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Home My Public Portal About10645 ROSEGLEN ST_Electrical__ f OOURTY OF LOS ANGELES APPLICATION FOR PE IM Department of County EnoneerELECTRIC 1 DIVISION OF HIIII-DING & SAFETY �f WILLIAN J. FOX. Omaty EW wr FOR FILL I DISTRICT NO. GROUP ZONA/ PERMIT NO. le, ELECTR ICI 'r R[ IVSD Ity READY FOR DAT9 MED ADDR FIRI<T INNFLOTION CITY T N0. DO '7LIOLNESNa IRE ■UILMINv PERWT FEE9 ADDREr f0 Fu NUMBER EACH I^^A' ITV LIGHT OUTLETS NEAR[iT OR asa REDEPTA131-ES WALL NW&TOHES OWNER TOTAL OIJ-It[Te 6o MAIL ELIM RANGES 24 ADDRESS [L[0. HEATERS 2s17 CITY TEL N0. FIXTURd a E� I HEREI<Y ADKNOWLEDB[ THAT I HAVE READ THIS 1 AMPIJ12ATION AND NATE THAT TH[ ADOV[ IS CORRECT NUMBER OF LIGHT OIROUITR AND ACRE[ TO COMPLY WITH ALL COUMTY ORDIMAJ4OEP NUMBER OF REDS TAOL[ OIROUIl7 AHD ■TATI! LAM7 REnULATING M-IMTRI13AL WIRING. MOTORB I CERTIFY THAT 1 P� THE AAOVE VALID LO!• Nu i[I� HORR[POW[R �[ ANGELES BOUNTY UDENSiE, OR I AM THY//x/ OWNER N Mw. HF mTe IN0. [Anil OF THE RESIDENt PR d0 YX • �S .28 �V61■IUMATURE 13 Ar B .60 P[RMITT 31 s e 1.00 INSPECTION RECORD s 16 1.60 1■ SO 2.60 SO 21313 5.00 71313 600 10.0b J 6013 1000 13.40 Z OVER 1000 YMOO MA. MI[T FR OHANBER-Hr R W[LDERII AD-KVA O GEN[RATCR! - KW TRANEIFORM[RIN - KVA TEMP. MOTORS 75or wilm. M OTCR111 (76 or ORiu MI SIGNS N4 NO.TRANN. 1L S N LA APPROVALS FOR EACH P[RMM DATE IN6P OR7 [ WIRING 1p 1.00 OOMDUtT FIXTURE! IP1.00 WI RINGSUPIPLS [ lop F fXTU RE7 IPOWER TOTAL FQE a UTILITY CG.NOTIFIED y F I M AL `fes 76AUM Dr#■A 2-1.7 y _ L V RKFRS'COMPENSATION DECLARATION 76A663 DPMJ�� APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certlflcate of consent to self -a9py Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) PIlcy No Company FOR APPtKANT TO RLL IN JOB ^ r Cie u CerMIfled copy Is hereby fumishea. New Residential Bldgs. 8 Pools EACH NO. FEEADDRESS L ECertified copy Is filed with the county building inspec- 1 8 2-Family, Sq. R. $ = $ LOCALITY 1 tion department. Multl-family Sq. Ft. NEARE— CROSS� ST. .E.0 Date Applicant Residential Swimming Pools NAME V , CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Ret Light Sw.— COMPENSATION INSURANCE MAIAL)DRESS Is section nod not be completed If the work Inwfved First 20 (Th mP � Total No. Additional CITY Tel. NVFY the permit Is for one hundred dollars (=100)or lees.) PLAN CHECK I certify that In the performance of the work for which this APPLICANT permit Is Issued, I shall not employ anyiOn In any manner Lighting Fixtures First do ADDRESS so as to become sub ect to the Worker Co pen tion Ldws. Qr r�I – � Total No. AddCITY Dat Appllcont CITY No. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making t IO Certificate APPUCATN Exemption, you should become subject the Workers' Range— Heater—D.W. — Compensation provislons 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. — i deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION Dlsp. — Room Air Cond. — LICENSE OR Class. ER I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Buslness Power Apparatus 8 Large Appliances DISTRICT NO.� Y and Professions Code,and my license Is in full force and effect. Size 8 Type HP, KW, KVA, or KVAR 0 License Number Uc. Class Up to 1 Incl. FINAL 0 Cc Over 1 to 10 Incl. Dom V TION 0 Contractor Ik.te Over 10 to 50 Incl. F- 1)0w Fl U I am exempt under Sec. Over 50 to 100 Inc. BY a B.BP.C. for this reason Over 100 U) C 8 Panelboor l Z fk�te: 0-200 Amp. t4er 600 V Ik Signature mp. Under 600 V ;205&7A Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY # o'o o.e • `L HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenant 1 hereby affirm that I am exempt from the Contractors Uceme Sign with One Branch Clrcult ° - 40.5.0 Low for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 4Q506 Professions Code): e � I, as owner of the o will do the work and the Misc. Conduits 8 Conductor property, o a 3l 8 structure Is not Intended or offered for sale(Section 7041, Other (See Complete Fee Schedule. , 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 Lenders Address I certify that I have read this application and state that the TOTAL FIE above Informatlon 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-me oned pe for`PspectIon pu IEE REVERSE FOR EXPLANATORY LANGUAGE J-3/ , Signature of Perm Date WORKERS'COMPENSATION cafe of 7&4,663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O ' I hereby affirm that I have a certificate of consent to self �7� Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS cr a certified copy thereof (Stec. 3800, Lab. C.) Policy No. r Corr pony FOR APPLICANT TO FLU IN DRESS - O pk ElCerttfled copy Is hereby furnished. New Residential Bldgs_ 8 Pools EACH NO. FEE Certified copy Is filed with the county building Inspec- 1 8 2-amlly, Sq. Ft. $ F] _Is I LOCALITY Cl tion department. Multi-family Sq. Ft. I Residential Swimming Pools CROSS ST. Date Apel Icant NAME CERTIFICATE OF E)F TION FROM WORKERS' Outlets: Re{ LightSw._ MAILADDRESS COMPENSATION INSURANCE First 20 (This section need not be completed If the work Involved by Total No. Additional CITY 7-- Tel. than permit is for one hundred dollars (;100)or 6ss.) PLAN CHECK I certify that In the performance of the"work for which this APPLICANT -� permit Is Issued, I shall not employ any Perron In any manner Lighting �Ixtures First 20 ADDRESS to os to become subject to the Workers Compe tion Laws. Total No. AddRlonal CITY N . Date �fY—Yi Applican Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making ttflca rtt APPLICATION Exemption, you should become subject the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Ov6n — Dryer —W.M.— ADDRESS / with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION UBdSE OR Dlap. — Room Air Coed. ,— N Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Buslneu Power Apparatus 8 Large Appliances DISTRICT PROCESSED and Professions Code, and my license Is In full force and effect. Size 8 Type HP, KW, KVA, or KVAR c O License Number Lic. Class Up to 1 Incl. FINAL U o M:Over 1 to 10 Incl. DATE �� (� VALJDA ON O Contractoa Over 10 to 50 Incl. FlU Elam exempt under Sec. Over 50 to 100 Inc. BY W IL B.BP.C. for this reason Over 100 00 Services, Swbd., MCC 8 Panelboards z Dat°' 0-200 Amp. Under 600 V 9 8 7,7 A ? Signature 201 - 1000 Amp. Under 600 V o o — o 2 ❑ Exemption for Reg. Malnt. Elect. Over 1000 Amp. or Ovef 600 V ( 0 0 2 5 5 0 SINGLE FAWLY Temp. Power Pole 8 Appurtenances o 0 0 2 S 5 0 55 HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Sl�n with One Branch Circuit Law for the following reason (Section 7031.5, Buslness and Additional Sign Branch Circults 0 E3 4-8 8 Professions Code): I, as owner of the property, will do the work and the MIK. Conduits 8 Conductors -'structure Is not Intended or offered for sale(Section 7044, Other (See Complete Fee Schedu16�_ Business and Profeulons 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, Cly. C.). PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE �r 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- ntlon operty for Inspettion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per ttDate Y