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Home My Public Portal About5419 CAMBURY AVE_Electrical__ 76A563 DBS SA 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ? < COUNTY OF LOS ANGELES VER Mm, ITm9 WILLIAM J. FOX, CHIEF ENGINEER ' FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. ELECTRICIAN /j �/ RECEIVEDIBY READY FOR DATE ISSUED ADDRESS FIRST INSPECTION CITY p TEL. NO.r-,o 9 COUNTY LICENSE NO. EXPIRES BWLDING / PERMIT FEES ADDRESS NUMBER EACH FEE LOCALITY LIGHT OUTLETS -p NEAREST CROSS 9T. RECEPTACLES 1 ,6 WALL SWITCHES Z OWNERIT TOTAL OUTLETS 5C $ MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES 5 'S I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS 1'6 AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES Y NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY,THAT 1 POSSESS THE ABOVE VALID LOS NOMBENHORS EPOWER ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER FEE MVD. HP OVER N0. EAGN OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. NEW I I/t A LESS $ .25 SIGNATURE O;s � I/x 2 .50 PERMITTEE 2 s 100 INSPECTION RECORD s 1s I.so _ 15 50 2.50 50 2DO 5.00 1;;200 500 10.00 J 500 1000 15.00 Z OVER 1000 20.00 In M.G. SET/FRED. CHANGER-HP It WELDERS: AC-KVA O GENERATORS - KW' TRANSFORMERS - KVA TEMP. MOTORS (7S% DF CRIB.) MOVED MOTORS (75% OF CRIB.) MISC. SIGNS N0. NO.TRAN& APPROVALS NO. NO. LAMPS FOR EACH PERMIT: DATE INSPECTOR'S NAME I i WIRING $1.00 V b1 CONDUIT FIXTURES $1.00 O (j WIRING SUPPLEMENTARY .SO FIXTURES POWER TOTAL FEE $ UTILITY CO. NOTIFIED �.g- in FINAL G 4. W. that I 'have a NSATIONDECLARATION, 76-663 ' 10/81 APPLICATION FOR ELECTRICAL PERMIT {� ,y i R��flam that 1 have a certificate of consent to'self insure, CE-606G LJ qr uerfificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY - dopy thereof (Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB' ❑ i7ertified copy is hereby furnished. ,EACH NO. FEE ADDRESS H TL • _ _ Y New Residential Bldgs.& Pools Certified copy is ifiled with the county,building inspection 1 & 2-Family, Sq.Ft. $ — $ LOCALITY„ department. Multi-family Sq.Ft. — NEAREST /` SE Date Applicant Residential Swimming Pools CROSS OR Oi G �C� CERTIFICATE OF EXEMPTION FROM WORKERS'. d � MAIM NAME r/ g� W 'I-'`. M-S COMPENSATION INSURANCE _ Outlets:Rae S�1C Light Svi:J_ IL-ODRESS / �,[Q 6Kbi}f T - (This 'section need not be completed If the work•involved b the .1 First 20 - Y H CITY Tel.No. ,permit is for one hundred dollars ($100)or less.) Total No.�W—r- t Additional � VAJ) '1 6� I certify that in the performance of the work for which this permit PLAN CHECK III is issued, I Shall not employ any person in any manner so as to APPLICANT become subject to the Workers'1Compensation Laws. Lighting Fixtures, . First 20 ADDRESS Additional Total No. - CITY Tel.No. Date Applicant Fixed Appliances Not Over-1 HP NOTICE TO APPLICANT: It, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation 'Range_`.Heater_ D.W:•_ APPLICANT 1 provisions of the Labor Code.you must forthwith complywith such Oven _ Dryer — WM.,_ ADDRESS provisions or this permit shall be deemed revoked. . .-.Top — FAU, >-- W.H.._. CITY Tel.No' .LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby,affirm that I am.licensed under.provisions of Chapter 9 - LICENSE OR (commencing with Section 7000) of Division .of the Business and Diep. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power.Apparatus 8 Large AppliancesDISTRICT NO. / PROCESSED BY 7 - - / } Size& Type HP,KW,KVA,or KVAR • ((,( QaO' License Number - Lic.Class Up to 1 Incl. FINAL - Over 1 to 10 Incl. DATE VALID- ION 0 Contractor Date Over 10 to 50 Ind. F_ ❑ . . - FINAL am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 - in n • Services,Swbd.,MCC& Panelboards D ( � Z Date: 0- 200 Amp.Under 600 V A 8,2 9 5 A Signature - 201 - 1000 Amp. Under 600 V - -'- ' ❑ Over 1000 Amp.or Over 600 V #.e le e 0- 2 Exemption for Reg.Maint.Elect. SINGLE FAMILY - Temp.Power Pole& Appurtenances I 0 .0 3200 HOME OWNER-BUILDER DECLARATION - Sign with One Branch Circuit a o'e 320.00 hereby affirm that I am exempt from the Contractor's License Law additional Sign-Branch Circuits for the following reason(Section 7031.5, Business and Professions I. L O 4 8 7 Code): - ,{Q - Misc.Conduits& Conductors •- ' - W I,as owner the property,wilLdo the work and the structure Other(See Complete Fee Schedule) is not intended d or'offered for sale.(Section 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(Sec.3097, PERMIT FEE' - (Sub-Total) - - Civ.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 above TOTAL FEE 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 3pect' n purposes. • - , oo - SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Permittee - ��} Da :7 - Wm that I haveCOMPENSATION DECLARATION 76-663 10/e1 APPLICATION. FOR ELECTRICAL PERMIT {� , I hereby affirm that I have a certificate of consent to self insure, CE-806G LJ ., or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES - BUILDING AND SAFETY copy theyeof(Sec.3800,Lab. C.) Policy NO. Company FOR APPLICANT TO FILL IN JOB 1Q -❑ Certified copy is hereby furnished. , New Residential Bldgs.& Pools EACH NO. ..FEE ADDRESS \ ❑ Certified copy ,s filed with Ztheounty buildi 'nspection 1 & 2-Family,Sq.FL $ _ $ LOCALITY. department. �L Multi-family Sq Ft. NEAREST ^ 0f'Y CROSS ST. DafehJ Residential Swimming Pools ' _ OWNER OR Applicaot - FIRM NAME CERTIFICATE OF EXEMPTION.FROM-W KERS'. Outlets:Rec Light 3 3w. AIL COMPEN3ATION INSURANCE ADDRESS P (This section need not be completed if the work involved b the' First 20 . Y 'CITY /' Tel.No. permit is for one hundred dollars($100)or less.) - Total No. Additional - 1 certify that in the performance of the work for which this permit PLAN CHECK Y p P , APPLICANT is issued, I shall not employ any person in any mannerso as to - become subject to the Workers'Compensation Laws. . Lighting Fixtures First 20 ADDRESS • - Total No. 3 Additional CITY- Tel,No. Date Applicant 1 1 fixed Appi nces Not Over 1HP PERMIT �- NOTICE -TO APPLICANT: If, after making this Certificate of is APPLICANT 1 Exemption,you should become subject to the Workers'Compensation Rangel1 Heater_ D.W. ' provisions of the Labor Code, you must forthwith comply with such Oven + Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top. FAU W.H. CITY - Tel.No. LICENSED CONTRACTORS DECLARATION. Hood — Fan I Other_ - l C �✓ I hereby affirm that I am licensed under provisions of Chapter 9 _ ICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. Room Air Cond. REG.NUMBER Class: Professions Code,and my license is in full force and effect. DSTRICT N0. PROCESSED LL Power Apparatus 8 Large Appliances - , R` fff� 1( Size& Type HP,KW,KVA,or KVAR �' U //. License Number—T WLic.Class 6 f , Up to 1 Incl. FINAL - �,.rr' /ems. Li�T•— _ /Q� Over i to 10 Ind. DATE Wo o . - 'C�J� 1,.�7�T"` I l _6 VALIDATION O Contractor Date Over 10 to 50 Incl. FIN F U ❑ I am exempt under Sec. Over 50 to 100 Inc. 8 d B.&P.C.for this use Over 100 V - 0 (//� Z Da 'Services,Swbd.,MCC& Parielboards /�"' 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V - - ❑, Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.EI ct. SINGLE FAMILY Temp.Power Pole& Appurtenances 0 9 2 3 A • HOME OWNER-BUILDER'DECLARATICN Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law ,e e(e a a 2 for the following reason(Section 703 1.5, Business and Professions Additional Sign Branch Circuits - Code): • "I a 03300 - t^ ❑ I,as owner of the property,will do the,work Misc.Conduits& Conductors ork and the structure a'e e 3 3 0 0 3 is not intended or offered for sale (Section 7044.Business Other(See Complete Fee Schedule) e and Professions Code). D • I al Til 8 8 CONSTRUCTION LENDING AGENCY 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.). - - PLAN CHECKING FEE Lender's Name PERMIT ISSUING,FEE Lender's Address I certify that 1 have read this application and state that the above TOTAL FEE - information is correct. I agree to comply with all County'ordinances _ andtale las regulating Electrical wirings and hereby authorize rep" emativew S of thisIccturity to enter.upon the above-mentione pro rty for ins ,ctio Pur uses. SEE REVERSE FOR EXPLANATORY LANGUAGE Si u of Folios Date /