HomeMy Public PortalAbout6033 CAMELLIA AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER ELECTRIC 1
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, COUNTY ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN \, rl ' sj9 k*�
ADDRESS - RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION ,
CITY TEL. NO. �.-
COUNTY LICENSE NO. EXPIRES BUILDING
PERM FEES ADDRESS D t
NUMBER EACH FEE
LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST
WALL SWITCHES OWNER
TOTAL OUTLETS Sc $
MAIL
ELEC, RANGES 25 ADDRESS
ELEC. HEATERS 25
FIXTURES S CITY TEL. NO.
MISC I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
Nummag HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVO. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2&LESS $ .25
- SIGNATURE OF
I/2 2 .50 PERM17TE
2 5 1.00 INSPECTION RECORD
5 1s 1.50
15 50 2.50
50 200 5.00
200 SOO 10.00 J
500 1000 15.00 Z
OVER 1000 20.00 z
M.G. 819T/FREQ. CHANGER-HP a
Wid-DERS: AC-KVA O
GENERATORS •KW
TRANSFORMERS-KVA
t
TEMP. MOTORS (75% of ORIG.) A" s
MOVCD MOTORS (75% of ORl6.) f '•'
MISC.
SIGNS
NO. NO. TRANS.
MPS
APPROVALS
NO. NO.
FOR MACH PIERMIT• DATE INSPECTOR'S NAME
WIRING $1.00 h CONDUIT
FIXTURES $1.00 WIRING 7 u
SUPPLRMKNTARY .50 FIXTURES
POWER
TOTAL FEE $ +tr UTILITY CO. NOTIFIED
FINAL
76A 663 9)R3# 6A. 4-52
WORKERS' COMPENSATION have cerci DECLARATION .7&k6 q J/V APPLICATION FOR ELECTRICAL PERMIT O
I hereby affirm that I have a certificate of consent to self �z
Insure, or a,certiflcate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof (Sec. 3800, Lab. C.)
�
cy No -2 6- � �
Company 1KMT FOR.APPLJCAM TO FILL M JOB /O 1
Certified c Is hereby fumished. EACH NO. FEE ADDRESS 9
QPl' Y New Residential Bldgs. 8 P Is
❑Cerilfied copy Is filed with the county building Irupec- 1 &2-Fa m I I y, Sq. Ft. $ — $ LOCALITY T 1-6. C47
tlon department. Multi-family Sq. Ft. NEAREST
���� Residential Swimming Pools t 4 •CROSS E57'
Date Applicant — L7
` FIRMNLAME
CERTIFICAT11OF EXEMPTION.FROM WORKERS' Outlets: Ren Light Sw._ MAIL
COMPENSATION INSURANCE
First 20
(This section need not be completed If the work Invofved by Total NoCITY el. No.
the permtt Is for one hundred dollars (;100)or b .ss.) Additional
I certify that In the performance of the work for which this ECK
PLAN
permit Is Issued, I shall notemploy pny Person In any manner Lighting Fixtures Fl rat 20 ADDRESS
so as to become subject to the Workers Compensation Laws
Additional '
Total No. CITY Tel. No.
Date Applicant Flxed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT; If, after making this Certificate of APPLICATION
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.— ADDRESStot 9
W.with comply with such provisions or this permit shall be Top — FAU —WH. —
deemed revoked. Hood — Fan —Other— CITY T I. No. O
LICENSED CONTRACTORS DECLARATION LKP4SE OR
Dlsp. — Room Air Cond. ) Class.Q—/(�
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 5 of the.Buslnaw Power Apparatus 8 Large Appliances DISTRICT NO. BY d
and Professions Code,and my license Is In full force and effect.
Size 8 Type HP, KW, KVA, or KVAR Q 0
License Number u Lic. Class 61y/12 Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE VALJDATION O
Contractor yu Data D❑ Over 10 to 50 Incl. U FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.BP.C. for this reason Over 100 d
U)
Services, Swbd., MCC& Ponelboards
Date: z
,p 0-200 Amp. Under 600 V
Signature LL�r [�4t►. �aT 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect. 0
SINGLE FAMILY Temp. Power Pole 8 Appurtenances i
HOME OWNER-BUILDER DECLARATION A
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ACCT.r
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 3307 103.E
Profeulons Code):
❑ I, as owner of the property, will do the work and the
Misc. Conduits$Conductors 1 ITEM
structure Is not Intended or offered for sale(Section 7044, Other (See Complete Fee Schedule) NITAL 103- 00
Business and Professions Code). CHECK 103.00
CONSTRUCTION LENDING AGENCY
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 FEE11
Lender's Name 000
PERMIT ISSUING FEE M6 1 AM 8:26
Lender's Address
I certify that I have read this application and state that the TOTAL FEE
above Inforrrwtlon Is correct. I agree to comply with all County
ordinances and State laws-regulating Elecitical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property for Inspection purposes.
. SE!REVERSE FOR EXPLANATORY LANGUAGE
Cf
SlgFkituro of Permi ee Da ms