HomeMy Public PortalAbout10656 ROSEGLEN ST_Electrical__ 4�
OOU■TY of Los ARa[L[i APPLICATION FOR PE MIT
EnginewELECTRIC 1
` DIVISION OF HUII..DINC� & SAFETY
WILLIAM I FOX. Ommty Emolow
FOR A 150,14T L IN ISTRIOTNO. GROUP ZONE PERMIT NO.
ELECTRICI IleR— I1.,17
R[O[IVXD ■Y PtFADV FOR DAT1C IISELFIED
ADDR[13■ rIR■T INDPK"DN / ..
CITY L N0. .17
COUNTY LIOlrN■[ NO. IRI ■UILD'
ERMIT AMM
PDDRI=
NUMo[R [AOR Flu
1^^ALPTY
LIGHT OUTLET■ NE Err
DR
REC[FrADL[1
WALL■WITDHKS I OWNER rf
TOTAL OUTLETS BD MAIL
[LED. RANGEI 125 ADDRICVIIII
ELEC. H[ATER1 28 CITY TZL NO.
FIXTURE■ ■ '
I H[R[■Y AOKNO`WLrDdX THAT 1 HAV[ READ THIN
MINE), AP IPU12ATION AND ■TATs THAT T-HE ANDVE 12 CORR[OT
NUMBER OF LIGHT CIRCUITO AND ADRI[ TO COMPLY WITH ALL COUNTY E3RDlNAi4QKJk
NUMBER OF RED11"NOLK CIRCUITS AMD 1TATZ LAWS RR17ULATIM13 ELECTRICAL WIRING.
MOTORS 1 OERTiFY THAT I 1.0=1010 THE ABOVE VALID L09
HUMO[II HOR■IPOW[RFZ[ EA 'ANGELS■ COUNTY UONEX. OR I M THE EBA OWNER
Ncw Mw. HP Ovn1 IN0. KA-G" OF TH[ RE1i1D[NT P [RTY RI
• ums .Z8 v
■1GNATUR[ OF
9 .BO PERMIT IC
s s 1.00 INSPECTION RECORD
B 16 LBO
la BO 2.801
so 200 ILOO
200 BOO 1D.00 J
BOC I 1 COO 10.00 Z
OVER IOM 90.00
M9. ■]ET FR CHANGER-HP Q
W[LD[R131 AD-KVA O
13ENERAT'13M - KW
T "OFORM[R9 - KVA
TEMP. MOTORO (76 or o111t1
MOVED MOTORE (75Or 13 lKJ
MISC.
BIONS
NO. N 0.T11AN8
APPROVALS
FOR EACH PIRMITI DAT[ IN OTOR'■ M[
WIRING 1.DC DOHDUIT
FIXTURE! 101.0a s WIRING
0W"L,KMFKTAffY ■O r DCrU REo
POWER
TOTAL FEE i UTILITY O0.NUTIF11CD
FINAL
7&A"M D=#&A s-ss
4-ft APPLICATION FOR ELECTRICAL PERMIT
COUITrY OF LOS AJP(CFKLXS
'3U
AD
D"ARTMXKT OF GOUNW KN(olfflon BUILDING.'
BUD-DING AND 8APW".DfVt8ION DR-11W
JOHN A.LAAWDL Couir"Zmauccut
WILLIAM A.JEENSIEN, SUP-r or eurLmme LD
J7
LOCAUTY
FOR APPLICANT TO FILL IN wo'a M.
PERW FES OWNER Ll J)te Et k"I 7-7--ok/E-
ITUX KumBjxR wAa" rmc MAIL te
EM
aHTtl
P111KC23-TA:� .10 ADDRST sc, c,
G+MNci-rIXTI-IRM8 -c 4::�l r 5,-.'
.10 CITY TrmipL I
JKLM KAKCCIKS oxio.t7RY17RM ELECTRICIAN p
WATXrt NZATIERS I XO ADDRIKAS
KLV=SPACK HA . MS"A6HJ3t6
cm TE3-No,
CIARSACK DtSposs" AuTo.- STATS
WASHIRM STA. C00MK4 UNITS UCZN9M NO.
MOTORal ovmt Ipm H.P. DICT-NO. G Z N P99VE
Ys 25
va — jk JSO INSPEC110N RECORD
2 — 5 .00
IVO
15 — 150 JtXO w
150 — 2Oo 5.00
131011M NO TRANS.
NO.LAMPS
SERVICE 0.800V 1.0.0
sxfnncx OVER 600V 5.00
misc.
WIRING PXR-Mrr 1.00
PIX
—'nJRX PERS!IT 1,00
SUPPLIllolKliTARY Fl!"IT 0
TOTAL FEE Isoll
I MM"MY
ACI"0WL
XD" THAT I HAVC PKAD TMG ArPUaATION
AP
P
R
OVAL—B— Z
2�DATZ �f'?,ftZP'KCT'0o
Ft'S 8104ATUFM
AND STATE THAT THK MOVE IS 0ORRECT AND A*7= TO 000PLY
WITH ALJ. COUNTY C3LDIKAJQM AND STATE LAVS "j=LATjH* CONDUIT
MrRICAWIFUNl.- WIRINGIHKjRESy CIDMrY THAT I Ali PtOPERLY PMOISTIM AND/OR
LJWMM AS MCQUMED BY LOS ANaXLX9 COUNTY AND STATIC OF PIXTUR-13
CAUFORMA OR THAT I AM THK LZMAL OWN= OF THE AM"
-OMCRIXCD POWER
SIGNATURE LMLrT-Y CO.GONOTIFIMOFPERMIT
VALMAf K) ARTHUR C.vErr.
CK no aAsa SuPawvjjsiNco ELvzmcAL EmaiNmm
3 9 7 8 OCT 6 2 D 3 .10
WCPJ COMPENSATION DECLAPJ C)N 7wa-s 10/61 APPL#CAT10N FOR' ELECTRICAL PERMIT
hereby,affltm that 1 have a certtnmte of oo Aa t to Belt tldiu�$ c��oea
or a oelttflD a of Wbrkere' Compwmatfon Inauranc% or,a certtfied COUNTY OF LOS ANOEL�S BUILDING AND SAFETY
oopyrthereof(9ea 3oo
a ,L b-a)
PoOpy.Nc. Cohiperry POR ,pPl Jr"dWT Tb PILL N JOB
Gerlt�edcopy.ip herrtby furnished New Reeidentiel5koPo
d .a ds EACH No. FEE ADOFtE98 D C . b �[� s 1
� Certf}fed ubpy le fled wtth U-6 oounty'bu6dlnp 1'bpeotlon 1 8.2-FemIN,S4 Ft
1'deperpridnt OA-fan*S4 t cx sr 1
t Amort Reside tW SwlmrtrfrQ I Gob vvrt R oR I
C8RTF"TE'OF EXEMPTION FROM WOWER:B' btiv NAAE
COMPE}J�PI WN INSURANCE' Ftret'20' SSS
(Thiel bection rwed not br cofnpiSbd rthe Work,RwoNo by the
' ' i
permk is for ons hurx dofYn(«100}of Trow.). Total No. 6 Adffk;el .. _. T6'Nd f
t-cwB -that kn the,perforrt�r.of the work fcr:whfch thle permR ��►! l
fp issued I W A11 not pMpby'any.person In arry men nec so aB to 4 {
become sub�t- Wbficera'Qcxnpartaatian.Laws 'Wtbrkg Fbd4uee Ffret 201 ADDRESS
T Totn1 Na Adel CITY TBI.No,
D� Fbced Appfiaficeq Not Over 1 HP Pp-"T {'{
Ta if, h4 tole.• APPrJCJlrT 1
the woi%eq
-EmTpdM'youdp�d Range
PKN >athe Wbor'.Gods,�ou. .fgrthwtth Asn Dryer ^M._ ADDRESS
pro4lebrb or�±k p-Tdt Abo be debn*revoked.• ,: Top--, FA1JWj L. —
r LICENSED OONIRAGTQOS QIHQIRAT-+4Hood — Fen r� OtherT° pffy Tel.No
I•hwBby,afftrnr t#qt I srn.ficera ed {ader.•prav)edorre of Ghapta<'ff . - _ Dfep. Roam Ak cord, cJ.ea
(=r nwckU wRh Section TOOQ}d.PMOod.8:o(the Sa*em,aki T aEri
RPfetaiorta!,Code,efld mS foenoe ba In,fuq fotte and 4(oct, ;:N fbpwef Appare S Lerbe•'AMdanoee - , -
Stto 8,Type HR KW,kw,or►
i,icenee Number' Lb.Cia>m -. - T up,to•,
DATE _U&WDAM
p'. Over 1.ib 101)cL`•r,
ca T—Over t0,[0''60 Incl_.
❑ FINAL,,
I.em•exerrzpt urde seo �_�r ' ��Over 6b 6o a00 Irpp . By
ehP.C_for this reeeon � �Over.10 0 U
Servlcm Swbd MX&ISane(bo e Z'
Dog,
0=200 Amp.Undar 600 V
r
201 -.1b0o AMP.OiFK*r80d'V r
y ' Over 1000 Amp,6r O%W.600 V
Q Rei.idalni E)ect,. _ _r
SINGLETAMtLY Temp.Po%w Pole A,App ts-f arloee
HOME OWNER-�R QEC f G�.
I NW^dffrrn that I am exempt horn the`Col'iU'adpr'e Llter Lew a " _
for,the tolkevinq re6n4n(SeQtW 7031.6,Bumf vem and Profaegione r
Cade):
i,as owner Qf tlie,property,wGl do the work and the sha,Ctura ' c«,dr)tts 8 Conduotorq EMS
#q
#B not InWn ed or-offeced for fame (SAdbn 7044, Brrefneee., (SBeFo�nplef Fee saheduAe) 1 T
and Profs-e-*Cade). T131AL
CONS Ruc-r"LENDING A ENCY c. - - 31. 9'
I hereby atfl m that.ttK" lea Ierdirw agarn y for tho T - ' 'Olt
pertomienCe d•tha work tar oh t}�a_w-K is jsecsd(Sea 3097; .. PERM[f FEE' . '. (,9ub-'TotfLO
'r Ctv;G.).
PL AWC-iECKM FEE '}..
Leridera Name �� 0000-W' . 1u/29/9 1
PERW ISSUING FEE
f L•andars address 972�.
I cWtIfy tt* I heve,ead'this appl;EW- and etata fret the above' To SEE
lubmi tion IA Qorrect I,agroe tu,00rtrpty with ah County•wrin g G
and Stgte Jaws regAatfhp Electi{oal Wtrtp, and.hereby autho&e - �•. 4
fepreeentatIYW Of thiS Canty to enter LLPon the ebo%4-merrWxled
SEE REVERSE FOR EXPEAMATORY LAHC3gl E
Data
WORKERS'COMPENSATIONDECLARATION CE-°� (2:80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have's 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. 380 .C.
FOR APPLICANT TO FILL IN JOB
Policy N mpanr EACH. NO. FEE ADDRESS
New Residential Bldgs.&Pools
Certified copy Is hereby furnished. 1 &2-Femlly,Sq. Ft. — m LOCALITYNEAREST
r
Certified copy Is filed with the county building inspection Multi-family Sq. Ft. CROSS ST
Residential Swimming Pools
department. OWNER OR
DateJV'b0 A llcar FIRM NAME
pp .o Outlets: Rec. LLight ADDRESS
�irst
rst 20
CERTIFICATE OF EXEMPTION FROM WORKERS', Total No. 7 Additional CITY Tel N
COMPENSATION INSURANCE
PLAN CHECK CL
(This section need not be comppleted if the work involved APPLICANT 4UUUJ
nndred (5100) or len.) Llphting Fixtures First 20
by the permit L for one h dollars Addltlonal ADDRESS CC
I certifythat in the Total No.� O
performance of the work for which this Fixed Appliances Not Over 1 HP CITY To] No.
permit b Issued, I shall not employ any person in any manner
PERMIT W
to as to become subject to the Workers"Compensation Laws. Reoge_ Heater—D.W. APPLICANT, Z
Oven Dryer_W.M. ADDRESS
rig
Date Applicant Top FAU _W.H. _ l
Hood Fen _Other— CITY Tel No. io
NOTICE TO APPLICANT: If, after making this Certificate of Dlsp. Room Al'r Cond` C 8
Exemption, you should become subject to the Workers' REO. NUMBER, Claw �/
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR OC ED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW,KVA,or KVA
Up to 1 Incl.
FINAL '
Incl.IDATE A// ^�
LICENSED CONTRACTORS DECLARATION Over 10 to Over 1 to 10 0 Incl. _IF C VALIDATION
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
BY
9 (commencing with Section 7000) of Divtslon 3 of the Bust- Over 100
noes and Professions.Code, and my license is in full force and-
effect. qq Services
License, er F Lic.Clan.-S.-r l� 0'200 Am Under 800 V
201-1000 Amp. Under 800 V
Contract /d_..V Over Over 1000 Amp.or Over 800 V
oe
HOME E
O R-BU R 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
nese and.Profeadon�s Code):
Misc.Condults&Conductors
1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— ;P 7 0 9, 1 A
structure Is not intended or offered for sale (Section
7044, Business and Profesalons Code). #'010 0 0 0 8
CONSTRUCTION LENDING AGENCY ,
I hereby affirm that there is a construction lending agency 2'0 0 34,30
for the performance of the work for which this permit L PERMIT FEE (Sub-Total) 0}0 0 3 a,306 '
issued(Sec. 3097,Ctv.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Q 2'5—a 2
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
hereby authorise representatives of this County to enter upon
the ab ve-mentioned rty or inspection purposes.
SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature ofee Date