shall not employ any person in any manner so as to PIAN CHECK 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, alter making this Certificate of CITY Tel.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 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 1 hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Ind.(commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Ind. } Over 50 to 100 Incl. LICENSE OR Class. REG.NUMBER a License Number Lic.Class Over 100 DISTRICT NO. SSED BY Q Services,Swbd.,MCC&Panelboards � Q Contractor Date 0-399 Amp.Under 600 V DIANE Q 400-1000 Amp.Under 600 V I am exempt under Sec. _q L ~ VALIDATION Q Over 1000 Amp.or Over 600 VW B.&P.C.for this reason er AL BRANCH CIRCUIT FEES Date: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits q SINGLE FAMILY Temp.Power Pole&Appurtenances G y HOME OWNER-BUILDER DECLARATION ACCT.4 I hereby affirm that I am exempt from the Contractor's License Law Sign with Ona Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3303 99.30 I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). , 191E 1 AM 8.37 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 FEE Lender's Name � PERMIT ISSUING FEE O Lender's Address y^ I certify that I have read this application and under penally of purjury state TOTAL FEE /• go 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 the above-mentioned property for inspection pqfgases. SEE REVERSE FOR EXPLANATORY LANGUAGE ,MIGNATURE OF PERMITTEE DATE