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Home My Public Portal About5208 CAMELLIA AVE_Electrical__r ■ wothat I'have a ENSATION DECLARATION 200017 OPW(,2-9,) • APPLICATION FOR ELECTRICAL PERMIT , 7tiME3 I hereby aftlrfi;that I have a certificate-of consent to self Insure, or a eertfflogtof Wgfkerte C414ipenbatlon Insurance, or a certified COUNT`(OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. oopf-thereol(Sec. 3800 Lab. C.) Policy No. Company FOR APPLr-AXr TO FUL IN ❑ Certified oopy Is hereby fumlete . New Realdentisl Sldge,S Pooh NO. EACH FEE ADDRESS _ = LOCAIJTY EJCertilled copy Ia flied with the county bulk ing Inspadion 1 8 2 famJty,Sq.Ft NEAREST del-17 t- Multi hmlty Sq.Ft — CFC68 ST. Deib App Ooant R vkenilal Swimming Pooh OR MAP BOON PAGE PAPCa CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Roo._Light Sw. NA'CI4,x � COMPENSATION INSURANCE First 20 L(This section need not be completed H the work Involved by the MAIL 10 permit Is for one hundred dollars(SlDO)or lose.) Total No. Addflcrmd tiv4K I certify that In the performance of the work for which this permit CryT1ko Is leaued, I shall not employ any person In any manner so as to PLAN CI : �� become subject to the Workers'Compenaadon Laws. Llghting Fbdurw Firm 20 APPLCANr Total No. AddtHonal ADDRESS Data Applicant HESIDEN AL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: I1, after making thre Certificate of CfTY TOL No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERltlrr provisions or this permit shall be deemed revoked. Power Apparatus S Large Appiianow AP?L)CAHT LICENSED CONTXIACTORS DECLAFAT10N Size S Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 8 (commencing with Section 7000) of Division 3 o1 the Business and Over 3 to 10 Ind. CF-Y TOL No- Professions Code, and my license Is In full foroe and effect. Over 10 to 60 Ind. LK>FNSEOver 60 to 100 Incl. NU� a Over 1 DO D18TR1CT NO. BY O LlceneQ Number Lb.Clasp �V� (� Services,Swbd.,MCC S Penelboerds a: Contrvcror Date 0-399 Amp.Under 800 V DATE Q O ❑ I orrr exempt under Seo. 400-1000 Amp.Under 600 V —S"► VALIDATION V Over 1000 Amp.or Over 000 V FINAL W B. P.C.for thio resaonBRANCH CIRCUrr FEES Uj Date: 16A,or 20A,12OV,Lighting or Recept. Z 1 To 10 Branch Circutta Slgnaruro 11 To 40 Branch Clrcults 41 Or ❑ Exemption for Req.Mnit.Sect. 16kMk 2DBV To 277V LVMtN Br.ore Cfraila C SINGLE FAMILY Temp,Power Pole d Appurtenenom wrr a HOME OWNER-BUILDER DECLA ATION ACCT■e I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 7f1 i for the following reason (Section 7031.6, Bualne"and Professions Additional Sign Branch Circuits rv•to �): 1 ITM i I, as owner of the property,will do the work and the structure Mlsc.Conduits S Conductors TOTAL �-k� 3 h not Intended or offered for sale (Section 704-4, Business Other(See Complete Fee Schedule) and Professions Code). , cwcyl 70.10 CONSTRUCTION LENDING AGENCY `4*41 ,00 I hereby nttlrm that there Is a constructlon lending agency for the h performanoe of the work for which this permit Is Issued (Sec. 3097, PERMIT FEE (Sub-Total) A Ctv. C.) PLAN CHECKING FEE t O0+] ill"1 est t.9/9916 Lenders Name 4172 1 b:02 PERMI'T ISSUING FEE Lender's Address I certify that I have read this appOcatfon and under pwmity of purJury slate TOTAL FEE 0 that the above tiformafion Is correct. I agree to comply wqh all County ord]nanceo and State laws regukrtlng Electrical wirlrp,and hereby authortre representatives N thh County to enter upon the obeys-mentioned property ' for I ntkocdon purpoeoe. SEE REVERSE FOR EXPLANATORY LANGUAGE 91Q4AT JLW OF PEFSV= DATE I WORKER's coMPENSAT►oN DECLARATION n>woN ' zo-oolo oPw(12 01). . APPLICATION FOR ELECTRICAL PERMIT I heby ottfr� that I have� certificate of convent to eel} Insure, or roertlflcate of Woriter's Cgmp6rieatlon Insuranos, or a certified 1COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Seo.3800 Lab. C.) Policy No. Company PORAPPUCARr TO FILL W JOB �3 ❑ CerLtW copy Is hereby fumlehed. New Realdentlal Bugs.S Pools NO. EACH FEE ADDRESSO $ i LOCALY L ElCertN copy to Rled with the county bulldlnp Inspection 1 8 2 family,Sq.Ft NEAREST department Mufti-fam y Sq.FIL CROSS ST, Data Applloam Reeidentlal Swimming Poo1n ASSE89DRBOOK E D /` PAO � PAFICg ef1/ / 2 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec. LJgM �v Sw.0 OY#I RFN�OR COMPENSATION INSURANCE Fl� DO - 20 (Thls potion need not be oompleted H the work Involved by theMAL H permIs for one hundred dollars(1100Total No. Additional ADDRESS )or law.) I oertlfy that In the performanoe of the work for which this permit CITY TeL Is Issued, I shall not employ any person In any manner so as to �p PLAN CHEcr( become subject to the Workers' Compensation Laws. Lg�ng fifes First 20 APPLIC—ANT Total No.�� Additlonal ADDRESS X De3e At REWENTIAL APPIANCES NOT OVER 3 HP NOTICE O APPLICANT: If,I1,, after making this Cgrtlilcate of - . CrrY TeL No. Exemption, you should bsoome subject to the Workers'Cop pensatlon OTHER APPLIANCES NOT OVER 3 HP. provisions of the tabor Code, you must forthwith comply`vilth such Pi'C provlalone or this permit shall be deemed revoked. Power Appfl"S Large Appllancee APPLJCr1FfT LICENSED CONTRACTORS DECLARATION Stxe h Type HP,KW,KVA,or KVAR ADDRESS I hereby afflrm that I am licensed under provisions of Chapter B Over 3 to 10 Ind. (commencing with Section 7000) of Dlvlelon 3 of the Business and CITY T«-No. Professions Code, and my license Is In full force and effect. Over 10 to 60 Ind. LICENSE Over 60 to 100 Ind. B Chum 11 Loense Number Lc.Clare Over 100 DOMUCT NO. PROCE88®BY (� SeM Swbd., boards Q Q Contractor Date nder coo V � DAT O ❑ I am exempt under Seo. "def e00 V VAUDATION w Over 1000 Amp.or Over 600 V F*1,ti ` / 11 B.SP.C.for thle reason BRANCH CIRCUIT FEES By x U) Date: 16.4,or WA, 120V,L�ghtlng or RecepL (/ z 1 To 10 Branch C1rctiits Signature 11 To 40 Brandi Glroujts ❑ 41 Or Moro Branch Ck=b �7 Exemption for Rep.Maim Elsot. 164 20,4 206V To 2TTV Br.Ctroutts L SINGLE FAMILY Temp.Power Pole 14 Appurtenancee ACCT.* ROME OWNER-BUILDER DECLARATION .7QSign with One Branch Circuit �tr� I hereby affirm that I am exempt from the Contractor's License Law 3W .70 for the following reason (Section 7031.6, Business and Profeeslons Addtlonal Sign Branch Circuits w1i �y ITM 1,as owner of the property,will do the work and the structure Mlsc-Ccndufts 8 Conductors TOTAL 40- 7❑ le not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , Cf CK 33.70 and Profeselona Code). J'Flf CONSTRUCTION LENDING AGENCY ■00 I hereby affirm that there Ip a construction lending agency for the performance v ) of the work for which this permit Is Issued (Sec. 3087, PERMIT FEE (Sub}Total) 1 / 7/9£ PLAN CHECKING FEE ,''?179 1I1O: L.endar'o Name 29 PERMIT ISSUING FEEO Lenders Address I certlty that I have reed this appflcatfon and under penaky c4 pudizy state TOTAL FEE O that the above tnlorrturion Is correct. I agree to comply with all County ordlnanom and State regulating Electrical wiring,and hereby authortze repreaentattvee of rtty to enter upon the above-mentioned property for hopectfon SEE REVERSE FOR EXPLANATORY LANGUAGE 03 d of DATE