HomeMy Public PortalAbout4853 CAMELLIA AVE_Electrical__ .WORKERS'COMPENSATION..DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT
CE-BO6G
I I�iereby affirm that I have a certificate,of consent to.self insure,- � w
cz.a,ceryflcate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800;Lab.C.)
Policy Nok Company • I FOR APPLICANT TO FILL IN - JOB ,
❑ Certified.copy is hereby tarnished , y _ ; • ,New Residential Bldgs.8 Pools EACH. NO. FEE
ADDRESS •3
❑.
Certified.'6o g p •1 & 2-Family, $ — S ^ LOCALITY � C.
py Is filed'.with'the count building ins ecfion Y, Sq..Ft. �
department , _ Multi-family Sq.Ft — - NEAREST
Dale .,
• - 'Residential Swimming Pools - CROSS ST.OWNER OR
Applicant - / ,t
CERTIFICATE OF'EXEMPTION FROM,WORKERS Outlets:Rec Light / Sw. t l _ 'MAIFJRM NAME
L •;1 '�
• COMPENSATION INSURANCE .. .'ADDRESS Cry
(This'section need apt be completed ii-the work involved by the First 20 .
_ permit is for one handled dollars ($100) or less.) Total No. Additional GITY, Tel.Nc(.{
.. •
certify that in the performance of'the work,for which this permit - PLAN CHECKAPPLICANT "
is'issued, I shall not employ any person in any manner so as to -.
become subject too the Workers'.Comppee6satioon Law, '"Q;6 L-.sL( Lighting Fix •CITYtures First 20, - RESS
27 d Y V l /c* /"c�'� Additional.- .., - _
Total No. / - Tel.No.
Date Applicant// / / Fixed Appliances Not Over 1 HP PERMIT _
NOTIC TO APPLICANT If aftermaking this Certificate of APPLICANT, '
.Exemption you should become subject to the Workers'Compensation 'Range_ Neater_ D.W. - ^
provisions of the Labor Cade, you must forthwith comply,with such Oven _ Dryer ' W.M._ ADDRESS �3 _�.• t (,J .
Provisions or thispermit shall be deemed revoked - Top — FAD W.H.
.CITY ' (.�
,LICENSED CONTRACTORS DECLARATION Hood — fan ' Other_ /� �G. Tel No. 4
herehy affirm that I am licensed under.provisions of Chapter 9 'Dep. Room Air,•Ccnd. vV� ICENSE OR 'Class.
(comrnenping with Section 7000) of Division 3 of the Business-and REG.NUMBER' -
Professions Code,and my license is In full force and effect. DISTRICT NO. 4 PROCESSED BY
Power Apparatus&Large Appliances, CK:
License
Size.& Type HP,KW,KVA,or KVAR �" (,J O
License Number Lid.Class. UP to Over 11 toCO Incl l. FINAL _ /J 7'� VALIDATION Ir
DATE y/J
Contractor ` ' Date r - • '. - Cl
Over 10 to 50 Incl
❑ ' I am exempt.under Sec. _ _
,Over
50 to 100 Inc. LLI
FINAL V
B.&P.C.for this reason Over 100 - 0-
'Services, SWbd.,MCC & Panelboards7D Z
Date: _ 0- 200 Amp. Under 600 V -
. Signature 201 '- 1000 AMP.Under 600 V -
�, Over 1000 Amp.or Over 600 V
.Exemption for Reg.Maint.Elect. - #
' .SINGLE FAMILYT
_ emp. Power Pole& Appurtenances '
HOME OWNER-BUILDER DECLARATION - Sign with One Branch Circuit ." 41 0-5.112 5.=
I hereby affirm that am exempt from the Contractor's License•Law, ° .-o 5,Q 2 5 5 ,
fogdhe following reason(Section 7031.5, Business and Professions Additional Sign Branch•Circuits _ ,
Code): 0 6 2 8!r 8 8
P_Iy
-I .Mist:Conduits&Conductors,
I;as owner of the property,will do the work and the structure -is not intended or offered for sale (Section'7044r Business Other'( e Complete Fees D _
and Professions Code)."
CONSTRUCTION LENDING AGENCY -. -
I hereby affirm that there is a construction lendingagency for
performance of thework for which this permit is issued(Sec.3097,.' PERMIT FEE (Sub-Total) - ..
•;Civ.C.).
PLA N.CHECKING FEE
Lender's Name
PERMIT,ISSUING FEE
Lender's Address - r
I certify that I have read this application and state that the above TOTAL FEE �D
information is correct. I agree to comply with all County ordinances `
and State laws regulating Electrical wiring, and hereby authorize -
representatives of this aunty to enter upon the above-mentioned -
prop fori specti
our es. _ SEE REVERSE FOR:EXPLANATORY LANGUAGE _
ign ture of Permittee Da
cOUNT'i OF LOS ANGELES TEMPLE CITY 9 0505 PlEt7TRICAL PERMIT
DEI%P.TMUNT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0410120042
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE Ci"'I CA 91780
PHONE: :'85-0488 EXT:
TLEGAL ID: FEES— p� ID ----
7R: 14467 LT: 43 4853 CAMELLIA AV
FEE DESCRIPTION: - DUANTITY: UDM: .J60C�NT: TEMP CA. 917x.04:;.1
ASSESSOR INFO MATIC:? NUMBER: NEARES! CRCSS STREET: LOWER AZUS,..
8589-015-020 Al PERMIT ISSUANCE FF.E 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW',RECP 50.00 OUT 79.50
�TENANT: G2 LIGHTING FIXTURES 20.00 LGT 39.00 ISSUED ON: PROCESSED BY: PLAN BY: F.XTTPEST
j H7 RES EXHAUST FANS 2.00 EX 21.90 10/12/04 JK 04/10/"5
JB AC UNITS +3-10HP 1.00 AC
OWNER: TEL. NO: _ LA 100 AMP PANELS, MC;; 1.00 PAN 38.85 FINAL DATE FINAL BY: CLUE:
CHENG ,!IAN H;DENG AEI ZHEN (626) 695-0864- TOTAL FEES 126.65
4853 CAMELLIA AV �— _r_
iTEMP 917504241 DESCRIPTION CF ''WORK — -
i ELECTICAL FOR THE GUEST HOUSE AND SERVICE 100 AMPS
!APPLICANT: TEL. NO:
(SAME AS OWNER
SPECIAL CONDITIONS: -_
I
ONTRACTOR:
SAFiE AS OWNER TEL. NO: APPROVALS DATE INS, EG OR S;u'
ThATUHE
- _
LIC. NGEMPO� ARNRYPOWER 'ULE -
UNDERGROUND CONDUIT
I' CHFC
RiTi OR ENGINEER: TEI HD: IIFLR GROUND -- __I------- ---
L iC. NC: TROUGH CONDUIT I
I
IT= IiC WING - -lp�� Y -------- --
� h1N1N WATER LICE
PLASTIC Y/N METAL Y/N
UTI LI Y COMPANY NOTIFIED
IW--27
I
i
I
i
REPORT ID: DPR265 ROUTE TO: BS0508
CL`Ukii ur LOS ANGELES TEMPLE CITY # 050a ci,Ei:7R1-A PERMIT
DEFARTMEt:T OF PUBLIC WORKS 9701 LAS ' EL E50_311110120029
BUILDING AND SAFETY ! LAND DEVELOPMENT TEMPLE Ui1Y '? 9 T'..ra
PHO'E: ;626) 285-0=:38 EXT:
AL PAID BUILDING ADD^ffc -
!TR: 14467 LT: 43 _ 4853 CAMELLIA AV
(FEE DESCRIPTION: QUANTITY: UOM: t.40HUT:I TEMP CA 917.znz 41
�f SScCSOR INFORMATION NUMB ! NEAREST CROSS STR-ET: LOWER AZUSA
8589-015-020 !Ai PERMIT ISSUANCE FEE27,75 THOMAS PAGE: :,, GRID: A5 LOCALITY: TE!41PL2 CITY, C
G1 OUTLETS-LGT,SW,RECP 35.00'OUT 59.25 TENANT: — lG2 LIGHTING FIXTURES 10.00 LGT 19ISSUED ON: PROCESSED TY: PLAN— _: ....
_IS .4C UNITS +3-10HP 1.00 AC ?9..50 65 10/12/04 JK 04/10;0`5
IB 200 AMP PANELS, MCC 1.00 PAN
ICWIlER: TEL. NO: IUTAL FEES 165.60 FINAL DATE / :INPA DY• CUGE:
1CHENG JI.AN H;DENG MEI ZHEN (626) 695-0864- Std
4853 CAMELLIA AV
;TEMP '17804241
j
IELECTRICAL FOR THE ADUI I:CN AND UPGRADE SERVICE TO 200 AMPS
-_
�nFPLIC:.NT: TEL. N0:
igk4E AS OWNER -
iSPECIAL CONDITIONS:
TEL. NO: i A?PRO'V;LS --;Tc —IN SPFCi G'- IgE
t�P.S OWNER
i- LIC. NO TEMPORARY POWER PULE
UNDERGROUND CONDUIT i
�iRCH:;FCi 0ORENGINcc- :: L. ND: UF_R SRS CUND — I
LIC. NO: I ROUGH
—i t
j NCUGB WRING ! i-----
-- -I -- Il �----
tiAIN uATER LIN'c
PLASTIC Y/N METAL 'i/N i !
UTAITY CCMPA Y Nr� .IF ED'---I
-- (REPORT ID: DPR265 — ROUTE TO: BS0508 --