HomeMy Public PortalAbout6053 CAMELLIA AVE_Electrical__ �A� , � 11/7. APPLICATION FOR ELECTRICAL PERMIT fl
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO PILL IN JOB
New Residential Bldpc& Pools
EACH NO. FEE ADDRESS 6053 N. 0-ambillia
1 &2 Fatally Sq. Ft $ — $ LOCALITY
Multi-famlly Sq. Ft — NEAREST
CROSS ST.
Resldantial Swimming Pools OWNER OR
FIRM NAME
Outlets: Light,Switch& Receptacle MAIL
FI rat 20 ADDRESS
Additibnel CIT T.I. No.
PLAN CHECK
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional
CITY T.I. No.
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT
Range Heater D.W.
ADDRESS
Oven Dryer W.M-
Top FAU W.H. CITY Tampl n rj ty T.I. No.
Hood Fan LICENSE Fld- -
AND
Disp. A-C. REO. NUMBER 7962 Cle.. p
1 H.R.SY ACKHOWL-KDO■ THAT 1 HAV. R.AD THIS APPLICA
■TATs THAT THL A.OV. IS CORR.CT AHO AOR.■ TOCOMLO
Power Apparatus& Large Appliances IT. ALL C6UNTY OR O IIA N C.
AND 1T4T1 LAW. .K.. 1.TI- I�
.L.CTRICAL.IRI RO. (W�
Size&Type HP, KW, KVA,or KVAR o_
Up to 1 Incl. I H.R..Y C.RTIFY THAT 1 AM --RLY R.SIST.R.D AND/OR Z
2 to-n A �r� 0 Incl. UC.NS.D AS R.OUIR.D ■Y LOS ANO.L.S COUNTY AND STAT. OF
.�J Over 1 to 1�(� CALIFORNIA OR THAT 1 AM T��HLK "SAL OWN.R OF TH. ASOV.
W
. Over 10 to Incl. D..CRI..D R..ID.NTIAL"Oli.
Over 60 to 100 Incl. PHRMITZE C//
Over 100 SIGNATURE
DISTHICT NO. PROCESSED BY
Services
0200 Amp. Under 600 V ��
201 -1000 Amp. Under 600 V APPROVALS DATFR
Over 1000 Amp.or Over 600 V
TEMP. POWER POLE SIGNATURE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Cfrcuit
Additional Sign Branch Circuits ROUGH CONDUIT
(Other) W I R I NO
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) UTI LITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL 7"-2 ^—t ---
PERMIT ISSUING FEE
NOTES
TOTAL FEE S13,5O
WO v"fRt LN-d ' TWW,' CASH PERMIT VALIDATIONM.O. CASH
POLICYHOLDER: ' C"p- '-T-5,
� 0
1 3.56
POLICY NUMBER: 2733 I'P27 I '
Ir WORKER'S COMPENSATION DECLARATION 20-10 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT hereby afflrrn that I have a certWoate of consent to self Insure, 78Aee3
or a certiflcate of Workdr'e Compenaatlon Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DN.
oopy thereof(Sec.3800 Lab.C.) f
Poacy No. Cartpiny rron APPLW-kNT TO RU IN
Certffled copy is hraby furnished. New Residontkil Bldgs.S Poole NO. EACH FEE J
LOCALJTY
1 8 2 famil
❑ Cery,Sq.Ft — _dnled ed copy la fwlrh the county building tnapeotbn __ NEAREST
department Alultldamlly Sq.Ft CF4068 ST.
AEB
Date Applkant Rookkmtlal Swhnming Pools ASS BBOR PAGE PAtICa
CE;IIIRCATE OF EXEh,PTK)N FROM WORKERS' Outlets Roc-_Light Sw. RRM RA)& ..V
COMPENSATION INSURANCE
FA 20
(This vection need not be completed tf the work Involved by the L
Total No. Addttlorral
permit Is for one hundred dollars(11100)or lose.)
I certify that In the performance of the work for whloh thle permit -" ' (
Is issued, I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers'Compensatlgn Laws. Llghtlng Fbduree FT rat 20 APPLlCAMT
T�!E No. Addttloru l
ADDRESS
NO ICE TO APPLICANT: 1�-
It, after making title Certlllcate of CES NOT OVER 3 HP. / � Tel-Na.
Exemption,you should become subject to the Workers'Compenandon OTHER APPLLAI CES NOT OVER 3 HP. PEFIET
provlslons of the Labor Code, you must forthwith comply with such
provielona or thls permit shall be deemed revoked. Pcwef �1e S age Apphlencee
LICENSED CONTRACTORS DECLARATION 84ze S Type,HP,KW,KVA,or KVAR ADDRESS
I hereby afflrm that I am Ilceneed under provlelons of Chapter 9 Over 3 to 10 Ind.
(commenoing with Sectlon 7000) of Dlvlelon 3 of the Buelnesa and CfTY Tat No.
Profemlons Code,and my Iloenee le In full force and effect. Over 10 to 50 Ind. LICENSE OR
over li0 t0 100 Ind. REG.NL}AIBER a� d
Over 100 S
DMTR1CV40. PROCESSED BY
uoense Number uc.Class �O� (,7
Servkee,Swbd.,MCC of PanNboerde I [C
FFNAL
Contractor Date 0-366 Amp.Under 800 VDATE 0
0
❑ 400-1000 Amp.Under 800 V
VALIDATION
I em exempt under Seo. Over 1000 Amp.or Over 800 V FML 7 LU
B.SP.C.for this rwaon BRANCH CIRCUrr FEES BY Z
Data: 15A,or 20A.12CrV,Ughtlng or Reoept _
1 To 10 Branoh ClrwhU
3ipnaTure 11 To 40 Brunch Clouds _/ /J G VVV m
41
❑ Exemption for Reg.Mairrt.Elect. 18A,20A,206V To ZM Mon Cinin ( +1 I Q •w
SINGLE FAMILY Temp.Power Pole d Appurtenances ` _ ER—COIR
HOME OWNER-BUILDER DECLARATION Sign with One Brenoh C1=11 ({! t o
I hereby affirm that I am exempt from the Contractor's Llcense Law _ 6 ,],��-T�{f1i]SJ1 _ ■�
for the following reason (Sectlon 7031.6, Business and Profeaalons Addftlonal Slgn Branch Clrcuhts aa !� �yy
I,as owner of the property,will do the work and the structure Misc.Misc.��&Conduct" n veli 11E .
Is not Intended or offered for eats (Sectlon 7044, BuelneOther(See Complete Fee Schedule) pop. T4TF� 00
and Profeaslons Code). �.y �ry�y�,r
. CONSTRUCTION LENDING AGENCY CWCK Q.W
I hereby affirm that there Is a construction lending agency for the GVNGE .00
performance of the work for which this permit Is Issued (Sec. 3097, PERMIT FEE (Sub-Total) fJ Q
CIV.C.)
PLAN CHECKING FEE VtAri 5/ 1/96
Lenders Nemo L.RaL1Lr-1M�
PERMrrISSUING FEE 6157 1 FM 5:26
Lenders Address
1 oertlfy that I have reed this application and under penalty of purjury state TOTAL FEE Q
the the&bow Information Is correct. I agree to comply with all County
9rdhencee and 8we IasN regulating ElecVfoal wiring,and hereby euthortm
r@Mwntntivee of ilia County to anter upon the above-mentioned property
for lrupectbn purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
eloNArl1RE CF DATE
COUNTY 0➢ LOB AlGEMES 78m]?L19 CITY # 0508 ELECTRICAL PERMIT
DS'iPARTMENT OF PUBLIC WORKS 9701 LAB TUNAS EI, 0508 0505310008
BUILDING AND SAY= / LAND DEV-HWPMIfT TEMPLE CITY CA 91780
PHONR: (676) 785-0488 ETT:
LIGAL IDS FEEB PAID BUILDING XT) REBS,
TR: 6561 LT: 157 UK: .001 6053 CAMELLIA AV
FEE DESC3ZIPTIOY. QUANTITY, DOM: AMOUNT: TEMP CA 917807008
ASS'ASSOR I]TORMATIOY NUMBIR: _ NMARESP CROSS STREET: GAR.IBALDI
5385-014-007 Al PERMIT ISSUANCE FEE 77.75 THOMAS PAGE: 597 (12 : A7 LOCALITY: TEMPLE CITY
F1 170V, 15/20A BR CKTS 4.00 BR 69.00
TIDUIYT� G1 OIITL=B-LGT,HW,RECP 57.00 OUT 87.70 ISSUSa ON: PROCEBBED BY: PLAY BY: EXPIREON:
G7 LIGHTING FIXTURES 19.00 LGT 37.05 05/31/05 JL 11/77/05
TOTAL FIES 716.00
OWtER. TAI,. NO FINAL DA - ➢ B7� - CODE:
HIDING, WILSON (676) 778-6111- L
6053 CAJM=IA AV
TE7P 917807008 DESCRIPTION OF WOR=
ELECTRICAL FOR TEE ADDITION -
APPLICANT: TEL. NO: �•�
SAME AB OWN'SR -
. SPECIAL CONDITIONB�
CONTRACTOR. TEL. NO: APPROVALS DATA IHSI?Z=k SIGMD\TUR.E
SAME AS OWNER -
LIC. NO TEMPORARY POWER POL➢
. UNDERLHi0LJ11ID COBDUIT
ARCHITECT OR WGIYYER: TSL. NO, UF-DIR GROUdID '
HU7NH, THANG (676) 315-6379-
3515 BELCROFT AVE. LIC. N0� ROUGH CONDUIT
KL MONTE, CA 91737 DTOH1<
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N MPTAL Y/N
UTILITY COMPANY NOTI➢IID
REPORT ID: DPR265 ROITP➢ TO. B90508