HomeMy Public PortalAbout6120 CAMELLIA AVE_Electrical__ APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DMSION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINIX1t
CAGZATT D. GRIFFIN.•ur r of IIUILDngo LOCALITY /
FOR APPLICANT TO FIL4 IN NEAR' `
PE WT FEES CROSS ST.
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NO.LAMPS
SERVICX 0-600V 1.00 / '00
BERVICE OVER 600V 5.00
YIBC.
WIRING PERMIT 1.0.0
FIXTURE PKRHIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE Is (�
1 HAY ,AZ"OWL�[ THAT I HAV[ RIAD THIS AFTLTCATIOK 'APPROVALS DAT[ DtSF[CTCR'■SIQMATURI
L1 THAT TH[ ASOV[ IS CORRICT AND AGRAX TO COYFLY
OOUMTY ORDIMAMCLS AMD STAT[ LAWS RIOLJLATING CONDUIT
AL WIRJlta.Y CU1IlfY THAT 1 AM PITOPI ttY RIGIST[RID AND/OR WIRING
AS RIOUDtm SY LOS AMO COUNTY AMD STAT[ OFIA OR THAT 1 THI L[ O Olr THi ASOV[RISJDIICf POWL'R
RE •UTILITY CO.NOTIFIED
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COMPENSATION DECLARATION 76A663 10/8, APPLICATION FOR ELECTRICAL PERMIT
that I fiav�f a certificate of consent to self � c
Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company POR A MXAt,T TO ALL N. JOB C 1
F9 Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
7 Certified copy is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. _ — i LOCALITY ,,C>L C T
tion department. Multi-family Sq. Ft. NIFAJT
Residential Swimming Pools CRO55 ST.��OR
Date Applicant FIRM NAAAE C
CERTIFICATE-OF EXEMPTION FROM WORKERS' Outlets: Reciff-JLight Sw. IAD 1L
COMP04SAlION INSURANCE
First 20
(This section nod not be completed IF the work Irr rohred by Total No Additional CITY PLIE7C Tel. No.
the permit Is for one hundred dollars'(=100)or iris.)
I certify that In the performance of the work for which this RANkETX
permit Is issued, I shall not employ any person In arty manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
�� f Total No. CrrY Tel. No.
ATpllcan Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
Exemption, you should become subject 10 the Workers' Range_ Heater_D.W.
Compensation provisions of the Labor Code, you must forth- Oven Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top FAU —W.H. �� (��
deemed revoked. CITY.' Tel. No.
LICENSED CONTRACTORS DECLARATION Hood Fan _Other" LI(B•ISE OR
l hereby affirm that I am licensed under provislons of Chapter 9 Dlsp. Ro Air Cond. —` �� REG. NUMBER Clan
(commencing with Section 7000) of Division 3 of the Business rX DISTRICT NO.
and Professions Code,and my license Is In full force and effect. Power,Apparatus 4 go Appliances ('
Size 8 Type HP, KW, KVA, or KVAR'
License Number Ilc. ClanT— Up to 1 InclFINAL // U
. I
Over 1 to 10 Incl. DATE VALIDATION O
Contractor Date Over 10 to 50 Incl.
NAi
B G
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.BP.C. for this reason Over 100 Z
Date: Services, Swbd., MCC 8 Panelboards ,
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
Exemption for Reg. Malnt. Elect. �2 Q 4,8 A_
SINGLE FAMILY Temp. Power Pole 8 Appurtenancin
HOME OWNER-BUILDER DECLARATION # o o.e o o 'Z
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7Q31.5, Business and Additional Sign Branch Circuits o -39,50
ofessions Code):
I, as owner of the property, will do the work and the' Misc. Conduits 8 Conductors 0 0 o39,506
structure is not Intended or oered for sale (Section Other (See Complete Fie Schedule)_ ' O 5 1 6 y g 5
7041, Busloff
nen-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 permit Is issued PERMIT FEE (Sub-Total) -
(Sec 3097, Clv. C.]
PLAN-CHECKING FEE
Lenders Name
PERMIT ISSUING FEE 1000
Lenders Address
I certify that I have read this application and state that the TOTAL FEE
above Informatlon Is correct. I agree to comply with all County
ordinances and Skate laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon'
•a vo-mentioned proppV for Inspection purposes.
_ SEE REVERSE FOR EXPLANATORY LANGUAGE
Slgrwture of Permittee Date