HomeMy Public PortalAbout5239 CAMELLIA AVE_Electrical__ WORKER'S have
a cNSATION Df consent
to 2o-0O10 DPW j12-91, APPLICATION FOR ELECTRICAL PERMIT
7t3ABC3
I hereby ajylrm that I neve a certificate of consent to self Insure,
dYa certlflcate of Worker's Compensatlon Insursnce, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof{Soo.3800 Lab.C.) .
Policy No. Company FOR APPUCANT TO Rl IN JOB
ADDRESS Z3
❑ Certified copy Is hlereby h,Iftahed. New Residential B1dga.8 Poria NO. EACH FEE
LOCALITY
1 h 2-Femlfy,Sq.Ft
❑ {:al—td copy b}1 ed with the county building Inepectlon Mult1-fam l ly Sq.FL NEAREST
fiST.
t- .. _
Deltat Roeldeftal Swfmminp Pools AOR
LW BOOK PAGE PAFCR
�EFMRCAT�OF EXEMPTION FROM WORKERS' Outlets:Rec. L1gh[ Sw. p�1
COMPENSArIOry IN8URANCE Flr>t 20 O v09 s
(This secUon fsod not be oompistod If the work Involved by the ADDRESS 523 ,
p4rmtt I�for one hundred dollars({100)br loss.) Tom NO ��
"
I cerfl}y that In the performance o} the work for Which this permit CfIY ��l,T'"1 T.I.Na.
Is Issued; I shall not employ any person In any manner so ae to PLAN C}iECtk
begorna subject to the Workers'Compensation Lowe. UghtIN Futures Rrst 20 APPLICANT
Total No. Addftlonal
ADDRESS
Dade' Appinent. RESIDENTIAL APPLIANCEB NOT OVER 3 HP.
NOTIC-E TO APPLICANT: If, after making th-le CertIf1cate of CITY TeL Na
Exempdon4 you should become subject to the Workers' Compoaaailon OTHER APPLIANCES NOT OVER 3 HP.
provls(ons of the Labor Qode, you must forthwith comply with such Power Apparatus 8 large Applar peed
provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION SI S Type HP,KW,KVA,or KVAR ADDRESS Z r
I hereby afflrin'that I am Iloensed under provlelons bf Chapter 0 Over 3 to 10 Ind.
(commencing with Section 7000) orOlvlelon 3 of'the Business and O 10 to 60 Inel CfTY � C( T'`"° .err
Professions Code,end my license Is In hill}eros and effect. Clad Over 50 W 100d
In .
Lkci n Number Lic.Class Over 100 oIeTFlICT NO. BY O
Satidp�e, I boards �D O (0
Contractor Dada r i �O�' AmA000 V DAT
❑
I em 400-1000 Amp.Under 800 V 7- % VALIDATION V
exempt under Bed Over 1000 Amp.or Over WO VW
FINAL
BY CL
B.SP.C.for this reason BRANCH CIRCUM FEES CO
Data: 1W or 20A,12OV,Ughtind or Recept D Z
1 To 10 Branch C4 its
Slgnature T 11 To 40 Branch Ctrcufls
BrancIrcults
❑ Exemption for Reg..Maim E3ect 18A �A{oro,2DA,208V To 2T7V Ctciulla
SINGLE FAMILY Temp.Power Polo S Appurterwncee
HOME OWNER-BUILDER DECLARATIQN with boo Drarah Ctrcult w�
I hereby affirm that I am exempt from the Contractor's L.lconae Law SignACCr■t
for the following reason (Section 7031.5, Buelneea and professions Addlbonal Sign Branch Clrcufte -+��� _ �p a�
Code): ,.7,7+..h:r i TT�F 8,.95
•�❑ I,as owner of the property,will do the work and the structure Mlao-Conduhs S�u�s 1 1 I[.f FS
Is not Intended or offered for sale (Section 7044, Business Other(See Corp a Kee Schedule) , Try - 5
end Professions CodTOTAL
CONSTRUCTION LENDING AGENCY > HECY, 88.95
f hereby afflrm that there la a construction lending agency for the .00
performance of the work for whloh this permit Is Isaued (Sec. 3087, PERMFf FEE (Sub-Total)
Cly. C.)
PLAN CHECNNG FEE
/ 1
Lenders Nemo 8/ 3/93PERMIT ISSUING FEE (d 1 i IM 10:19
L.e xWa Address
I certify that I have read thle NVkadion and undpe
er nally d puhury state TOTAL FEE () /
thal the above Informnrion is correct. I agree to comply with all County
ordinances and State laws regulating Eleotrfoal wWng,and hereby au h"tzs
repreoer tadveo of this County to enter upon the above-mentioned Property
IWP SEE REVERSE FOR E]IPLiANATORY LANGUAGE
,�E� DATE
• CODITS OF LOB ANGUM" TWOLI CITY # 0508 RS,IC R-ICAL PERMIT
DEPARTKENT OF PUBLIC WlORJCS 9701 LAB TUNIS YL 0508 0603030076
BUILDING AND SAPSi'Y / LAND DKVZWPMD$T THMPLI CITY CA 91780
PHONE: (676) 785-0488 EMT:
LZ6AL ID: TKES PAID BUILDING ADDRESS.
TRc 15683 LTz 79 5739 C'AJCKLLLIA AV
FRE DESCRIPTION: QUANTITY: UM. AXOONTTRKP C:FL 917803858
ASSESSOR IJiTORMAATIOY NW®ER, NYARYBT CROSS HTRZIM
8589-013-001 Al PZRXIT ISSUIMCH FZY 77.75 THOMAS PAJ32i 597 GRID: A4 LOCALITY: 7 MULE CITY, C
O1 ODTLZTB-LGVT,BX,RZCP 8.00 OUT 15.60
TYIANT: 67 LIGHTINGV FIXTURY8 8.00 LOT 15.60 ISSUED ON: PROCZ8819D BYs PLAN BYE NXPIR7S OY.
HS RZS LUSH MACH LT 3HP 1.00 WAS 10.95 03/03/06 JK 08/30/06
TOTAL PZZB 69.90
OMGTIY: R'ZL. NO FINAL DATA FINAL BY: CODE:
CUIVAS RAYIgID J;LI•URA L (676) 309-0653- �],,
5739 C'AJ� �IA AV 1-3` _Fb
TIMD? 917803858 D CRIPTIOK OF WORK
ZLECTRICAL FOR ADDITION
APPLICA3T. TIL. NO-
GDIRCIA (676) 875-7544-
5739 CAJIWL IA AVE SPECIAL CONDITIONS.
TZJPLZ CITY CA 91780
CONTJVCRORt TIL. NO: APPROVALS DATE INSPI=OR SI®\TOR➢
RAYMOND CUY (676) 309-0653-
5739 CAKILLIA AVE LIC. NO T12CPORART POWIR POLY
TZKPLZ C=, CA 91780 NONZ
UNDO CCXD=
ARCHITZCT OR YNGIIYYR, TIL. !Oc UFZR GROUND
LIC. NO, ROUGE CONDUIT
ROVW RARING
MASH WATZR LINE
PLASTIC Y/N Mr AL Y/N
DTILITY COKPANY NOTIFIED
RZPORT IDi DPR265 ROUTE TO: B80508