HomeMy Public PortalAbout5712 CAMELLIA AVE_Electrical__ 7f1AG6.C..9O8_„,APPLICATION FOR ELECTRIC PERMIT 1:
CO"Iff OF Los "cun
D£PAETI= OF COUNTY ENGINEF$ S U I LD I N G
BUILDING AND SAFETY DIVIMON ADDRESS
C D �Pi�. BaP t - LOCALITY
FFOR APPLICANT TO FILL IN C CNEAREST
PEH.MTr FEFS
HUMZJM RACH FKi OWNER
I j f MAIL
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na10 �ZoADDRESS
FIXTURES .10 CITY NO oIu ¢LO.DRYod ELECTRICIANTXR HKATERS DOIADDREBS
X HTRl. DIBHWASHJU 1 IIIPl fL AvrO.- CITY / TEL.NO.
IrrA.COOKJHG UHrn .215 ATE r”
LICENSE NO.
MOTORS, ovKR IMG H.P.
■iADY Pon lmjL"cTIDM
0— lfi .20
r
— Y .150
INSF TION =ORD
2 — D 1.00
'
I7 — 115 1.150
150
115 — 2.150
150— 200 15.00
SIGNSI NO.TRAWL
NO.LAMPS
SERVICa 0-e00v 1.00E 0 Q
SERVICE OVER 600V 15.00
MISC.
WIRING PERMIT 1.00
F'IXTU RE PEER M TT 1.00
WR
SPLEHSNTAY PERMrr DO
TOTAL FEF j AMOVAU
1 ACQIO7LEp4E THAT I HAVE READ 'PHI APPLICATION DATE tNSFECTOR'S 211GNATURE
AND BTA L$ THAT THE ABOVE IE CORRECT AMD AG TO COMPLY CONDUIT.
WITH ALL COUN•R` ORDIKANCES AND STATE LAWS REGULATING
ELECTRICAL W 21NG. WIRING 2
1 H CEYTIFT THAT I Al PROPYYLT REG13TEM AND/OR FIXTURES
I1C]QidJs� AD REQUIRED HT LOS ANGELES COURTT AND STATE OF
CALIFORNIA OR THAT I AN THE LEGAL OWRER OF THE ABOVE POWER
DESMBBD RESIDENTIAL OPERTT.
SIGNATUREUTILITY CO.NOTIFIED -�
OF FINAL
ATIONru- e.
CLY
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DA Mo CAH Ur�vI�1Na CTRICAL EJi6IN61� '
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m,a„-cawe_1f"APPLICATION FOR ELECTRIC PERMIT
comm OF LOS )ftfam»
MPItHTi M OF COUNff ENCS BUI
BIIIIAG AND SAFE= DrMON ADD=
CSA DSLCd
t=w LOCAL TY
NEAREST
FORAP To LL IIvQR91w UT,
1 Y HUUMM tACH FQ OWNER
/ MAIL
uarrls fP s .f 0 S ADDRESS lsv
Ljc;l- 1rya FIXTURES f0 CAft TEL.NO.
IQiC.RAMord rn.o.DRYus ELECTRICIAN
WAT<R HXATKR■
�C.rrACK HTR52 DUIHW ADDRESS
a
aAi�AOt DltirOfQ1W AVTO_ CITY TEL.NO.
WAAHnes rrA.COo10H0 . 5 �'� 3 7 c
LICSN NO
YOTOF29t OvIER RIC H.P.
RAST rota TI
u4splU' OR
O—, Ya .2 D
— 2 .50
a — 5 1.00 nqSP=QN MMED
5 — 15 1.50 s-
15
15 — 50 250
50— 200 5.00
NO.TkA?M -• s '4 -
DIGNSt
NO.I1.Yrs
SERVICE 0•800V 1.00
SERVICE OVER EOOV 5.00
MISC.
ad
r
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .dO' -
TOTAL FEE 1 f AP'PHOVAIS
1 HEREBT ACKNOWLHDGE THAT 1 HAVE REJ1D THIdCA 0 GA's - 1116 R S SIGNATURIE
AND STATE THAT THE ABOVE 19 CORRECT AND AGREETO COIPLT CONDUIT
WITH ALL COURTT ORDINANCES "D'STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBT CIKRTIFT THAT 1 AN PROPMT REGISTEOkSD AND/OR
LICENSED AS REQUIRED BY LOS ANG1143 COUNTT AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF- TIM ABOVE POWER
DESCRIBED REBID OPBRTT
SIGNATURE UTILITY CO.NOT
OR PERM Fri RALrf
TI N" THUFISUPIRYI!•ltiai BL.Lrm"AL
C E�iQll�R
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7ew6e2c[pobfiss APPLICATION FOR ELECTRIC -PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF POUNTY ENGINEER BUILDINoloop
BUMZMG D BAFM-Y DIVISION ADDRSBJ�
JOHN A.LAM�IE;Cgit![I'Y Srta>iMme
CAMAW D.GRIFT1ti. or Bunmme LOCAI_,IYy
' I FOR.APPLICAW TO FML IN NEARsst,G
PE WT FSS c4lo�aa OT
OWN Eft
ITUM XUYIiR GCFI FQ
O AD RK"
!< MAI
uoH-nif Rs .to �}�•
LIGHTING FIXTURHS ,tQ Ty NQ
!T/ 7
[L[C-RAt1Q[Y CLO.DRY"ll" ELEc7rFuC.LAN
W A T[R H R A T E R■ .130 A1DDMtB8 ?/ Z Sr /
d[C-/rAC1HTR1. DI[HWASHR'" �/
CITY &AW � C"r7 TEL-NO. . 'V77Z y4
OAR1A0[DI/rOiE]'ll AUTO.- !'iT'ATLI
WAS'HIMS /TA.COOKIXO Ullff■ -215 UCLINBE NO. I
MbTORS. O"m IXC, k.r.
VAV- : .DQ IN3PfiG'iZON BECOBD
2— I 1.00
15,— 115 1.150
To— 150 2.150
17o—Zoo 15.00
BIG": NO.TRAHS, ,
NO.Lkmpu
aERvIC$0-e00V 1100
BERVICH OVER eoOV 5.00
Y I SC.
WIRING PERMIT 2,00 �O
FIXTURE PERMIT 1,00 O
SUPPLEMENTARY PERMIT .700
TOTAL FEE
I H[ADY ACKNOWLLDON THAT I HAVE RYAD Try I■ A l-LICATION DAT[ IN<RCTOR'S 8IaltATURX
AND /TAT[ THAT TH[ ADOV[ 1• OORR[.CT ALID AORE[ TO CQYRLY CONDUIT
WITH ALL COUNTY ORDINANCE AND SMATE LAWS R[OUL.ATINO
[LXCrRICAL WUNO. — '
U
1 HER® 1f
Y CIfIFH
Y THAT 1 Ail rttOrQ�LY R[OIfTQRiN
D AD�OR
WIRING
LI CIN[m Al "QUIRXD ■Y LO,{ ANQM"COYXTY AXD 1TATI[ OR FIXTURES
9ALIFORN'A OR THAT I All W
T14X LAGAL OXXFR OF TH[ AI [.
OV
DECRIs[D RYIIDIXTIAL rROFpr[Y, r� POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERM ITTE
mr ATjON ARTHUR C. UT1
O CA>oi UPLAVISINa CAL ENOIN[XR
LAC,07 9 5 1 AN 2 n 2.8 0
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab. C.)
Policy No. Com)pany FOR APPLICANT TO FILL IN JOB
ADDRESS - -
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO.1 EACH FEE LOCALITY
❑ $ $Ft
Sq. . —
Certified copy is filed with the county building inspection 1 &2-Family, NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR
P MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR
COMPENSATION INSURANCE g FIRM NAME
First 20
MAIL
p
This section need not be completed if the work involved b the
permit is for one hundred dollars($100)or less.) Y Total No. Additional ADDRESS
I certify that in the performance of the work for which this permit CITY Tel.No.
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions comply of the Labor Code, you must forthwith com I with such PERMIT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. CITY Tel.No. }
(commencing with Section 7000) of Division 3 of the Business and a
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE ORO
Over 50 to 100 Incl. REG.NUMBER Class. V
Over 100 DISTRICT NO. PROCESSED BY W
License Number;!' � 1 Lia Class --^-- J
Services,Swbd.,MCC&Panelboards LL
0-399 Amp.Under 600 V FINAL
Contractor Date DATE
400-1000 Amp.Under 600 V VALIDATION
El I am exempt under Sec.
Over 1000 Amp.or Over 600 V FINAL
B.&P.C.for this reason BRANCH CIRCUIT FEES ev a
Date: 15A,or 20A,120V,Lighting or Recept.
.'
1 To 10 Branch Circuits W
Signature 11 To 40 Branch Circuits ~
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits
*i_:+� - "
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law . .{-( �(}� ir
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code):
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ,
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total)
Civ.C.)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE
that the 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 the above-mentioned property
for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE DATE