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Home My Public Portal About9931 LA ROSA DR_Electrical__ TBABs3, DEls.s 3 I l.ss APPLICATION FOR ELECTRIC PERMIT 1 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer BUILDING / County of LOB Angeles ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER PLOCALITY / G�'1 / (� CASSATT D. GRIFFIN, SUPT OF BUILDING /////1 FOR APPLICANT TO FILL IN NEAREST PERMIT /�/1 / v� PERMIT FEES CROSS ST. ' % MO�A NUMBER OWNER -7 LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES FEE CITY " , TEL. NO. /�'� TOTAL OUTLETS Ce 54 5 ELECTRICIAN ''II C• pT — W Ja • ELEC. RANGES 25 ADDRESS V _] L �EL`EC..HEA*GRS- 25 n^ y,., 3 KW EA CITY S///T Jt) /yi TEL. NO � ISJ9 STATE FIXTURES 5 LICENSE NO. S MOTORS DISTRICT NO. GROU ZONE READY FOR INSPECTION NUMBER HORSEPOWER FEE I NEW MVD. HP OVER INC. EACH y y2 B LESS s .25 i7 INSPECTION RECORD 2 5 1.00 /$->.t'r I/T] s•1"J.-Ls,v -✓..��/r'"f!_r...,......s 5 15 1.50 15 SO 2.50 50 200 1 5.00 M1SC. 'NF41 L ' Tr I NO. SIGNS NO.TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING 51.00 60 FIXTURES '$1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE S DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES v 7 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE.LEGAL OWNER OF THEABOVE POWER / DESCRIBED RESIDENTIAL_P'ROPER . . 4 1 f/ UTILITY CO.NOTIFIED / /.� SIGNATURE .T IAL P 1, (//YLIi(. L OF PERMITTEE FINAL (/ JOHN A.LAMBIE.COUNTY ENGINEER TION, ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR CK MO CASH A :,r�7 8 3 5 MAY 3 2 . 2.0 0 � DEC TION 76A66 _ WORKERS'that t I have a certificate cafe of co,se CE-806 10/e1 APPLICATION FOR ELECTRICAL PERMIT 'vel hereby affirm that I have a certificate of consent to self CE-806G � t Trisure, or a cer'scote of Workers' Compensalion Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY oro certified -copy Thereof (Sec. 3800, Lob. C.) ert y `x,s7 Policy No. Company•/ 7<// ` • FOR APPLICANT TO FILL INJOB Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS / L-4 J-05- el N H Certified copy is titled with the county building inspec- 18 2-Family, Sq. FI. $ — S LOCALITY tion dep(artment. / Multi-family Sq. Ft. — NEAREST // O�f�D 7 �� / n N Residential Swimming Pools OWNERO 6q C✓W.%'• - Dole Applicant a C, ` (y OWNER OR FIRM NAME J C, CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec.�LightSw._ MAILRESS / COMPENSATION INSURANCE ADD (This section need not be completed if the work involved by First 20 r,s q"f the permit is for one hundred dollars($100)or less.) Total No. Additional CITY G'• Tel. No. Sy3.2�Sd I certify that in the performance of the work for which this PLAN CHECK permit is issued, I shall not employ any person in any manner APPLICANT so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional nt CITY Tel. No. Date Applica Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT C� Range Healer_D.W. C/ � •e �. Exemption, you should become subject to the Workers' 9 Compensation provisions of the Labor Code, you must forth- Oven — Dryer _ W.M.— ADDRESS •- with comply with such provisions or this permit shall be Top _ FAU —W.H. — �- deemed revoked. CITY / �•,� Tel. No. 5_�,`p 6/a LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other— Dis _ Room Air Card. LICENSE OR '// f.3-_� C /v I hereby affirm that am licensed under provisions of Chapter 9 P REG. NUMBER ! Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESS Y > and Professions Code,and my license is in full force and effect. .�' !'� tY //!! �f /v Size 8 Type HP, KW, KVA, or KVAR V r C O License Number Wr_Z 75__�Lic. Class Up to I Incl. FINAL V Cd r✓ /CTS, P `O p/� Over 1 to 10 Incl. DATE VALIDAT N 0 Contractor Date Over 10 to 50 Incl. F F-1FINAL am exempt under Sec Over 50 to 100 Inc. B ✓I[�¢d suit B.BP.C. for this reason Over 100 H Services, Swbd., MCC 8 Panelboards ® #,o e�e '2 Date: 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V - ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V A 3"O SINGLE FAMILY o 3 0 0 5HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances hereby affirm that exempt from the Contractor's License Sign with One Branch Circuit Additional Sign Branch Circuits 3a8 Low for the followingg r reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lenders Name PERMIT ISSUING FEE ;275 &7A Lender's Address0 0'o e 5ps I certify shot I have read this application and state that the TOTAL FEE 3 t O 1 •'• 3 (*1 0 V above information is correct. I agree to comply with all County 0 0 e'3 Q 0 0'0 ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon 0 a 0 3-8 7 the above-me pr ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Siifnature of rn-ittee Date WORKERS' COMPENSATION DECLARATION .200019DPw3/87 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self [Eqp 3 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lob. C.) c.. Policy No. z1`7 r�� Company �r/�� T r IIV� FOR APPLICANT TO FILL IN J08 7-"C7 ❑Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS J C ❑Certified copy is filed with the county building inspeo- // 18 2-Family, Sq. Ft. c�9 $ — $ LOCALITY tion department. / Iti-family Sq. Ff. — NEAREST j /// / CROSS ST. /.� / /f Fc Dote:�� s =� ly Applicant C1�L �/'"C �•� /Gsidentia Swimming Pools OWNER OR FIRM NAME .7f 7 yk. . ERTIFICATE OF EXEMPTION FR M WORKERS' / Outlets: Rec_Light Sw._ COMPENSATION INSURANCE - ADDRESS First 20 (This section need not be completed if the work involved by Total No. Additional CITY / i 'I/ err Tel. No. the permit is for one hundred dollars (5100)or less.) tonaPLAN CHECK ' I certify that in the performance of the work for which this permit isissued, I shall not employ any APPLICANT P p y person in any manner so as to become subject to the Workers Compensation Laws. Lighting Fixtures: First 20 ADDRESS' Additional Date - Applicant Total No: - CITY - Tel. No. NOTICE TO APPLICANT: If,-after making this Certificate of Fixed Appliances Not Oven'1 HE PERMIT /t / Exemption, you should become subject to the Workers' Range Heater—D.W. APPLICATION / _ S,�! //„K,)Vt• Compensation provisions of the Labor Code, you must forth- Oven / Dryer L W.M.— ADDRESS with comply with such provisions or this permit shall be Top FAU -L W,H. — deemed revoked. - CITY �^"�' Tel. No. Disp. Room Air.Cond. Hood L Fan —OtherCITY CONTRACTORS DECLARATION i%✓' rn�' f/ LICENSE OR r' r�-• ' I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY O_ and Professions Code:and my license is in full force and effect: U Size 8 Type HP, KW, KVA, or KVAR License Number - cJ. ,c. Class /? l . Up to 1.Incl. - . `f"/a` FINAL - J Over 1 to 10 Incl. r DATE VALIDATION } Contractdr • Date❑ Over 10 to 50 Incl. FINAL I om exempt under Sec. Over 50 to 100 Inc. BY Q �• B.BP.C, for this reason Over 100 2 Services, Swbd., MCC 8 Ponelboards _ U Date:— 0- 200 Amp. Under 600 V - ,Signature 201 - 1000 Amp.-Under 600 V LU ,F_1Exemption for Reg. Mainz. Elect Over 1000 Amp. or Over 600 V -' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances - - s hereby affirm that nSign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch CircuitsProfessions Code): ' +'•�'- ❑ I, as owMisc. Conduits Conductors owner of the property, will do the work and the •'^ - structure is not intended or offered for sole(Section 7044, Other (See Complete Fee Schedule)_ 11110, Business and Professions Code). - H• rfr "" t ( - j ' '.y CONSTRUCTION LENDINGAGENCY r,. ' ''°' rT I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) r� (Sec. 3097, Civ. C.).. - PLAN CHECKING FEE /; : n`t �t`,-f• z Lender's Nome - - PERMIT'ISSUING FEE - L'ender's Address / .f tI) I certify that have read this application and state that the TOTAL FEE - above information is correct. I agree to comply with all County - ordinances and State lowi regulating Electrical wiring, and hereby authorize representatives of this County to enter upon th above-mentioned property P inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE K ii/� Signolure of Permute' Date O°s t