HomeMy Public PortalAbout5233 CAMELLIA AVE_Electrical__ ,GAO- 11 -BA •-" m APPLICATION FOR PERMIT
DEPARTMENT OF Buzz.DnNa AND SAFETY ELECTRIC 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CHiQ ENGIHNXR
FOR APPLICANT TO FILL IN DISTRICT NO.- GRUP ZO S PERMIT NO.
EL IMTRICIAN - D L/
RIECKI by DY FOR DAT[ ISSU[D
ADDRX" !7 1 [CTION
CITY TEL N
COUNTY C O -�o ■UILDIN6
PERMIT FEES ADDR[ts
FEE
NUME�2 OUTLETS ]EACH Lm
LIGHTS 6C III N]EAR KST
R[C[PTACL" 5
CROSS ST.
FIYTURK8 s OWNER
1J SWITCHKS E MAIL
Q]EC. RANGES IIE ADDRE"
Ric. H TKR8 25 CIT' T]EL NO
1 IIRKIlf ACXNOWIJt&K THAT I HAV[ READ THIS
NUMDSR OF CIRCUITS INUTALLIrDi
APPLICATION AND STAT]E T4AT THE ABOV]E IS CORRECT
1
RXC-KFTACLJW AND AGRIZ TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STAT[ LAWS R[GULATING 0_IDCTRICAL WIRING-
Nummut ORSKPOW@2 I CKRTIFY THAT I POSSpS TH[ LI
AMOVK .VAD LAS
Fp ANGn as COUNTY LICQiS[, OR'1 AM THE LEGAL OWNXR
OF TFI]E_ 1 D VCTIAL PPKRI V�DKOCRIDtm ADOV_L
6
LiLso .215
II SQ SIGMA [
P4RMITT]E�
2 8 1.00
e 15 1.e0 INSPECTION RECORD
1E ISO 2.00
00 Soo 5.00
100 1700 10.00
00 1000 5.00
OVER '1000 II 0.00 _
M.G. SR FRS . CHANGER-HP
WX DSRS AC-KVA
GXN"ATORS - KW .
TRANOFORMQiS - KVA '
TKMP. MOTORS.(70% or, o1no.
MOV® MOTORS 7 or olu0.
1
SKINS
TYPES NO. TRANS.
TYPE s NO. LAN PS
APPROVALS
R KACH PKRmrri
D TK INSP[CTOR'S NAM[
WIRING $1.00 400
CONDUIT
FIXTU R p 1.00 WIRING
OUPKAMEKTAFtY UQ FIXTU R p
POW]ER
TOTAL FEE UTILITY co:NOT FI[
FINAL .
i
WORKER S'COMPENSATION DECLARATION 7BA663
CE-806G (2-80) APPLICATION FOR ELECTRICAL ,PERMIT
fS �
I hereby affirm that I have a certificate bf consent to self COUNTY OF LOS ANGELES r�� BUILDING AND SAFETY
Insure, or a certificate of Workers'Compensation Insurance,or
a certffled copy thereof(Sec. 3800, Lab-C.) J
X25745 S to Fund FOR APPLICANT TO FILL IN JOB
Policy No.425745 Company- � ADDRESS 5233 No. Camellia Avenue
New Residential Brdps.&Pools EACH NO. SEE
Certified copy is hereby furnished. 1 &2-Famlly,Sq. Ft. $ — >: LOCALITY Temple City
ST
�ertifled copyV filed with the cou❑ building Multi-family Sq. Ft. —
ty g Inspectfon CROS$ST
department. 'Residential Swimming Pools OWNER OR
FIRM NAME Hazel Britzman
Datil 2 26 2 Applicant Outlets: RecA2LightSw Q MAIL
ION FR M WORKERS int '� ADDRESS.
CERTIFICATE OF EXEM Sam@
Total No. Additional 6 CITY Tel No.
COMPENSATION INSURANCE
LAN CHECK d
(This section need not be COmppleted if the work involved APPLICANT ^
by the permit is for one hundred doRus ($100) or tea.) Lighting Fixtures FIrrt 20 0 �� ADDRESS VX
Total No. /d Additional cc
.I certify that In the performance of the work for which this CITY Tel No. Q
ermtt is Issued, I shall not em to an Fixed Appliances Not Over 1 HP
p p y' y person tri any manner PERMIT
to as to become subject to the Worker' Compensation Laws. Flange, ter HeaD.W. PPLICANT Avron Electric Inc, W
Oven —Dryer_W.M. ADDRESS 11775 Cardinal Circle -85
Top _ FAU _W.H. Z
Date Applicant ^- [] M
Hood Fen _Other_ City Garden Grove Tel No� 7- 00
NOTICE TO APPLICANT: If, after making this Certificate of Dlsp. Room Air Cond` 3,60 LICENSE 0-F-1- 416010 CIO
Exemption, you should become subject to the Workers' RE . NUMBER- Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROC SSED BY
with comply with such provisions or this permtt ahall be Size&Type HP,KW,KVA,gr KVA ��
deeuied revoked
' Up to 1 Incl.
FINAL
Over 1 to,10 Incl. DATE r�r
LICENSED CONTRACTORS DECLARATION Over 10 to 60 Incl. ( ..- VALIDATION
I hereby.affirm that I am licensed under provisions of Chapter Over 60 to 100 Inc. FINAL
BY
' 9 (commencing with Section 7000) of Division 3 of the BusF Over 100
neas and Profeaalons.Code, and my license D in full force and
effect. gefvlcey J�
I License Number416010 Llc.Clara CIO 0-200 Amp. Under 600 V
201-1000 Amp. Under 800 V- /
ContrncfyrOn Electric Date 2%16/$2 Over 1000 Amp.or Over 600 V `�(pC> �I
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt frorp the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Bull- Additional Sign Branch Circuits
nags and Professions Code): 2 3 1 Q 4 A
Misc.Conduits r#Conductor
F] I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— # o a a a o 2
atructwle is not intended or offered for sale (Section'
7044, Business and Profeaafons Code). r
CONSTRUCTION LENDING AGENCY 34, 10
i I hereby affirm that there Is a construction lending agency ,
for the performance of the work for which this permit V o 0 0 3a 1, 06
Issued (Sec.3097,Civ.C.). PERMIT FEE (Sub-Total) p
Lender's Name PLAN CHECKING FEE (One-Fourth Permit.Fee) 0 3 Q —8 2
i
Lender's Address PERMIT ISSUING FEE 0
I certify that I have, read this application and state that the TOTAL FEE ! fj
above Information V correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize rep rataof this County to enter upon
th ova- tion r pe f inspection purposes.
SEE'REVERSE FOR EXPLANATORY LANGUAGE '
Signature ttee Date