HomeMy Public PortalAbout6031 CAMELLIA AVE_Electrical__ "'°` °°"" "S"T'°" DECLARATION �°°'qDPW"� APPLICATION FOR ELECTRICAL PERMIT O
I hereby affirm that I have a certificate of consent to self CE4p6a
Insure, or a certificate.of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof (Sec. 3800, Lab. C.)
Pity No R l�4 Company FOR GM M.
TO L LN /
❑Certified copy Is hereby furnish New Residential Bldgs. 8�P.o.,o�l � EACH NO. '
❑Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft.— $
— S LOCALITY
tion department. Multi-fomlly Sq. Ft. — NEAREST
D Applicant� A� KLL� �lE Residential Swimming Pools OR
Date -� _ f 3 \ ` v NAME
CERTIFICA OF EXEMPTION FROM WORKERS' 'MAR
COMPENSATION INSURANCE Outlets: Rer Light Sw._
First 20
(This section need not b*completed N the work Invofved by Total No. Additional CITY el. No.
the permit is for one hundred dollars (=100)or less.) PLAN CHECK
I certify that In the performance of the work for which this APPLICANT
permit Is Issued, I shall not employ any Person In any manner LJghting Fixtures First 20 ADDRESS
so as to become subject to the Workers Compensation Laws.
Additional
Total No. CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLK�4TlON
Exemption, you should become subject to the Workers' Range— Heater—D.W. —
Compensation provisions of Jho Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS 4'F
with comply with such provisions or this permit shall be Top — FAU —W.H. —
.deemed revoked. Hood — Fan —Other_ CITY el. No
LICENSED CONTRACTORS DECLARATION LJCENSE OR
Dlsp. — Room Air Cond. REG NUMBER Class. a--
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. BY >-
and Professions Code,and rry license Is In full force and effect. 11
Size 8 Type HP, KW, KVA, or KVAR O
License Number 4 Uc. Class r" �� Up to 1 lhcl. FINALU
Over 1 to 10 Incl. DATE Vy'tLDA-nom a:
Contractor 1 era Wm A. ).Mr, ° Over 10 to 50 Incl. HNAL 0
❑ I am exempt under Sec. Over 50 to 100 Inc. gY U
W
B.BP.C. for this reason Over 100 d
Services ., MCC 8 Panelboards z
Date: Z
200 Am Under 600 V
Signature 6KLA LTEV 201 - 1000 Amp. Under 600 V
❑ Exemption for ROver 1000 Amp. or Over 600 V
RN. Malnt. Elect..
SINGLE FAMILY Temp. Power Pole 8 Appurtenances y
HOME OWNER-BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Slgn with One Branch Circuit r�7
Law for the following redson (Section 7031.5, Business and Additional Sign Branch Circuits 3307 102.50
Professions Code): 1 ITEM.
❑ I, as owner of the property, will do the work and the WK• Conduits 8 Conductor r
structure Is not Intended or offered for sale(Section 7044, Other (See Complete Fee Schedule}_ , TOTAL 102—50
Business and•Professions Code). ry���J C�y
LiZ4ii 1�.•JJ
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for '011
the performance of the work for which this permit Is IssUed PERMIT FEE (Sub-Total)
(Sec. 3097, Clv. C.).
PLAN CHECKING FES 00700-WW1 2/14/90
Lenders Name
PERMIT ISSUING FEE 892.0 1 AM 8:27
Lenders Address
I certify that I have read this application and state that the TOTAL FEE
above Informatlon Is correct. I agree to comply with all County
ordinances and State laws regulatlhg Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentloned property for Inspection purposes.
. WE Rt?VERie'FOR EXPLANATORY LANGUAGE
fignature of Permlttee Date