HomeMy Public PortalAbout9926 LA ROSA DR_Electrical__ 76A863.CE808-11.10. APPLICATION FORELECTRICPERMIT 1•
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
CASSATP D. GHIFFLAMBIEDI', Sp .1 En
OS Su91tDOQ LOCALITY L} f
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES
ITEM NUMBER EACH FEE OWNER
OUTLETS: ,l $ $ MAIL
MAIL
LIGHTS�" RECEPT. O SW ♦7 .10 ] V'(a ADDRESS 1
LIGHTING FIXTURES .10CITY TEL.NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN t'
WATER HEATERS .50 ADDRESS \ ) {
ELEC.SPACE HTRS•. DISHWASHERS G
LGA BAGR E DISPOSERS AUTO. CITY TEL.NO: �<
WASHERS STA.COOKING UNITS .25 STATE
LICENSE NO. •'-wr
MOTORS: OVER INC. H.P.
G - 1A 25 DISTRIC GR P ZONE READY FOR INHPHCTION
\�2 - 2 .50
z — 5 Loo
INSPECTION RECORD
5 — 15 1.50
15 — 50 2.50
50— 200 5.00
SIGNS: NO.TRANS
NO.LAMPS
SERVICE O-600V 1.00 G�
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 Tj
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE $ Gl :S APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE,�»� INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT ,Z' 6•)!. /JG
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING 1111�{'�
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR FIXTURES I'7. _ Y/
LICENSED AS REQUIRED BY LOS ANGELES COUNTY, AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER T
DESCRIBED RESIDENTIAL ROP TY.
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE FINAL
giV ARTHUR C.VEIT.
.IDATI CASH SH SU ERVISING ELECTRICAL ENGINEER
K MO
L,ACD5652OCT 10 2 A 9.45 M
Ixh .eby fiirm that I haave aPGeeSAcIOe off consent to self insure, 76AS63 DPW it 91) APPLICATION FOR ELECTRICAL PERMIT IJ
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.3600 Lab. C.) If
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑ ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
❑ $ $ LOCALITY T
Certified copy is filed with the county building inspection 1 ul i--Family, .Ft Ft.
department. Multi-family NEAREST
P t gi FC
S CROSS ST. N�
Date Applicant ftesitlenliaSwimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw._ OWNER
NAME 5 1
' COMPENSATION INSURANCE
First io MAIL
(This section need not be completed 0 the work involved by the Total No. Additional AODR ESS
permit Is for one hundred dollars(5100)or less.)
I certify that in the performance of the work for which this permit CITY Tel.
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date
Date' Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY T.I.Noe _j Q
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 PER
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APRLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 101nc1.
(commencing with Section 7000) of Division 3 of the Business and CITY Tal.No. Z
Professions Code,and my license is in full force and effect. Over 10 to 50 Ind.
SE OR
Over 50 to 100 Ind. RIEGNNUM ER Clas, EL
Over 100 DISTRICT NO. P SSEO By 0
License Number Lic.Class o
Services,Sw 39., CpC n b LPO
NAL
Contractor Date der 60 V DATE
❑
400-1000 Amp.Under 600 V 0 am exempt under Sea ���_ VALIDATION LU
Over 1000 Amp.Or Over 600 VFINAL d
B.&P.C.for this reason BRANCH CIRCUIT FEES BY
Z
Date: 15A,or 20A, 1201,Lighting or Recept. Z
1 To 10 Branch Circuits
Signature f TO 40 Branch Circuits
❑, 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect, 15A.20A,2081 To 2771 Lighting Br.Circuits BVI
SINGLE FAMILYr /
Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION
's License Law Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ +ill h' '''T
Code): 4 •v:
TIMI._,
❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is rat intended er offered for sale(Section 7044, Business Other(See Complete Fee Schedule)_ i f%{NL _e .F
and Professions Code). .a7l_-.q ;y, I'l
CONSTRUCTION LENDING AGENCY 4.l�E:lil]G •�^)�
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.) rnr
PLAN CHECKING FEE f13011j-0f0.!]
Lender's Name /
PERMIT ISSUING FEE 2 C� 87.1>57 L ra:1<i-UO
Lender's Address / ,/ L�
I certify that I have read this application and under penalty of perjury state TOTAL FEE (p l�- a
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' spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
s (-/a-E- -
lGuaru E of ER� DATE