HomeMy Public PortalAbout6048 CAMELLIA AVE_Electrical__ "' "`° C°'' " '°"DEGLARCMN � '°'B1 APPLICATION FOR ELECTRICAL PERMIT .
I P*weby adttrm that I hem a certlM1cate of consent to &W bvkM
or a cerffikte Of Workers' Compereatk)m Insurance, or a oeFttfled COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sea 38DO.Lab,C.)
Poky Na Cornoany FOR APPLICAN7 TO FILL-N JOB • '
❑ Certtfled copy ie hO+-aby furnishe • New Resbartal Skips.h Pools EAGH. NO. FEE ADDRr 38 N
Certfited oppy Is fried with the oourdy. txtfidlrrg h6peotion 1 S 2-Femfly,S4 Ft $
depulrpent
M46-famlty Sq Ft —
NEAREST
� ;CFi08S 8T:
Data A Retldeiiti9l 8wlmmUip Pooh OWNER OR lit
FFMI RME
CERTIFICATE OF EXEMPTION FROM WOR}O=RS' OutletADDRESS L
COMPEN8ATION INSIiOutlets:Rao Limit ' lF1rat 20
'Ohio socUon need net be coriQiated 11 the work Involved by the Total No. _ AddRlonal CrFy -rush; Tat.No.
*TnR# .for"hundred doJFan,($100)or i"&)
oerft(y that In the performance of thet work•for whigh-thle'permR / su
Ir
Ia Ise I shall no( ?rnploy arry person IR any meoner so as to
bAcorne sub�eck to the Wmicersl LoTttrp rixturee Fhet 20 ADDRESS
CK
Total No._ 0 C4-FY Tel.NO.
Flied Ap*moes Not Ower.1 HP PEIt1iT
NOTICE TO APPPI�CCANr:. 1f, ,after
Emn )dQn,You should beoome sub}ect to theVkrkam'5NnpKmatI6n Fianpe1 Heab j D.W. '
ppb Of the�Code, YOU must.Sorthwrth OOnIANY wtth mph Oven Dryer 11 SVM_ ADDRESS
proviaiore of this permit she➢be deefned retioked- Top FAU WJ-L
LICENSED CONTRNGTOR$DECLARATION Hood Fan Other_ TeL Na •
I hereby a ii m that I em kansed under provbiorn Of Chapter 9 p� T Room Air Corid RKt N AKENSE OR Z �+
(bQmrTtendnp.wf1h Section 70M) of DMa" 3 of the RAIineee and
Profeeeione:Code,an&n-y kanse Is In fuH.foroe And effect Po%w AMmuhm&���� T
Stre A Type HP,KW,Kor KN4R ..� V 8
Lbeose NWmber. 'LIo.CiaasFINAL
Up tO 4 Ind., DATE
- J4k OveT.1 to 10 hd.
Contractor Date Over 10 to 60 kid. .
❑
FINAL
am exempt opt drd Sea Over 60 t 100 Ino- r ww
BAP.a for tits meow Over 100 Cl)
Services.%Ybd,MCC S Permiboerda , Z
DatEr. 0-200 Arrp.UrKW 600 V
S4grrahrre 201 - 1000 Amp.Under 600 V
Over 1000 Amp.or Over 800 V'
❑ Emuptfon for Rep,Malnt Elect
SINGLE FAMTLY Temp.Power Pole A AppcuWwx)ee
HOME OWNER-BUILDER DECAARAMN Sim W6 One Branch Clrartt t�+ti+� ■i
I hereby aMrm tttio
at J am mwnpt from the Contrac 's License Lbw
foe the folbwlrq raise«, (Section 703 1.6,BUeirxm and Profesafona Addrtional Sign Branch CMxdts =7 121.25
GDde) 1 ITEMS
Elas owner of tyre property,wlI do the work and the st> re M}ec Corrdutts S Conductors 7 -
is not htwn or-al ed for sale (Section 7044,Eueiriees• Other(See Complete Fee SctredUle) _ TOTAL., •121.25
and Professions Code). ,. DECK 121.25
CONSTRUCTION LENDING AGENCY r�uw�trt
I hereby affirm thet there b 9.cor�l.rotlon lending agency for the . ti.fri't� • '
performance of the work for which this permR is leered(Sec,3097 PERMrr FEE (Sub-Total)
Civ.tr.).
PLAN CiAMONG FEE - DODD-OW1 10/24/89
.L.erder's Name - ,�
PEWrr ISSUING FEE t�L AM a_ 4+741 1 F 7:24
Leaders Address
I certify'that r hffA read this eppomtlon and stats that the above T01AL FEE
hfomvt n is Oormot.I agree to cOnpty wfth adl County,ordinances
and State Paws regutaft Electrical wiring, $nd hereby authorize
repreeentathee this County to enter upon the abovo-mentbrred
I purpoeee. SEE REVERSE FOR EXPLANATORY LANGUA13E
Date