HomeMy Public PortalAbout5203 CAMELLIA AVE_Electrical__ 7aAaaa-C G:COa a-OD
APPLICATION FOR ELECTRICA ERMel Tel
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS Z U
JOHN A. LAMBIE COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY -M—KPLE CITY
FOR APPLICANT TO FILL IN FOR LAC
CROSS ST. q f'� 1�
MO, EACH F[[
S i OWNER C L�n A/�
RECEIPT ADDRESS to ` lGLkkA
LIGHT TO L FIRST 20 .20 r-�
SWITCH OVER 20 .10 CITY lL C TEL.NO. —3c76
PLAN CHECK
LIGHTING TOTAL I FIRST 20 ,20 APPLICA INT
FIXTURES 1-151 OVER 20 .10 ADDRESS
� RANGE_DRYER_WTR. HTR.
CITY TEL.N0.
STA. COOK_DISP. F.A.U. CONTRACTOR
SPACE HTR. AIR CORD. ADDRESS
CLOTHES WASH._DISHWASH. I CITY TEL.NO.
FAN_OTHER 1.00 LICENSE NO. CLASS.
MOTORS,TRANSFORMERS RATING I HERESY ACKNOWLEDGE THAT I HAVE RIAD THIa APPLICATION
IND. HEATERS, ETC. HP. KW. KVA, AMD •TAT[ THAT THE AaOV[ 15 CORRECT AND AAR[E TO COMPLY
SIZE 11 TYPE OVER TO WITH ALL COUNTY ORDIMAN C[/ AND aTATt LAWS REGULATING
ELECTRICAL WIRING.
O 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/oR
LICKMSKD A■ REWIRED By
LOLO ANGELES COUNTY AND STAT[OF
1 — 10 3.00 CALI FORM IA 0R THAT I AM TH[ L[OAL OWM[R OF, AMD INTEND TO
RESIDE IM, THE AZOV[ DES CRIa[D RE/I DENTIAL PROPERTY. n
10 — so a.00 ��.J{
SIGNATURE
50 - 100 10.00 OF PERMITTEE ` O
100 - 500 15.00 DI a T No GRou xo P cEI/E rj
SIGN,GAS SIGN AND ONE CIRCUIT 5.00 0� Cjl
TUBE, OR ,Z
MARQUEE ADDITIONAL CIRCUITS 1,00 NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00 L
TEMP SERVICE, POLE, &APPURTIENANCES 3.00 APPROVALS DAT[ GfOPECTOWS SIGMATURK
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
POWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
UTILITY CO.NOTIFIED Allf
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE JOSEPH C. R0OHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAIN
[y a 15� oar 3 2 D 4 A 04 z
SE[ SACK OF APPLICAT10M FOP COMPLETE FI[ ECHIDUL[
i 1
J 1. Lwr"r:1,V.K)RKER3 COMPENSATION DECLARAT)ON 78A883 10/81
. �Lfw,Bby al. that rhave a cerdfloats d =verd to sell � GE-8000 APPLICATION FOR ELECTRICAL PERMIT
or a oerffbate of Wbrkwa' Compensation Insuninoa, or a oerttW COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thered (Sea 3800,Lab. C.) nn
Pdlvy No. Corrlper,y. FOR APPLICIWT TD FlL IN AADDDRFM d
Certtfled copy b.hereby turNehed New TiQaidentlel.Bkips d Pods EACH NO, FEE
1 d 2-Femfty,S4 Ft $ — S L Y
n Cw tW copy Is flied with the bounty buildinghepection F
�' deperpl>ant' Muld-temky.S4.Ft. —
caoss eT.
Day, - eflt�Ap~ .�Ytm nitllQ POOH •y OWNER OR .
Yalu I ' F"A tLAAC
CERTIFICATE OF EXI=MPTION-FROM WORKERS' Outlets:Reg-L.Light —Sw. MAL
COMPENSATION INSUF*CE Ftret 20.' ADPREW
(T'hts section reed not bo co+npMtrad If ire work Invofred by the Total No. Addltldnal No
prarrnft It for one hupdrsd,dollars(-$100)or Terra.)
Guy
I certifyeued,that bn the'.perfovnarne d the work for which U* permit PLAIT
Is leI'shall not•employ any.person-In ern maruwr eo as to
beoodo al 41 ft Wurtaere,&DOLaws. Llghrao Ficin FUV 20 ADDRESS
�. Total Na 3 AddbDnal CiTI Tel.
f/ Date O APA"
NOT1C H,- niter making this d Fixed Appkmoes Not Over 1 HP PEFMT
P .-YOU puld b--Pe-*Ct to the Wbri—'Corrpeneatlon Heater— D W.
F-� � d ' � •
provisions of the Labor Code, you must krthNrfth oom* with s{oh oven Qryer_ Witt-— ADDRESS
provisions or thb'permlt.ehgll be deemed rewind. Top- —,FAU WN CITY Tei.Na
LICEN8ED.CONTRACTORS DECLARATION Hood Fen other—
FU—CENSE OR
'I hereby a#fhrm that.l,,am licensed under provisions d Chapter 8 Dbp_ Room AirConq.-'— RE NU10ER Ci�ea
(oommencfng wtth'Section 7000) of Dfviebn 3 d fhe &Ak-eea and
j .Prdessione Code,and my Tisane 1:51n full foncb and eflec t- Power Apperah.s 8 Large Appllanoee. DOTFOCT No. �.. ` BY
Slzs 8 Type HP,KW,K)A�,or KIAR v
Uceme Number U O.Cieas up to 1 Diol. FINAL
I Over 1 to 10 hmL DATE
on
Ctreator Data Over 10 to 60 Ind. -+
' FINAL - U
I am exerrrpt,under_Seo. over 60 to 160 Inc. BY iLu
B_SP.C.for this reason Over 100 U)
r �� Services C'Swbd,MCG&Pdrio[b69rde _
4- 200 Amp.Under 1300 V
Signature 201'- 1000 Amp.Under 800 V -
Orw 1000 Amp.or Oven 800 V
Ex mption for Reg.Malnt Elect , a
SINGLE FAMILY -efnp.Power Pde S Appurtenencee 1 .0 3.2 A
HQME OWNEP,13UILDER IDLECLARAJ10N Sign Wth One Branch Clroult # o'o io o o 2
1 hereby affirm that I am exempt from the ContrwWa Lbenee L13w
for-the folbwtrrg rsaaoh (Section 7031.5, Buelno"and PrdeeaiomAdditional Sion Brarcty Ch:culte - -19.25
Code):
0 I,as owner d the property,*11 do the work and the etruoture 1�ibo Coridl 'd Cordcictord d ° -1 9 2 5
I b Intended or pftered for sale (Section 7044, Buslrxm 011ier(See Compietle'Fee Schedule)
nq1 l a 31, 8 8
I `: and pr�ofe4sbne.Code). .
CONSTRuCijok L-rNDiNG AGENCY
I
hereby affirm tliat.there:ls a calsinrodon lending epw y for the
)3rfomVance
of the wor-k.for wtlioh thls pgrmft Is bared(Sea 3007, PERMIT FEE (SUb Totsl)
PLAN CHECKING FEE -
LarKWs.Name
PERMIT ISSU I FEE.
1_6nder'e Address
I oWttfy that I haye read 0:01a'epplbabon and state that the above TOTAJ_FEE
intorrnatbn,le correct I agree to oDm ty,with all Coupty ordlnenoes
and State Laws regulaWV Electrical wtrtrrg, and b6cetry audxxtze .
represerrtabves of.thio Canty to enter upon the above-merrbon d
for out' SEE REVERSE FOR EkPLANATORY LANGUAGE
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