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Home My Public Portal About6044 CAMELLIA AVE_Electrical__ T WOFZKERS'COMr-NSAIION DECLARATION MAW3 1a81 APPLICATION FOR ELECTRICAL PERMIT r .I heraby afflnti that I have a oertflioate of consent to sett trlerre, or a cert kale of Workers' Compensatbn hr unince, or a certtfled COUNTY OF LOS ANGELES BUILDING AND SAFETY oopy Uvredf(Sea 3800,Lab.C.) Peicy Na Company/ FoR ArprcArrr-r0 Fli-tN toe ❑ Certtfled copy-e Nweby•furaWied. Nen,Reeidential Bldgs.S Pude EACH Na FEE 1 A 2famITy,Sq.Ft' b — $ LOCALITY k Certified Dopy b flied wkh the county bu6dlnQ YlapeotSon Muttl-�N S4 Ft _ NEAREST t deparhnent C i W. Aa rt Reeidwitfai Swlmmft Pods RTTE (� 14, FFM NAAE L MAV CE COM F E F IN4llfiAtJCE R°A �t jL Sw. � gDDRE88 Mda adlgn n&W not be oomph od tt the wdrk Invof by the FVet 20 TOL pern-At Is foF one hundred do0mrs ($100)or feta_ TOtal Na CITY CITY , Na I FeFtffy that In ttie periormeno$.of the wprk for y¢loh this permPIANit CHECK APR-"KF b fsa<aAd I I not errlpby any pwagn In, manrW so as t0 becomes to,Lha Wor ksrmUgtltiW Ftxhmae First 20 ADDRESS Toiw No.1 Additl4nel CrrY Tel.Na Date Fbapd AppfQnoee Not Over 1 HP TO APPt�CJ1Nr; If, after of PEF T Fxampilon,yqu ehould become etib)eot to•the RaDoe Hester D.W. �'rNT provWons'pf the Labor Cade.you myat forttrvfttm i ooply wfth each Oven Dryer 'W-M-_ ADDRESS pfoyWche or tbfe perrr?tt*hO be deemed revoked` Top w WI-L CTFY TeL fJa LJCENSEI)CONTFiAC?GEIS DECI AR/�TION Hood Fen Other_ ry)� 4573 n(j )b"reby afftrjTa that I am Ibenaed under' provfal0ne d Chapter 9 Dish Room Air Cord LICENSFOR Chea (oonvnenohQ with Section 7000) of Dlvt 3 0 the Bunlroma and REOL NLSABER Pro(eeabre Code,and n-y kense b to full force and effect. Povve< &LAW AppllertceeDISTRel HY ATOver HP,KW,KW.,or KWR a Warm Number Lb.Caa U1eo to 1 Ind. JFINAL Over1 to 10 Incl DTE 10:m 60-Incl. E] FINAL I am exempt under Sea Ov4r 60 t0 1D0 Lia _ RAP.C.for thb reason oww 100 Date: Services;Swbd,MCC S Panelboerds Noll.. -200 Amp.Under 900 V Siplehue 201 - 1000'Amp.Lhx*800 V Over 1000 Amp.or Over 900 V ❑ F_mcObn for Req.MalnL Eleot SINGLE WALY _Temp Power Pte S Appurtenances HOME OWNEp-BUILDER DEGARATION S$gn with One Branch C"d ■# I Hereby affrM that I am wwV from the Contraotora Lbwm Law for the bOowfr>o reeeon(Section 7031.6,Bmh ass and PmOaa bne Adartionel SfQn Branofl Phrwha 3 J7 121■25 Code): 1 .ITE1fS 4 as owner d 1 the property,wI do the work and the shirW e' Mteo Conduits a ca,duotora b ded not hteror offered for salg (Seobw 7044,-Buetneea Ott"(See Compiebe Fee 8d-dile) , TOTAL 1.C.1 +� and Pm%aefone Code). "CK 121.2 CONSTRUCTION LENDPIG AGENCY' y - I hereby afM1m the there t8 a oxmtr.ucriq len agency for the OWE • perforrnarae•of the work for which thle permit b blued(Sea 3097, PERMrr FEE (Sub-Tolan Ctv.C.). nv rs PLAN CHECKING FEE UV24/899 Landes Name PERMIT ISSUING FEE. 0361 1 All 9=25 Landers Addrett I cw* that I have reed this appilc t and state that the above TOrIAL FEE knfprmetion Is oorreot,I agree to comfy with afl County ordYlancee Brod State Tawe roWletkV Electrical wlrinV, and hereby aut)ort7e f repraeertativee d thb County to enter upon the above-mentioned SEE REVERSE FO.R.EXPLAHATORY UMLIAQt re of Date WORKERS'C�rNSAPN DECLARATION 764.663 P`"�� APPLICATION FOR ELECTRICAL PERMIT I hereby affirm thr5t I have a certifyate of consent to self „�z� O Insure, or a cert[flcate of W'brkers' C'o'mpensatlon Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS «a certified copy thereof-(Sec.3800, Lab. C.) PQcy No. Company FOR Al'htlCJltff TO RL W JOB U Certtfled copy Is hereby furnIthed. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS ❑Certified copy Js filed with the county building Inspec- 1 8 2-Famlly, Sq. Ft. $ = ; LOCAUTY ST tion department. Multi-family Sq. Ft. CROSS ST Date Applicant Residential Swimming Pools Oyr�OR R NAME L CERTIFICATE OF DT-A1PTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlet}: R� Light Sw._Rat ADDADDRESSem (This section need not be completed if the work Imrohred by Total No. Additional CITY�i- Tel. No. w,,•ml $ 1 the pt Is for one hundred dollars (=100)of teas.) b- I certify that In the performance of the work f« A which this APPU AN NT permit Is Issued, I shall not employ anyrson In any manner so as to become subject to the Workers ,o Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No. Date Applltant Fixed Appliances Not Over 1 HP PERMJT NOTICE TO APPLICANT: If, after making this Certificate of APPLK.ATION Exemption, you should become subject to the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you most forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other— CffY Tel. No, LICENSED CONTRACTORS DECLARATION LICENSE OR Dlsp. — Room Air Cond. � Class. I hereby affirm that I am licensed under provisiord of Capter 9 (commencing with Sectlon 7000)of Dlvlsloff 3 of the Business Power Apparatus& Large Appliances DISTRICT NO., Y and professions Code,and my license Is In full force and effect. Size 8 Type HP, KW,KVA, or KVAR O License Number LIc. Class �_ Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE n VALIDATION Contractor �e Over 10 to 50 Incl. FINAL 0 ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W B.BP.C. for this reason Over 100 t1 Services,•Swbd., MCC 8 Panelboards Z Date: Z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Matnt. Elect.. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power P61e 8 Appurtenances HOME OWNER-BUILDER DECLARATION ACCT.i I hereby affirm that I am exempt from the Contractors License Law with One Branch CrculT � I Law for he following reason (Section 7031.5, Business and Additional Sign Branch Circuits 20 Prof ons Code): 1 ITM I, as owner of the property, will clothe work and the Misc. Conduits&Conductors TOTAL 20-(31Dstructure Is not Intended or offered for sale(Section 7Q44, Other (See Complete Fee Schedule)_ Buslness and Professions Code). ® CWK 20.11 CONSTRUCTION LENDING AQU4CY OWE .Cc' 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 FEE W—OWI 1/29fK Lenders Name PERMIT ISSUING FEE 8544 I Am a:33 Lender's Address ' I certify that I have read this application and state that the TOTAL FEE 4001 above Inforr atlon Is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of thl;County to enter upon t e above- ntlon property for Inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE ts, Slghature of Permittee Date WORKERS'COMPENSATION cafeDECLARATIONcor4e � 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Workers' Comperuatlon Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) PolicNo. Comparry FOR ArPUCANT TO PR.L IN +108 y (a V'(/f1 /f Certified copy Is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADD 55 1/7 ❑ = yc Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. R. t t LOCALITY tion department. Multi-family Sq. Ft. 'NEAREST. ' Date Applicant T. Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Llght Sw. L COMPENSATION INSURANCE ADDRESS (This secilon need not be completed Ff the work Involved by First CI Tel. No the permit Is for one hundred dollars (;100)or less.) Total No Additional PLAN CHECK I certlfy that In the performance of the work for which this AppL}CANl permit Is Issued, I shall not employ any person In any manner so as to b orae subject to the Workers'Compe Ilan ws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. N Date Applicant Fixed Appliances Not Over 1 HP PER T NO TO LICANT: If, afteYLooda, s Ifcote of APPLICANT e Exemption, you should becomthe Workers' Range_ Heater—D.W. — Compensation provisions of theyou must forth- Oven — Dryer —W.M ADDRESS r ' with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION — LICENSE I hereby affirm that I am licensed under provisions of Chapter 9 Dlap. — Room Air Cond. REG NUMBER Class. (commencing with Section 7000) of Division 3 of the Business Apparatus Large App DISTRICT NO. BY Power 8 La a Ilances IL and Profeuloru Code,and my license Is In full force and effect. p. Size 8 Type NP, KW, KVA, or KVAR' S�Q O License Number I Ic. Class Up to 1 Incl. FINAL DATE Over 1 to 10•Incl. �G �2 - VAUDATION O Contractor Date l 50 I 10 Over to nc. ❑ FINAL UJ I am exempt under Sec. Over 50 to 100 Inc. BY � W _ d B.BP.C. for this reason Over 100 Z Z Date: Services, Swbd., MCC 8 Panelboards ►0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V r 7 1 .4 5 A ❑ Over 1000 Amp. or Over 600 V f o o o,o o 2 Exemption for Reg. Malnt. Elect. " SINGLE FAMILY Temp. Power Pole 8 Appurtenances 2 0 - 2.5.50 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractors License ° o ° 2 5.E- 0 Law for the following reason (Sectlon 7031.5, Buslneu and Additional Sign Branch Circuits Profmslons Code): 1 1. 29-83 ® I, as owner of thero a will do the work and the MIsc. Conduits 8 Conductors p Other SComplete om lete Fee Schedule structure Is not Intended or offered for sate (Section ( p )— , 7044, Buslneu 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 permlt Is Issued PERMIT FEE (Sub-Total) (Sec. 3097, Clv. C.). PLAN CHECKING FEE Lenders Name PERMLT ISSUING FEE Lender's Address I)I I certify that I have read this application and state that the TOTAL FEE 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-mentloned pr erty for nspectlo pu SEE REVERSE FOR EXPLANATORY LANGUAGE �Slgnat I of Permltt to