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Home My Public Portal About5428 CAMBURY AVE_Electrical__ 7SA663 DBS 5A 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES � �� C'• WILLIAM J. FOX, CHIEF ENGINEER 1 ' FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN 141-t.viJ RECEIVED BY READY FOR DATE ISSUED ADDRESS. _ I FIRST INSPECTION CITY TEL NO. Oma L'�G / � •�v � �/�" ' COUNTY LICENSE NO. 9 t7 EXPIRES BUILDING PERMIT FEES ADDRESS NUMBER EACH FEE LOCALITY - `` LIGHT OUTLETS NEAREST CROSS ST. RECEPTACLES //' /y �•/}'.' 'R WALL SWITCHES TOTAL OUTLETS 3 2�! Sc $ MAIL V ELEC. RANGES J- 25 ADDRESS ELEC. HEATERS // 25 _CITY TEL. NO. FIXTURES / 5 1 HEREBY ACKN13WLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS - AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS Num, R HORSEPOWER ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MVD. HP QVE9 INC- EACHFEE OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. I/ 6 Less $ .2S - SIGNATUREEE or ir/ %z 2 .50 PERMITTEE 2 5. 1.00 INSPECTION RECORD 5 is 1.50 _ is sD 2.50 50 200 5.00 200 Soo 10.00 Q 500 IOOD 15.00 Z OVER 1000 20.00 Q M.G. SET/FRED. CHAN13ER-HP. R WELDERS• AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF EIRIOJ MOVED MOTORS (75% OF ORm) MISC. SIGNS HD. NO.TRANB. APPROVALS NO. NO. LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT: WIRING E$1.430I h CONDUIT FIXTURES $1.00 U D WIRING 040— U SUPPLEMENTARY .5q FIXTURES POWER i TOTAL FEE $ � O UTILITY CO. NOTIFIED /d FINAL 7GA663C- CE406B 12/75 APPUCATWO FOR ELECTRICAL PERWiv IT � I f' ' I1IIr11'I BUILDING AND SAFETY DIVISION BOB APPLICANT TO FILL IN JOB New Residential Bldgs. & Pools .•� EACH NO. FEE ADDRESS+ . 1 & 2 Finaily Sq. Ft - S LOCALITY Co-r Multi-family Sq. Ft. CFOSS ST. Residential Swimming Pools OWNER OR FIRM NAME Outlets: Light, Switch & Receptacle y�6 MAIL First 20 ADDRESS Additional 3 CITY Tel No. PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS ' Additional CITY T.I. No. PERMIT _ Fixed Appliances Not Over 1 HP APPLICANT 'Tho ec Qs G. Range— Heater_ D.W. ADDRESS 41 J. Oven Dryer W.M. - 3 Z. Tap FAU N.H. CITY N T. o. 1�p 10 �� y Hood Fan _� .2 p REG NUMBERE N SE OR &, Class. s.A.C. I ISREY AC1" 1SD Z C THAT I "AV' DEAD THIS^�PIICATION d z A. 0 TO E.Rr11 Power Apparatus& Large Appliances DCODnTT DAT THE am NANCE6 AND STATE A IS EVE 15 CORRECT ANEnws EREGULATING ~ U W Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIPING. Q_ - Z>Up to I Incl. HEREBYCERTIFVTHATI AIS REGISTERED ANDrOB Z oDNT. A Over 1 to 10 Incl. g�q Over 10 to 10 ncl.Inc CALIFORNIA Es�°aEo RE31OE o"E LEGAL Ow I g21"ONE AeDN Over 50 to lOO Incl. � PERMITEE PROPERTY. ' �`Y1.✓_C--_-/ Over 100 SIGNATURE Services DISTRICT NO. P CES D BV 0-200 Amp. Under 600 V 37-. 0 f 201 - 1000 Amp, Under 600 V APPROVALS EVE 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-Total) UTILITY CO.NOTIFIED FINAL �/ y/9 PLAN CHECKING FEE (One-Fourth Permit Fee) 1 c/ /12--1PERMIT ISSUING FEE - TOTAL FEE NOTES PLAN CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATION CK. M.O. CASH. 6 1 Off EB 2 D 2 5.85 A�: 76A66'L•CE00fiB 12%75 AY Y L ICA V IOM FOR ELECTRICAL PERMIT MIT BUILDING A SAFETY DIVISION FOR APPLICANT TO FILL IN EACH NO. FEE JOADDRESS- B w G� New Residential Bldgs. & Pools' _ 1 &2 Finaily Sq. Ft. - $ — �$ LOCALITY Multi-family Sq. Ft. NEARECROSS 5T.� � Residential Swimming Pools OWNER OR FIRM NAME • L Outlets: Light, Switch & Receptacle MAIL. �j First 20 ADDRES�S,� 0L—D vc y Additional CITV�G c� � 'Z� Tel. No..�pJ^ 033 PLAN CHECK ^1 APPLICANT RS Lighting Fixtures i First 20 ADDRESS Additional CITY Tel. No. PER Fixed Appliances Not Over 1 HP APP LIICANT Range_ Heater_ D.W. Oven _ Dryer W.M. ADDRESS Top FAU 'L W.H. CI TV ��7)G� Tel, No. / r�($p"/ >. Hood Fan SZ�LEG NN UMBER �! Class. 6.7"'x/ Disp. _ A.C. / 0 COee¢CT w ecom Power Apparatus& Large Appliances ALL E c RDLNgnces qNo STATE LwwE REGULATING w Size&Type HP, KW, KVA,or KVAR ELECTRICAL`"'RIND' Q_ 't,' Up to 1 Incl. AN.lOR Over 1 to 10 Incl. REQUIRED BY LOS ANGELES COUNTY AND STATE OF ONNIA RNA 50 OWNER OF THE ABOVE Over 10 to 50 Ind. EEca eeo Resl Ex Over 50 to 100 Incl. PEFMITEE Over 100 51GNATURE Services DISTRICT NO V 072, PROC SED 0-200 Amp. Under 600 V SC 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 is Additional Sign Branch Circuits ROUGH CONDUIT p (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) f7 UTILITY CO.NOTIFIED 7/) 'PLAN CHECKING FEE (One-Fourth Permit Feel FINAL PERMIT ISSUING FEE TOTALFEE NOTES E'L&DIXIAECK- A.LMAMIP1N 1 RKIv - xv -qSH PERMIT VALIDATION 17, CK. M.O. CASH POLICYHOLDER: 7 Le 'u 2 D 7.2 O a�-,6 POLICY NUMBER: 3 7S1 2_��.— � G T �� 7SA665-CESOO-11-51APPLICATION FOR 'ELECTRIC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING L BUILDING AND SAFETY DM�{{yySION ADDRE'00 SS CASSAAL LAMIE. Count II'D. GRIFFIN, Sw It W 9uRdiM LOCALITY N ""` - NEA ES _ FOR AP PLICAT TO FI LL IN CROSRS ST. PERMIT FEES 1 T E M NUMBER EACH FEE OWNER tY OUTLETS: S $ MAIL LIGHTS RECEPT. SW. .10 ADDRESS ' LIGHTING FIXTURES .10 CITY TEL.NO J ELEC.RANGES CLO.DRYERS ELECTRI AN WATER HEATERS '.50 ELEC.SPACE HTRS. DISHWASHERS ADDRESS GARBAGE DISPOSERS AUTO.- CITY TEL.NO. • WASHERS STA.COOKING UNITS ,25 \ STATE LICENSE MOTORS: OVER INC. H.P. O — 1/2 25 DISTRIC1 NO. IGHULJPjW I REAOY FOR INSPECTION Vz — 2' 50 S z — 5 1.00 INSPECTION RECORD 5 — 15 150 15 — 50 2.50 50— 200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 _ SUPPLEMENTARY PERMIT .50 TOTALFEE $ APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE IN ,51 ATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I ELECTRICAL WIRING. • WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FI%TURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE,fABOVE ` DESCRIBED RESIDENTIAL PROPERTY. Yl SIGNATURE UTILITY CO.NOTIFIED OF PERMITTE POWER ' FINAL .I ATlj0N A rHUR-C.VEIT. CK Mo GSH SUPERVISING ELECTRICAb R , p '!r s1 _ ItA 0 4 1 5 691 AUG 2 2 2 A2,$ Q 'FD, w WORKERS COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or o certified copy thereof (Sec 3800, Lab. C.) Is Fail icy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs, 8 Pools EACH NO, FEE ADDRESS ��Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY tion department Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. OWNER OR Dote Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec=Light,Sw. ADDRESS completed if the work Involved b First 20 (This section need not be com P T Total No. - CITY Tel. No. the permit is For one hundred dollars ($100)or less.) AdditionalPLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person iri any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel No. Date APphcont Fixed Appliances Not Over 1 HE PERMIT NOTICE TO APPLICANT: If, after making this Certificate of yy��,, r APPLICANT Exemption, you should become subject to the Workers Range— Heater_OLD.W. 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. — CITY Tel. No. deemed revoked. Hood — Fan _ Other— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY a and Professions Code,and my license is in full force and effect. _ O Size 8 Type HP, KW, KVA, or KVAR U License Number Llc. Class Up to I Incl FINAL Over 1 to 10 Inc. DATE LL VALIDATION Contractor Date ❑ Over 10 to 50 Incl. FINAL oa I am exempt under Sec. Over 50 to 100 Inc BY Q B.BP.C. for this reason Over 100 K Services, 5wbd., MCC 8 Panelboards 1101. d Dore. 0 - 200 Amp. Under 600 V W Signature 201 - 1000 Amp. Under 600 V H' ❑ Exemption for Reg. Mainz. Elect. ;Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances ,. . HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): - r a f . I, as owner of theMisc. Conduits 8 Conductors property, will do the work and the 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 Lender's Name PERMIT ISSUING FEE Lender's Address 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 authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Point Dale WORKERS'COMPENSATIONDECLARATION 76A66 CE-806G (280) APPLICATION FOR ELECTRICAL PERMIT {j J 1 hereby affirm,that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance, or 7 a certified copy[hereof(Sec. 3800.L( - —vl . �,�`/' FOR APPLICANT TO FILL IN JOB Policy NO Company EACH NO. FEE ADDRESS ( It O . , New Residential Bldgs. &Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection GROSS ST - �/yq��///,/.,///�� Residential Swimming Pools department. /'�/G'Y OWNER RM NAME Gt OZZe "YL— Data Applicant Outlets: Rec.—Light— Sw._ MAIL, ,., =J T/-� Gi✓✓ First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional 'CITY Tel No. COMPENSATION INSURANCE PLAN CHET 1 (This section need not be completed if the work involved APPLICANT O by the permit is for one hundred dollars (SI00) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional 1 certify that in the performance of the work for which thisCITY Tel No. Fixed Appliances Not Over 1 HP permit is issued, I shall not employ any person in any manner PERMIT r. U so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT Oven _ Dryer_W.M._ ADDRESS (q/• Date Applicant Top _ FAU W.H. yy Hood — Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room.Air Cond.— LICEN E R ��// � Exemption, you 'should become subject to the Workers' REG.NUMBER Y Z- ?Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED, Y .with comply with such provisions or this permit -shall be Size&Type HP,KW, KVA,or KVAR deemed revoked. Up to 1 Incl. FINAL VALIDATION •.] z G� Over 1 to 10 Incl. C' DATE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division of the Busi- BY Over 100 - ness and Professions Code. and my license is in full force and l effect. Services - // 0-200 Amp. Under 600 V _ Ce�) License Number r Lie.Class - / 201-1000 Amp.Under 600 V Contractor IWO Date �L9�^ Over 1000 Amp.or Over 600 V , HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances p Sign with One Branch Circuit Z..(.3 7,7 A 1 hereby affirm that I am exempt from the Contractor's Additional Sign Branch Circuits r. License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): # 2 Misc.Conduits& Conductors 1, as owner of theproperty, will do the work and the Other(See Complete Fee Schedule)— x.°,° 1 T5 O structure is not intended or offered for sale (Section ,� 7. 50 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency - O 4.2 4-8 4 .for the performance of the work for which this permit is PERMIT FEE (Sub-Total l' issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One'Fourth Permit Fee) - 'Lender's Address PERMIT ISSUING FEE S I certify that 1 have read this application and stale that the TOTAL FEE / �u above information is correct. I agree to comply with all County - - ordinances and State laws regulating Electrical wiring, and r authorize representatives of this County to enter upon the ab c e`men bone prpp t for ins n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE _ Viinature of Permittee Date '