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Home My Public Portal About6029 CAMELLIA AVE_Electrical__ WORKERS'CI have a cera DECLARATION �°'qDPW�� APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self �� Insure, or a cVllflcate*f Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3800, Lab. C) Pql c No Company IA176110 Tr POR APPLICANT TO FILL[N JOB U Certified copy Is hereby fumished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS EJCertifiedcopy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. Afb2 — S LOCALITY tlon department. Multi-family Sq. Ft. t�ST CRO55 ST. Date T7 Applicant LONLLN t'. Residential Swimming Pools OWNER OR NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rem Light SW.— MAIL COMPENSATION INSURANCE A FI rst 20 (This section need not be completed If the work invofved Ery Total No. Additional CITY Tel. No, the permlt is for one hundred dollars(:100)or fess.) PLAN CHECK I certify that In the performance of the work for which this APPLICANT permit Is Issued, I shall not employ anyPerson In any manner Lighting Fixtures F1 rat 20 ADDRESS so m to become subject to the WorkersCompensation Laws. _ Additional 1 ., lam— V Total No. CITY TelS No. Date Ilcant LO>J "114 7�� Fixed Appllances Not Over 1 HP PERMIT NOTICE TO APPLI : If, after making this Certlflcate of APPLIUTION Exemption, you should become subject to the Workers' Range— Heater—D.W. Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU W.H. — CIN To.. No. deemed revoked. Hood — Fan —Other Qj 74_ — LICENSED CONTRACTORS DECLARATION LKINM OR I hereby arm that I am licensed under provisions of Chapter 9 Dlsp. — Room Alr Coad. — N MB3Z J Cl affirm ass. f (commehcing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. D BY and Professions Code,and my license is In full force and effect. IL y q Size 8 Type HP, KW, KVA, or KVAR O License Number S 1l S�" / Uc. Class C,ID Up to 1 Incl. FINAL O Over 1 to 10 Incl. DATE VALIDATION � Contractor)i0W )4144% &JIf D to O ElOver 10 to 50 Incl. FINAL H I am exempt under Sec. Cher 50 to 100 Inc. BY U W B.BP.C. for this reason Over 100 0- Services, Swbd., MCC 8 Ponelboards , z Z Date: 0-200 Am Under 600 V Signature lads~WiLA L45,= 201 - Amp. Under 600 V ❑ Exemption for Reg. Malnt. Elect. Over 1000 Amp. or Cher 600 V EFADECLARATION ILTemp. Power Pole&Appurtenances HOME OWNER-BUILDER I hereby affirm that I am exempt from the Contractors License Sign with One Branch Circuit ANT.T Law for the following reason (Section 7031.5, Business and Additional Sign Brarxh Circuits i . Professlorts Code): ❑ as owner of the property will do the work and the Mlsc. Conduits 8 Conductors i ITM s Other structure Is not Intended or offereder ( Pete Fee ScheduleSee Complete for sale(Section 7444, TOTAL 103- CIO Business and Professions Code). CONSTRUCTION LENDING AGENCY �� 1CItiy■��! I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued PERMIT FIE (Sub-Total) (Sec 3097, Civ. C). PLAN CHECKING FEE Lenders Name 1 2/M WI PERMIT I SSU I NG FEE Lenders Address 8' 7 I certify that I have read this application and state that the TOTAL FEE above Information Is correct. I agree to comply with all Cqunty ordinances and State laws regulating Electrical wiring, and hereby authortze representatives of this County to enter upon the above-mentioned property for Inspection purposes. SEE-RMRSE FOR EXPLANATORY LANGUAGE - SX —4&cRQ,IQ 3 Signature of Permittee Date wornn that I FMavNSATION cEta Of 766663 °R"�m APPLICATION FOR ELECTRICAL PERMIT O I herebti,afflrm that I have.❑ certificate of consent to self ,Iniure, or a Eertiflcate,of Workere Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or b certified copy thereof (Sec. 3800, Lab. ) F'qiI No Company y FOR APPUCAN1 TO KU tai JOB UCertifled copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. e. ❑Certlfied copy Is filed with The county building Inspec- 1 8 2-Family, Sq. Ft. ; — $ LOCALITY Y tion department. Multi-family Sq. Ft. tIFOSS T Date Ilca Residential Swimming Pools OW ORt FIRM NAME CERTI ICA OF EXEMPTION F KERS' Outlets: Rem Light Sw._ MAIL COMPENSATION INSURAN ADDRESS 4 #� Flet 20 ` (This section need not be completed ff the work Irrvohred by Total No. Additional CITY. Tel the permit Is for one hundred dollars ($100)or less.) I certify that In the performance of the work for which this A permit Is Issued, I shall not employ any person In any manner Lighting Fixtures First 20 ADD to as to become subject to the Workers Compensgtlon Laws. RESV Additional Total No. CITY Tel. No.DOW Date -Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICA Exemption, you should become subject to the Worker' Range— Heater—D.W. — Compensatlon provisions of the Labor Code, you must forth- Oven Dryer —W.M.— ADDRESS p with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. Hood Fan —Other— CITY T.1'N ECLo _ 7 LICENSED CONTRACTORS DARATION — D�OR Dlsp. — Room Air Cond. — , NUMBER p Class. I hereby affirm that I am licensed under provbloro of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT P BY d and Professions Code,and my license is In full force and effect. Size 8 Type HP, KW, KVA, cr KVAR /O 0 License Number Lic. Class Up to I Incl. FINAL 01 0 ry to Over 1 to 10 Incl. Dpi cc VALIDATION 0 Contractor ElOver 10 to 50 Incl. FINAL O I am exempt under$ec Over 50 to 100 Inc. BY LU B.BP.C. for this reason Over 100 d Services, Swbd., MCC 8 Ponelboords , Z Z '0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Malnt. Elect. Over 1000 Amp. or Cher 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirrri that I am exempt from the Controctof's License Sign with One Branch Circuit Law for the following reason (Section 70n 31.5, Business and Additional Sign Branch Clrcults ACCT■1s Professions Code): 07 Ell, as owner of the property, will o the work and the Mlsc- Conduits&Conductors structure offered hComplete Fee Schedule ucture Is not Intended or oered f for}ale(Section 7044, OterSee Comp (See �-- 1 ITE15, TOTAL 25 - 50 Business and Profeuions Code) CONSTRUCTION LENDING AGENCY CWK 25.50 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) (Sec. 3097, Clv. C.). PLAN CHECKING iE Lender's Name PERMIT ISSUING FEE 0M&-"1 12/ 1/9 Lender's Address �O } 1 AM 10:I certify thot I have rood this application and state that the TOTAL FES 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 he above-mentioned property for InspectloR purposes. SEE RlVP_RSE FOR EXPLANATORY LANGUAGE ms SIgnc ifqre f Pe h Date