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HomeMy Public PortalAbout6131 CAMELLIA AVE_Electrical__ r 76A61-CE80611-71 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION fADDRESS LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE $ $ OWNER A, Moreno RECEPT. MAI L 4'k, LIGHT TOTAL FIRST 2 25, ADDRES p .w SWITCH OVER 20 10 CITY T. Cit TEL. NO.286 0224 PLAN CHECK LIGHTING TOTAL FIRST 20 25 APPLICANT FIXTURES OVER 20 .10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER WTR. HTR._ APPLICANT RAy=r Electric STA. COOK DISP. F.A.U. ADDRESS 315 So. San Gabriel Blv 1 SPACE HTR, AIR COND. CITY $n Gabriel TEL. NO. „ 7�r 4+#q CLOTHES WASH. 01SHWASH. LICENSE NO.251 206 CLASSC-'l0 FAN - OTHER 1.00 F 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE & TYPE OVER, TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR OL O - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF O CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO V F' 1 - 10 3.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. LLI .11 SIGNATURE 10 - 50 5.00 OF PERMITTEE LL 50 - 100 10.00 >_ DISTRICTNO. JCLASS ZONE PROCESSED BY Q 100 - 500 15.00 0 SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: TUBE, OR LY MARQUEE ADDITIONAL CIRCUITS 1.00 H SERVICENOTOVER600VOLTSOR200AMP 3.00 *t2 APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 3.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE B5 S 2-46 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC COUNTY OF LOS ANGELES WM. J. FOX CHIEF ENGINEER a �Ip.ntEr DISTRICT NO. GROUP ZONE PERMIT NO. ADDRESS ''1' r/ 1 �UC� y/G. RECEIVED BY READY FOR DATE ISSUED U _CITY _ TEL.NO. FIRST INSPECTION �. J COUNTY- W CERT.NO. EXPIRES fo A APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS ;' NUMBER OF OUTLETS ON CIRCUITS LOCALITY _ LOCATION BY ROOMS NEAREST 1A LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. CIRCUIT A B C ME F G H W NAME S I W Z MAIL ~� 3 ADDRESS O I CITY TEL.NO. �! 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTI Ir F QUALIFICATION- ELECTRICIAN. UALiF1CAT10N.. _ �•vs r i ELECTRICIAN. I AM THE LEGAL OW 11til OF THE PROPERTY DESCRIBED ABOVE OWNER. CORRECTIONS J Z 19 O TOTAL NO. OF OUTLETS $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE $ UTILITYCO.NOTIFIED TOTAL FEE FINAL WORKERS' COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806Ginsure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB / j n ILL / F1Certifiedcopy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS c— ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ? 1,1 ADDRESS First 20 (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. N Additional Total NR." CITY Tel. No. Date Applicant— NOTICE licant f 't_1 pp Fixed Appliances Not Over 1 HIP t=-t PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to 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 Hood — Fan —Other— Tel. No. ' LICENSED CONTRACTORS DECLARATION ` LICENSE OR Disp. — Room Air Cond. '` Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER _(commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BYd` O and Professions Code, and my license is in full force and effect. 1 F Size &Type HP, KW, KVA, or KVAR _ V License Number Lic. Class Up to 1 Incl. FINAL J Over 1 to 10 Incl. DATE VALIDATION LL Contractor Date Over 10 to 50 Incl. F1FINAL } I am exempt under Sec. Over 50 to 100 Inc. BY � B.&P.C. for this reason Over 100 Services, Swbd., MCC & Panelboards 1 ► 0 Date: 0-200 Amp. Under 600 V !1" 2 Signature 201 - 1000 Amp. Under 600 V H ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business 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, Civ, C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE ;`f 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ©s WORKERS' COMPENSATION DECLARATION 76A663 DPW3/87 APPLICATION FOR ELECTRICAL PERMIT hereby affirm that I have a certificate of consent to self �EAgp G insure, or Agcertificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or w certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ! L LL ❑Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ _ $ LOCALITY — tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR _T y> 22 FIRM NAME !! !C_ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecL� Sv�r, _Li ht 5 JQ� MAIL COMPENSATION INSURANCE g J[1 First 20 ADDRESS ,ps ���� (This section need not be completed if the work involved by Total No.L� Additional CIT /n 7j e Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total N /1 CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP V PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven DryerW.M.— ADDRESS with comply with such provisions or this permit shall be Top FAU T W.H. — deemed revoked. Hood Fan Other CITY Tel. No. — LICENSED CONTRACTORS DECLARATION Disp. yLICENSE OR L Room Air Cond. — Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR SSED BYN-,,,, and Professions Code,and my license is in full force and effect. �" O /' ,, Size &Type HP, KW, KVA, or KVAR . License Number7i 3 K 16 Lic. Class /O Up to 1 Incl. FINAL U f9G/fioA)�Q- '- —�—�Q Over 1 to 10 Incl. DATE VALIDATION 0 Contracto Date _�_ Over 10 to 50 Incl. U F-1 FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 IL Services, wbd., MCC &Panelboards /U , Z Z Date: !J 0 20�Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V EJ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances i HOME OWNER-BUILDER DECLARATION & I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ACCT•* Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 3";3" i�y1a 30!_ Professions Code): ❑ Misc. Conduits&Conductors 1 ITEMS 1, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— , TOTAL 161.20 Business and Professions Code). CHECK 161.2`0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE ■ 013 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). if PLAN CHECKING FEE 0000-0001 1/ 0/911 Lender's Name p PERMIT ISSUING FEE / ti'�, cis 1 HI'�s -:cc �•. Lender's Address I certify that I have read this application and state that the TOTAL FEE r�o above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and you thorize representatives of this County to enter upon bove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ts ignature of Perm Date