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Home My Public Portal About5076 SERENO DR_Electrical__ I- !' COUNTY OF LOS ANGELES APPLICATION FOR PERMIT , Department of CGGatp EaglJJ ��V�� DIVISIONSION OFFSIIII.DING & SAFETY WILLIAM J FOX. Oa[INy [RElww DISTRICT NO. DROyP ZO PERMIT NO. FOR APPLICANT TO FILL IN ELECTRICIAN McROBERTSELECTRIC ./ ADDRESS3M N IVAHV 5II(Eff- RecElym BY 1 D R�N L DAISSUED CITY TENO �O 7 COUNTY LICENSE NO E PIREB BUILDING I O PERMIT MS AGGRESS PICK NUMBER UGH LOCALITY Q LIGHT OUTLETS N[AR[BT ROS BT RECEPTACLES WALL SWIT13HES OWNER TOTAL OUTLETS Be • MAIL [LEC RANGES 25 ADOR[SS [LCC HEATERS 25 CITY TEL. NO rIETURES 6 F�Tl1 HERESY AOKNOWLLDO[ THAT I HAVE READ THIS MISE APPLICATION AND STAT[ THAT THE AROV[ IB CORRECT NUMBER Or LIGHT CIRCUITS AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER Or RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING MOTORS 1 C[RTIrY THAT I POSSESS THE ABOVE VALID 1.05 NYMBww HORS[ICWEp r[E ANGELES COUNTY 1-10 SE. OR 1 AM THE LEGAL OWNER N[w Mw HP av[w Ewa [ACw Of TH[ R[BID[NTI OP[ DEBDRIS[D A I.[o S 15 SIGNATURE Or \J'j- va S 50 P[RMITT 44 • 5 IDD INSPECTION RECORD 5 IB I •o 15 50 S 50 BO LOO 5 OO 100 BCC 1000 J BOO low 15OO Q Z OVER IOOD 31000 MD SCT FRED CHANOER-HP WELDERS AC-KVA O GENERATORS - KW TRANSFORMERS - "A TEMP MOTORS (76 or DRla MOVED MOTORS (75% or awla) SIGNS NO NO TRANS �n NO NO LAMPS APPROVLSA ►OR EACH PERMITt DATE INSPECTOR'S NAM[ WIRING 81.00 CONDUIT rD(TURES •I Go WIRING a. SUPPLEMENTARY rmTUREB �1 POWER Y TOTAL FEE • �J ITYcO M13TIFIED •( 00 4 rINAL TEAS![ DSS#5A 4-52 76AS43C CaANIW 1=17¢ APPLICATION FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION POR APPLICANT To FILL IN JOR ADDRESS New Residential Bldgs &Pool¢ EACH NO FEE _ 1 &2 Finaily Sq Ft $ — $ LOCALITY roa c Multi family Sq Ft C o5S ST Residential Swimming Pools OWNER OR N FIRM NAME Outlets Light Switch& Bkoaptacle ADDRESS First 20 • 01� U C1 n"� Additional s CIT STOI No 0 D PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel No PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range_ Heater_ D W qDD RESS Oven _ Dryer _ W M Al tor Top _ FAU WH CITY Tel No Hood Fan LICENSE OR O Disp _J_ AC / 7 D REG NUMBER Class U HERESY NowueGE THAI I N.Y. AND AGREE TO n THIS Power APparatus& Large APPhenxs STATE a EASw PuUcwTWITH ALL ORDINANCES AND STATE LAWS NEOLAnINoON pw Size&Type HP, KW, KVA or KVAR ELZ CTB'cAL °- N Up to 1 Incl THAT I N PNOPENLr B nDroB z Over 1 to 101nc1 wS wcaoiniD My LOS ANGELES COUNTY AND Over 10 to 501ncl EECNie ED n r E LEGAL Gw.EP OPTHE ABOVE Over 50 to 1001 ncl PERMITEEEE N%ALP NO Br Over 100 IGNATUR Sir Services ! I TRICTTNNO• PRO SSE V 0 200 Amp Under 600 V /J 0 5 , 201 -1000 Amp Under 600 V APPROVALS DATE INSPECTOR'S Over 1000 Amp or Over 600 V SIGNATURE TEMP POWER POLE Temp Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub Tote LFI YCOjNOTIFIED PLAN CHECKING FEE (One Fourth Permit Feel PERMIT ISSUING FEETOTAL FEE PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CAS 8,581zja 7 2 24.65 1 \ WORKERS'that Ihave COMPENSATION DECLARATION 7~ �w3rV APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self �a� insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ora certif,iedcopy thereof (Sec 3800 b ,�— Polity NoA(L_Ziy _cmpany <7A CAI 02 FOR APPLICANT TO FILL IN JOB ❑Ce fled copy is hereby furnished New Residential Bldgs & P000llss� p� EACH NO FEE Certified copy is filed with the county building inspec 1 8 2-Family Sq Ft�_ $ _ $ LOCALITY hon d omgnt Multi family Sq Ft NEAREST Residential Swimming Pools CR S ST Date Applicant R 09 FIRM NAME CERTIFICATE OF EXEMPTION F WORKERSMAIL COMPENSATION INSURANCE Outlets Rec_Light_Sw_ - ADDRESS First 20 (This section rtwd not M completed If the work Imolvod lir Total No Additional CIN Tel No orm the jslt Is for one hundred dollars ($100)or lass) RAN CHECK I certify that in the performance of the work for which this _ APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS Additional ' Total No CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICATION A4M,,DjQn `" Exemption, you should become subject to the Workers Range_ Heater—DW — Compensation provisions of the Labor Code you must forth- Oven _ Dryer —W M _ ADDRE with comply with such provisions or this permit shall be Top _ — FAU —W H — deemed revoked Hood — Fan —Other_ CITY 0A;A I No OY9a .1 NUMBER Disp Room Au Cond REG _W-34C Q Class LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO SSED BY d CIL • and Professions Code,and my license is in full force and effect p Size 8 Te HP KW, KVA, or KVAR D/ tl a!,e .sem O License Number 4!!L1316 0 Lic Class C— Up to 1 Incl TBY !� Q Contractor to l Over 1 to 10 Incl (p��> �� VALIDATION ❑ Over 10 to 50 Incl U 1 am exempt under Sec Over 50 to 100 Inc P W B 8P C for this reason Over 100 � Dote Services Swbd, MCC 8 Ponelboards Z 0-240 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ ` Exemption for Reg MoOver 1000 Amp or Over 600 V Moms Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION •- I herebyoffum that I am exempt from the Contractor s License Sign with One Branch Circuit i Law fothe following reason (Section 7031 5 Business and Additional Sign Branch Circuits H�-L� .>< Professions Code) 1707 I2?x 4_I ❑ I, as owner of theproperty, will do the work and the Misc Conduits 8 Conductors structure isnot intended or offered for sole(Section 7044, Other (See Complete Fee Schedule)_ I ITEMS Business and Professions Code) , TOTAL 129 - 40 CONSTRUCTION LENDING AGENCY _ '.HELI'. 12`7.4C 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) _ CHANGE .Cl.l (Sec 3097 Civ C ) PLAN CHECKING FEE _ Lenders Name �1]I�I fjfa5�iI PERMIT ISSUING FEE �� Lenders Address ''�JG I QMICI,cL 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 r ordinances and State laws regulating Electrical wiring and ' hereby authorize represent rives of this County to enter upon l e ve menhone pr rty for inspection purpo , SEE REVERSE FOR EXPLANATORY LANGUAGE arure of ar i e � Dbto Jth = ®s ` �WORKEBS.C.OMPEN4ATIONDECLARATION 76Aa93 CE a0B0 APPLICATION FOR ELECTRICAL PERMIT {� ~f hereby affirm that I htive•a certificate of toner, to pelf (r ure, �J or a<cerhfca(s of lhbTkare Comnerisatort Insurance or a certified. COUNTY OF LOS ANGELES BUILDING AND SAFETY copy'themof(Sec 3600.1eb C) policy No , Opmpary FOR APPLICANT TO FILL IN JOB � Certified copy a hereby furnished EACH NO , FEE ADDRESS New Residential Bldgs 6 Pods 1 & 2-Family Sq Ft LOCALITY —C $ v $ — Certified copy is Bled with the county builtling inspecttat department Multi-family Sq Ft NEAREST S7 17) Date Applicant Residential Swimming Pooh OWNER OR _ FIRM NAME N CC CZ ERTIFICATE OF EXEMPTION FROM WORKERS Outlets Ree_Light _ Sw MAIL z— N COMPENSATION INSURANCE Fust 20 ADDRESS (This section need not be completed N the work imWolwd by the permit Is for one hundred dollars($100)or leas) Total No AdddwW CATV T L el No W PLAN CHECK 0 I certiy that in the performance of the work for which the permit APPLICANT 00 is Issued-I shall not employ any person In any manner so as to ) become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS so Date Applicant Total No Additional CITY Tel No NOTICE TO APPLICANT elver making the Certificate d Fixed Appliances Not Over 1 HP PERMIT APPLICANTAPPLICANTEExemption you should becomea sublet!la the Vwbrkere Compertsatgn Range— Heater_ D W A4 VA-19 Prov$mrls of the Labor Code you must forthwith comply with such Olen — Dryer _ W M — AD _ pnoviams or this permit shall be deemed revoked Top _ FAU _ WH — ' UCENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITU Tel No I hereby affirm that I am Licensed under provisions of Chapter 9 Disp — Room Air Cond LICE _ (commencing with Section 7000) of Division 3 of the Business and REO NUMBER Professions Code,and my license is in full force and effect ncDISTRICT NO W Ov Power Apparatus 8 Large Appliaes �/•1�. Size& Type HP KW KVA or KVAR License Number Lq Class UP to 1 Incl FINAL _ SL Over 1 to 10 Incl DATE Z YAl1DAT10N �tOr }e Over 10 to 50 Incl RNA BY µO m I aexempt under Sec Over 50 to 100 Inc µU1t B&PC for this reason Over 100 p. Services Swbd MCC& Penelboards ® fn Date 0- 200 Amp Under 600 V `••' Signature r 201 - 1000 Amp Under 600 V - Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V - SINGLE FAMILY Temp Power Pole& Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Qrcud I hemt hereby affirm that I am exempt from the Cractofa License Lae for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits_ r�lC�T•T Co) ,3,30'Wt3.C10 El1 as owner of the property will do the work and the structure Misc Conduits & Conductore 1 1i CMS is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) and Professions Code) _ ► TOTAL 43 - OQ CONSTRUCTION LENDING AGENCY CHECK t-.or) I hereby affirm that there Is a construction larding agency for the Li��I� performance of the work for which tis Permit is issued(Sec 3097 PERMIT FEE (Sub-Total) CHANGE •[tri Civ C) Lenders Nemo RAN CHECKING FEE 13000-130131 7/31/50 PERMIT ISSUING FEE Landers Address 3071 2145 1 AM 10:315 I certify that I have read this application and state that the above TOTAL FEE information is correct I agree to comply with all County ordinerices and State laws regulating Electrical wrong and hereby authorae representatives of this Crony to enter upon the above-memgned ��p for inspection par s SEE REVERSE FOR EXPLANATORY LANGUAGE / nature of of Oaf WORKERS COMPENSA710NDEConsent to CE ,d,a, APPLICATION FOR ELECTRICAL PERMIT {� I hereby a}(yrm that Lh2ve a ceriAlcete of carreem to self insure CE 6090 LJ or a certificate of Workers Compensation Insurance or a certllled COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800 Lab C) Policy No 'Company FOR APPLICANT TO FILL IN JOBS Certified copy is hereby furnished New Residential Bldos E Pads EACH NO FEE ADDRESS C Certified copy s bled with the county amlding rspecticn 1 fl 2-FamJy Sq Ft $ — $ LOCALITY NEAdepartment Mum-tam0y Sq Ft — CROS Sr _ _ CROSS ST Applicant Applpt - Residential Swimming Pools OWNER OR FIRM NAME f CN CERTIFICATE OF EXEMPTION FROM WORKERSMAIL. COMPENSATION INSURANCE Outlets Roc_Light _ $w ADDRESS 10b (This section need not be completed If the work involved by the First 20 permh Is for one hurdred dollars($100)or lass) Total No Additional CITY �r Tel No yEp•� I certify that in the performance of the work f« which this permit - n PLAN CHECK is issued I shall not employ arty person in any manner so as to 11 t ( ^ I APPLICANT become subject to the Workers Compensat.xl Laws Lighting Fixtures First 20 L Y \�� (� 1 `I I� ADDRESS Jw i2C,(,O �'✓(�. Total No Additional J , ` CATV //� Tal No 6 _ .fa Date Applicant Fixed Appliances Not Over I HP NOTICE TO APPLICANT It after making this Certificate of PER Exemption you should become subject to the WDrkers Conpemsaton Range_ Heater_ DW APFIIGNT provLwaa of the Labor Code you must forthwith comply with such Oven — Dryer _ W M — ADDRESS pnovnsl«s or this permit shall be deemed revoked Top — FAU WH _ LICENSED CONTRACTORS DECLARATION CITY Tel No I hereby affirm that I am licensed under provscns of Chapter B Hood in, Fan Other— _ Z,COnd LICENSE OR SV I Cl+ (commencing with Semon 7000)of Drvsan 3 of the Business and REG NUTABER Professors Code and my license is in lull force and effectPower Apparatus 8 Large Appliances DISTRICT NO Ep 9YA Size fl Type HP KW KVA or KVAR 5 ((I\,J�/ry1 Over 1 to 10 Incl DATE VALIDATION Worse,Number Lc Class UP to 1 Incl - FINAL Contract« Data Over 10 to 50 Irct FINAL O I am exempt under Sec Over 50 to 100 Inc BY yUyJJ BBPC f«this reason Over 100 O. N Services Swbd MCC 8 PanelboarA9 Z Date 0- 200 Amp Under 600 V Signature 201 - 1000 Amp Under 800 V ❑ ExemptO.er 1000 Amp or Over Exemption for Rag Memt Elect SINGLE FAMILY Temp Paver Appurtenances U HOME OWNER-BUILDER DECLARATION Sign vii &arch Circuit ACCT.i I hereby affirm that I am exempt from the Contractors Leena Law for the following reason(Section 7031 5 Business and Prolosaore AddilxxW Sign Branch Cresta 3M7 31.00 Code) Mies Conduits fl Conductors 1 ITEMS I as owner of the property or d do the work and the structure Other(See C«nplete Fee Schedule) TOTAL 3 1.00 Is net essni « offered f« sale (Sean 7044 Blslrsae SCK 31.00 and Prdeasioors Code) Poo- CONSTRUCTION LENDING AGENCY H,A`� •� I hereby affirm that there is a constructor lending agency for the A.1'P77 i performance of the work for which the permit s issued(Sec 3087 PERMIT FEE (Sub-Total) Gry C) PLAN CHECKING FEE 0000—MOI 5rU190 Lenders Name PERMIT ISSUING FEE __aob 1031 1 AM 7-57 Lenders Address I codify that I have read thin application and state that the above TOTAL FEE mformaton is correct I agree to comply with all Caurrty ordinances and State laws regulating Electrical wmrg and hereby authonze representatives of this County to enter upon the above mentioned! - property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE X 3/- po 1, reg Re tee Date