HomeMy Public PortalAbout5200 CAMELLIA AVE_Electrical__ 7GA8"-CF805 4-85 APPLICATION FOR ELECTRI AL PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS O
JOHN A. LAMBIE,.COUNTY ENGINEER !
COLEMAN.W. JENKINS. SUPT. OP BUILDING LOCALITY �` �� 71
N¢.A R S9T
FOR APPLI111111110" CROS• ST.
RECETTACLE TOTAL NO WAqq
LIGHT OUTLen FIRAT 20 111.20 4 OWNER
MAIL
SWITCHADD'L 10 ADDRIE98
OVER 20
TOTAL FIRST 20 .20 CITY { TEL NO.
LIGHTING 1�'
FIXTURSH FIXTURES VIER 2 10 CONTRACTOR
OVER 20
RAN QEI DRYLta WTR trTRs. 1.00 Crb ADDRWI
OARS.DIE. GTA.COOK
clTr No.
DIGH .. AUTO..WAIH. STATE
SPAC31 HT'Rs. ,( H f. .e0 LICENSE NO.
MOTORS. Ovu MOT FJVKR DI>�1CF G P Zr P
0 1 1.00
/ � l :7-
1 a 1.6o INSPECTION R CORD
i 8 2.00
6 1 e 2.60
1D 503.00
U
eO 100 6.00
SIGN. No.TAANa.
! NO.LAIPa
SERVICE 0.600V-NoT ovmt 200A 1.00 ad a
I �
aERVICI O.eoov-OvER 100 A. 2.00
SERVICE OVER 600V 6.00
OTHER (SEE COMFLrr[ FEE■c HEDu L[)
I
PERMIT ISSUING FIE 2.00
OUPPLXMENTARY PERMIT I6MUMG FII 1.00
TOTAL FEE �Q DATE INATLM
1 [ E
HERXAY ACKNOWLEDGE THAT I HAVRAD THIS APPLICATION UNDHRULAB WORK
TI
+K STAT=THAT T [A19OVK lE COMU=AND Aa REE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND CTAT= LAW REGULATING
ELECTRICAL WIRING. WIRING
1 H[R[EY CERTIFY THAT AM PROPER GIGT[RiD AND�OR FIXTURES
LICINE[D Aa REQUIRED Y LOS AHG[ NTY A STAT[ OF
CALIFORNIA OR THAT 1 LEGAL OF, INTEND TO POWER
R[EID[IN,THI AE I D RL IAL
t
SIGNATURE ` UTILITY CO- IFI
OF PERM ITT
FINAL
L ATION JOSEPH ROOH
E
SUPRVISING ELECEC
TRICAL ENGINE[1R
CK O CAJ<li
X3.483 &113 2 q ' 5.70- Q
79AB63 De•SA 11-00 APPLICATION FOR PMDE
DEPARTMENT OF BUILDING AND SAFETY
OF LOS ANGELES ELECTRIC 1
WILLIAM ILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT O. GROUP PERMIT NO.
ELECTRICIAN 1;— C ,36- 57�4'
V BY READY FOR DpTlK[p [
UD
ADDRESS F=MCTION CITYTYL No
COUNTY LICKH91 NO, KXPIRZVZ BUILDING �}
PEBMff FESS ADDRmi. Q
FEE i NU B EA LOCALITY
LIGHT OUTLETS N[ARZnT
RZC<fTACLiS CROSS ST.
1
WALL SWITCHES OWNER
TOTAL OuTLATv sc S C4 MAIL
[LEC. RANG[B sa ADDRESS
CLEC. HEATZRS IIa CITY
FIXTURES a
Tia- NQ-
misc. 1 HERESY ACKNCWLJIMGZ THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE LS CORRECT
NUMBER OF LIGHT CIRCUITB AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBQR OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING M-KCTRICAL'WIRING.
MOTORS 1 CERTIFY THAT I POSSESS THE AIOVE VALID LOS
Numm" HORSKPOWKR ANGELES COUNTY L ICKNS[, OR I AM THE LZGAL O1MNKR
Ft[
NEW HP oval INC. EACH OF THE RZSIDENT1AL PROP[R"IY DtSCRtL
1ID AIOVMw.
•L.o III IIaSIGNATURE OF
1 R .bo ATURK Tt
s a 1.00 INSPECTION HD
- e 1n 1.ao
1e no 1,60
so 200 5,00--
loo
o0:oo a00 10.00 J
ZQO 1 boo 1a.bo
OVER 1 ooO 10.Ocr �
M. G.SET FR[ . CHANGER-HP (K
WELDtRSI AC-KVA O
GKN[RATORS-KW .
TRANSFORMS-KVA
TEMP'. MOTORS 75or oiva.
MOVED MOTORS 75or ORIG.)
misc.
SIGNS
NO. NO. TRANS. P"ROVALS
No. NO, LANIll
DATE INSP R'S E
FOR EACH P ITS
WIRING 1,00 CONDUIT .
FIXTURES 1.oo WIRING /
SUPPLEMENTARY FIXTURES
POWER
TOTAL FEE S UTILITY CO. NOTIFIED
FINAL
WORKERS'COMPENSATIONDECtARATION CE� (2-80) APPLICATION FOR ELECTRICAL PERMIT
}` hereby offlrm that I have a certificate of consent to self COUNTY OF LOS ANGE S ING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab. C.)
FOR APPLICANT TO FILL IN JOB
Policy No. CompanyADD
New Residential Bldgs.&Pools EACH NO. FEE
Certified copy is hereby fUrnished. 1 &2-Femlly,Sq. Ft. $ — 3 LOCALITY
MultiCertified copy Is filed with the county building Inspection Residential
SM miFt. CROSS ST'
department. Resldentfal Swlmmlrp Pools OWNER OR
AtL t3 /J FIRM NAM
Date Applicant. Outlets: ReAllght SW. MAIL
Irst 20 ADDRESS -rr
CERTIFICATE OF EXEMPTION FROM WORKERS' . Total No Additional
CITY Tel No
COMPENSATION INSURANCE }
PLAN CHECK 4
8
('This section need not be completed it the work h'tvoh+ed APPLICANTLI Lighting Fixtures First 20
by the permit L for one hundred dolhn ($100) or len.) G U ADDRESS
Total No. Additional 0
1 Certify that in the performance of the'work for which thisCITY Tel No.
parson permit is issued, I shall not employ any In any manner Fixed Appliances Not Over 1 HP
PERMIT �
to as to become subject to the Workers' Compensation Lawn. Range— Heater DW. PP ]CAN r L
Oven _ Dryer W.M. ADDRESS � Z
Date Applicant Top FAU'_W.H.
Hood Fen _Other_ CITYTel No.
NOTICE TO APPLICANT: If, after making this Certificate of Dlsp. _ Room Air Cond. J ENS
Exemption, you should become subject to the Workers' REO. NUMB R Claes
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Applierlcea DISTRICT NO. PRQCESKED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW,KVA,or KVA _U61
Up to 1 Incl. a 5
Over 1 to 10 Incl. u� FINAL
LICENSED CONTRACTORS DECLARATION DATE VALIDATI
Over 10 to 50 Incl. �C3
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY
news and Professions Code, and my license Is In full force and
effect. Services
License Number Lic-Class 0-200 Amp. Under 800 V
201-1000 Amp. Under 800 V
Contractor Data Over 1000 Amp.or Over 800 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for Cho following tesson (Section 7031.5, Busi- Addltlonel Sign Branch Circuits
neva and Professions Code):
Ml,c.Condults&Conductors
I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)—
structure is not intended or offered for sale (Section 2 8.B 2 A
7044,Business and Professions Code).
CONSTRUCTION LENDING AOENCY # o a 0 o Q.2
1 hereby affirm thst there Is a construction lending agency
for the performance of the work for which this permit Is PERMIT FEE (Sub Total) 2 0•o G 2 �' -
Issued (Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) o o o 2 a 2 Q cS3
Lender's Address PERMIT ISSUING FEE I Q3 1 -8 o
I Certify that I have reed 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
t bove-mentioned prbpQFty for Impaction purposes.
/�- SEE'REVER3E FOR EXPLANATORY LANGUAGE
Signature of Permittee Date