HomeMy Public PortalAbout6042 CAMELLIA AVE_Electrical__ •,WbqXQW COMPENSATION DECLARATION MAW3 10/91 APPLICAMON FOR ELECTRICAL PERMIT
al+7ier9try JJ have a cw fixate d cormont to self-heirs, CE 809Li
pr aWorkers' Combertsaton Ineurar" or•a certtflod COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy,_ftV9c1�(A&c 3800,Lab.C.) 1 P {1 Q
Posy ry!V l�I N ►�1✓ j7Q� FOA,max ANT To dal N, toe
l El Certtfled oopy•fa hereby fumfat» Now R
d eeiderttiel gkigy&P0018EACH NQ FEE
1 A 2-FamEy,Sq.Ft T� $ . S LOCALITY
❑ t3ertifled copy b flied wttin the c6unty txr6ding Brepeciion � �
i �,r Mufti-famQy Sc.FL —
9 AI>7�rd NQ ffin G A Alm Reelderrtiel Swimn*ig Pooac CROSS ST.
aMFA OR /''Z� T-C
CERTIFr-ATE OF EXEMPTION FROM WORKERS', FF14 NNAEMAL
'/` LTJ
COMPENS�SiON INSURANCE ouHeta Reo� IJgbt_ Sw.• ADDRESS Ll�r CIF,t —
(Thle eecbM rmW not ba oompWtO If the work trnoh*by the First 20 crry - -�
permit Is for oris hundred dollars(S 100)of lrara) Total No. Addttlonal, 1U s T I� Ste] 7�
11•cArttfy.that In the.perfornwm of the work for which ffi permit PLM CHECK
M tner»d 14 riot.offpbY arry person to-pjw marxrer ea as to APKJI
beGorne eub}eot to,tha..Wxkers'Componeation Lowe-, Lighting Fbdtuee Bret 2d -ADDRESS
of maWQ APPLAc lkxial
Data Total Na___; Cffl
NOTOL Na
TICE TO ti K?.�f�IG: .ff, after th}s� Certiticabo Pissed Appfierrcee Not,Over 1 HP pg�r
. e{rgtld,beborne in,the. ,� — �—
puNWono cf*the LaborI'Code,.YOU mist forthwith cmpy with &xh Oven — Dryer--- WAC— ADDRESS 1,f s!1 O
proO 1.A N
, vfdgne othis Rte*?r '@t)afl be deemed revoked Top FAU — WJ-L �+ /y� n
LIC,�ENSED CQNTRAgTOR3CI-ARA�IO�DE . -Hood Fan ' — Other l CITY C.� •l/O A/c
/c
1 hpfeby affl m,thet_Lgm Ioenp d Lndel' provhorda of Chapter 8 OR
1 (�"ft$action 7000).of DMsiori 3.of the Businew and D�`— Room AtF Coed REG_NU VEA
P&malcm Code,and hV Incense-ie'h tali foroe and'effect. D18TRSCT.NO p1cywBY
Powor Apperabe S Large Applbnoes
Size S type HP,KW,K or
NLmtw a , JL*4 LJo.c Q 6 ! KW
77++ a .� Up to'I ind. RNAL _. .
�l4Xy- NO L f I NQ'I �. Over 1 to 10 N. DATE - XUDATf
em ex } Over 10 to-¢O,bcL b
❑ 1 exempt ,Jr. RNAL
er,Sea ��Over 60 to 1 QQ Ino- F
Over 100
'B.SP. for this reee6n
C.
N
• Servkco%Swbd.,MCC d-Panel&Wde
0- 200 Amp.Under 600 V `
.•34-4ure' 201 -1000 Amp.Undo(,800.V
= Over 1000 Amp or Over 800 V
❑ Exemption bo Reg want.Ebat _ j -
SINGLE FAMrLY. t Temp.Power Pole k, AQpu tonarrceO AUT.i
I herbgy
HOME UI.amt xen#Dfroom pthe a License Law Ad "rftt'°^e:'Bran h clroorft �7 2J.10
for the foOo*i iQ reason(Section 703.1.6,Bu inees and Profsealone AddTtiortel 31Qn Brandi Cirn>tts
ter. 1'
ElI ea opr
wner of the �� v%qdo the worfc'snd the etruohre Attao Condom a cbnducmrc .T
b nMended ended oroFfe ed'tor sale (Section 7044, Buetnees Other(see Complete Fqe Sdnedr6e) +�`ql�' .�J�I
and Proteeelom Code), rti
G`ON.STRUCIICN LFNbM AGENCY
I hereby effk that ffiom ie a =*ructhn lending agency.br ft,a TOTAL 51--_ 00
performanos pf the work for wNch tits permft b Issued(Sea 3097, - PERMIT FEE.. - (SutrTatal)
Ch.a). CXH 25,50
PLAN CHECKM FEF
Lenders Name-
PEFMI ISSUMLFEE
LwxWa Address
I certtty Chet I have read bde appbmt n and affibe that the above TOIL FEE J
hfoTretion fa correct.I agree to oon#y with all County ordirnancea
and State Igwe rgwu abM Eleoitioel vAdrQ and bersby'authortze
repreeentattvee of tile Coretty bD order upon the abovementioned
property for trrpeotiort purposes SEF REVERSE FOR EXPLANATORY LANGUAGE
Sole"at Perrrrlttee Q DEd@
WORKERS' "SAT°"DECLARATION � APPLICATION FOR ELECTRICAL PERMIT ' ', r
I tweby� that I have a cor f k%f&a cons" to self kxum
ore of,Workoro- Corrpeneatlon Inwrance, or a oerMod COUNTY OF LOS ANGELES BUILDING AND SAFETY
Oop�thereof(Seo.3800,tAh C.) ;
Pdi NaT FOR APPUG1Nr TO FL4 Pf l09
Q ADDRESS
CerMW copy b hereby furnlehed. H NO. FEE !
Ngrr Realderrtiei Bkige.a Podle _
1 S 2- Ft $ — fs - LOCALJTY
GerffM1sd copy b��,wtth the Ocurrty burro FamRy,Sq.
department. Mu}t1-tamlty S4 Ft r�3T
. C4084 8T.
APPI Reeldentkel Srvhnrnlrrp Poore gyytl�OR
FnM NILE ■(�
t (;8 MIFKftTT=Or.EXEIJ 0-"FROM WORKERS'-_ OLA.UAT Aec.,�l� Llpht � Sw.�— r�
•COMPENSAT)ON fNSt1RA1JC�E.' ADDRESS Llgr
(17iw � be compWed 0 the work Invotred by&a. Flref 20
pehnFt It for on&huh4red cohere ES tdO)or lets:) Total No. Aodftkx-6 3L Tel.No.
t ttrat In the petidrn;ar,ce gt thA wo�c foe wafer, t}1Ia Perrnff PLAN CHECK
bDied, I EWNAd not;e)nploy. .p&eo+i In aRy rfisnner 'to'ea.fo,
fiedoir�e sub)ec tD that } g LtMbV Flxturde Ftret 20 ADDRESS z
Acid rd ne7
Total Na I�
y APpk-d CITY lk No.
NOTICE 1 HP
Ov
TET APPTJCAN r:, �, a of Fbed ANAarrpee Not er ' L
xerrptign Yom.cbouA became to the Compenee Hoa Renee I teeter D.W.
'.' pnzvlelor�e'of the Labor Cgde,,You rrluat ocmpty with such Oven IJryer. W.W. { ADDRE, Z
provlaione or'#& permit Aha➢bar boomed revokAd.' Top. FAU WJ L'
L}k1E_�1 D-60_ T- FACTORS DECLARATION3,r Hood Fah Other 7e1.No.
I' that f am under prgvkeione,(T Chep—,9. Iaoorn Alr,Corrd. T LICE =OR f
4{Gorr1}nerx p wftfi`Sdotfon 7,600) of DNtebn'3 of " Btre� and FE(i Nlpea R
:ProfeQelo ,Ctide,end my l0w-sB is In full farce and etfo
• Paatier Apparahie✓4 Large Appltanoee
S>ze S Trype HP,KW,.K1M4 or KWRI.
/
Llcege nNumber Lb:Class UP tQ,1 Ind. FINAL
Ouer 1 to.10 trill,
c_tb`aotgr Date T� T Over 10 to 501noL ' _
_ r FINAL /
I em exempt finder Sec.. Over 6Q to 1(?0 Inc. 4
:B.3P,C.igr this reason Over 10f)
u)Seevbaa,Swbd.,hWt G7 S Panelboarde
Qk * 0-200 Amp,Under 800 V
Signature .-201 - 1000 Amp.Under 800-V
Over T000 Amp.or QvW 800 V
'LvwnpQon for Req.Mart.EVeot -
SINGLE FAMILY Tanto Po%w.Polio& Apptuterr�ed 2
HOME OWNER-B I ER DECIAWION" -Steri wkh One Braix CtratttT■# -.--. -
I hereby affirm that I am exempt frgm.the C,00Racore L•fcenee Law
for'*followlnp raaean(Sbrd6c7031.4•fes and•Pro(omiona Addttlonel Slpn Brancb Clrai}ta-
��77 TT� 13.50
L_1 I,as owner df the property,will-do the wor}c efid the strlbture Mfeb.Con fte S.Conductore t -1 -i t C.A 1�7-- -
fa raot btofm3 d or of ed far'eale (Seobon 70aa,Bueingm ( �trr�+ete FQe �)'— TOTAL. 50
ar)d Prb%ftmone code). OECK
11 .54
J GONSTfwcMN LENDM AGEf4C1
f twoby.amrM-that piers'is$oorietr'ucion land lop agency for ttie" -• '
periamance o�the work fpr whloh this perm lt)e feaiied(bed 3097, - -`- _ •
lMrr FEE (Sub Total)
PLAN CWEClQNO Fri 1G.�24fyi�'
Len¢er a Items PEITmrr IsSURJ(3 FEI 1 AN76'125
Lender a Ad¢rbee TOTAL FEE
1110T
I cw* tt� I have read t A8 appllec t and abate that ths above
L15 i
information fe correct I agme-to oorr#y wfth.all Cpunry ord4+encee
and State haw* redulafirlg vwfdng, and hereby aytt-,r
reP_kwttati_ 9f thla County,to enter upon the above-mentioned
for purposes- n' SEE REVERSE FOR EXPl.AN�Of[Y LANGLtAG-0.
hT
re Date -