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Home My Public Portal About5133 CAMELLIA AVE_Electrical__ 76A50,.CIZ805 j0"9 APPLICATION FOR ELECTRICAL RMIT COUNTY OR LOS ANGELES DEPA5TMENT OF COUNTY ENGINEER e � r 3 � �}j� BUILDING AND SAFETY DIVISION 7 LOCALITY T N�P,REST FOR APPLICANT TO FILL IN CROSS STeve I( OUTLETS OWNER OR $ FIRM NAME RECEPT.-2— MAIL LIGHT 2 TOTAL FIRST 20 1 T5 ADDRESS ' , f i� CITY TEL. NO. SWITCH 1 OVER 20 10 — PLAN CHECK LIGHTINGFIRST 20 2D APPLICANT TOTAL FIXTURES OVER 20 .10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO_ PERMIT RANGE DRYER—WTR. HTR._ APPLICANT STA. COOK - DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. Cl TY TEL. NO. CLOTHES WASH. DISHWASH. LIAISE OR' IR+EtuQ NUMBE7i CLAS8. FAN OTHER 1.00 I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND [TATA THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS IIA TPNG WITH ALL COUNTY ORDINANCES AND [TATE LAPIS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. G IZE 6 TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/QR 60 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES 'COUNTY AND STAT[ OF CALIFORNIA OR THAI I AM THE LEQAL OWNER OF THE ABOVE 1 - 10 Epp DESCRIBED REGI L PROP[ TY. PERM1 EE /A 10 - 50 6.00 SIGNATURE ✓✓((( pp ISO - 100 1000 DISTRIC N0. CESS D BY 100 - 500 16A0 /) N ' � Z SIGN, GAS SIGN AND ONE CIRCUIT 0.00 APPROVALS DAT[ GNINATURIF TUBE, OR MARQUEE ADDITIONAL CFRCUITS '1A0 TEMP. POMIER POLE ' SERVICE NOT OVER 600 VOLTS OR 200 AMP 3A0 UNDERSLAQ WORK SERVI CEOVER 60-0 VOLTS OR 200AMP IO.00 ROUGH CONDUIT TEMP SERVICE,POLE, &APPURTENANCES &OD WIRING TEMP LIGHT OR RECEPT. SYSTEM 5.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PUN CHECK FEE PERMIT ISSUING FEE SAO TQTAL FSE b. 25 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.o. CASH 1 4 SEE SACK OF APPLICATION FOR COMPLETE SCHEDULE rl' as cEeoe 9--e7 APPLICATION FOR ELECTRICAL PERMIT �COUN-tV OR LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUIhDING AND SAFETY DIVISION ADDRESS JOH A. LAMBIE. COUNTY ENGIN[CR COLIhMAN W. JENKINS, SU"RIHTKNDKNT OF BUIL.DINOLOCALITY [NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO, PAC RECEPT._ OWNER MAILf LIGHT TOTAL FIRST 20 .20 ADDRESS SWITCH_ OVER 20 .10 CIT TEL. NO. LIGHTING JTOTAL FIRST 20 .20 CONTRA TOR FIXTURES OVER 20 .10 ADDRESS LAW- RANGE RYER WTR.HTR.— / �D C I TYCk TEL. NO. STA.COOK_DISP.—F.A.U._ LICENSE NO. SPACE HTR. AIR GOND. IF ACKN L DGE THA I HAVE READ THIS APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CLOTHES WASH._ WASH._ WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING [LECTR ICAL WIRING. _ FAN OTHER 1.00 1 HEREBY CERTIFY THAT I AM PRQPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOa ANGELES COUNTY AND STATE OF MOTORS,TRA"FORMERS RATING CALIFORNIA OR.THAT I AM THE LEGAL OWNER OF, AND INTEND TO IND. HE.ATER8, ETC. HP. KW. KVA. RESIDE IN, THE ABOVE DESCRIBED RESIDE X"f IAL FR TY. SIZE 5 TYPE OVER TO SIGNATURE 0 - 1 1.0.0 OF PERMITTEE 0 t - to 3.00 DISTRICT O. G P Z NE P E ED BY U 10 - Bo 5.00 G AIx 50 - 100 10.00 NOTES: I- 100 - Soo 18.0 G ��+J+ EIGN,GAS TUBE, OR SIGN AND ONE CIRCUIT 3.00 �/c-{/� 1'i I MARQUEE ADDITIONAL CIRCUITS 1.00 SERVICE NOT OVER 800 VOLTS OR 200 AMP 2.00 SERVICE OVER 500 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, h APPLRTIENANCES 8.00 APPROVALS DAT[ UISPECTOR'S SIGNATURE TEMP. POWER POLE UNOERSLAB WORK ROUGH CONDUIT WIRING ISSUING FEE 2.00 FIXTURES SUPPLEMENTARY ISSUING FEE 1.00 POWER AUTHORIZED PERMIT FEE UTILITY CO.NOTIFIED PLAN CHECK FEE (50% PERMIT FEE) FINAL Z /� TOTAL FEE JOSEPH C. ROOHAN mmi6W SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION ( Co M.O. CASH 6 00 QkS X19 2 0 6jQD- h IDEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ' WORKERS'COMPENSATION DECLARATION CE$06o (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES �UILDING AND SAFETY Insure, or a certificate of Workers'Compensation Insurance,or ( �y� a certified copy thereof(Sec. 3900,Lab.C.) L/ Gmf> FOR APPLICANT TO FILL IN JOB f Policy No. Company EACH NO. FEE ADDRESSS)New Residential Bldgs.&Pools Certified copy Is hereby furnished.�d —� - 1 &2-Famlly,Sq. Ft. S LOCALITY sxkl Certifled copy L filed with the unty building irupection Multi-family Sq. Ft. CROSS ST L-A V-411r:41121l, d�epartment¢.-� Residential Swimming Pools OF n ' fL5-• `Applicant r Light RM NAME Date f 1` Outlets: Rec. Sw.� ADDRESS —�Irst 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.�� Additional CITY Tal No. } COMPENSATION INSURANCE tl PPLICANT First 20 t Fi Fixtures 8 (TIL section need not be completed if the work htvoh*ed by the permit is for one hundred dollus ($100) or len) Lighting151 Additional � DDRESS � I certify that in the performance of the work for which this F xet Il No. CITYt Over 1 HP CITY Tal No. "7 O permlt is Issued, I shall not employ any person In any manner PERMIT LLIU so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. _ PP I ANT CL ! Oven _ Dryer-_W.M. DDRESS to Date Applicant Top _ FAU _W.H. Hood _ Fen _Other_ TY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Dlsp. — Room Air Condom Q Exemption, you should become subject to the Workers' REG,NUMBER 1 Clans 8 Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. P E88 BY f with comply with such provisions or this permit shall be deemed revoked Size&Type HP,KW,KVA,or KVA Up to 1 Incl. Over 1 to 10 Incl. FINALDATE 7 LICENSED CONTRACTORS DECLARATION Over 10 to 60 Incl. f-- VALIDATION I herebyaffirm that I am licensed under FINAL provtsions of Chapter Over 60 to 100 Inc. 9 (commencing with Section 7000) of Division 3 of the BwBY l- Over 100 BY nags and Profeadom.Code, and my license Is In full force and effect. Services 0-200 Amp. Under 800 V License Num ' Lie.Clea- 201-1000 Amp.Under 600 V Contncto Data Over 1000 Amp,or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Powef Pole&Appurtenances 23656A I hereby affirm that I am exempt from the Contractor's Sign with ON Branch Circuit $t 0'0 0 0 0 2 License Law for the followtng reason (Sectlon 7031.5, Bual- Additional Sign Branch Circuits 2,0,0 2 1. 1. 0 noes and Professions Code): Misc.Conduits&Conductors 2 t I, as owner of the property, will do the work and the Other(Soo Complete Fee Schedule)— structure Is not Intended or offered for sale (Section Q 5.-82 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 PERMIT FEE (Sub-Total) issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth.Permlt Fee) Leader'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 regulathn Electrical wiring, and hereby authorize representatives of this Count to enter upon the a entioned property for ins tion rposes. SEE-REVERSE FOR EXPLANATORY LANGUAGE 2 Sl¢natura of Permittee Date