HomeMy Public PortalAbout6155 CAMELLIA AVE_Electrical__ COUNTY OF LOS ANGELES APPU 'CATION FOR PEHMIT
°f ELECTRIC 1
DIVISION OF BIIII�DING & SAFETY
WILLIAM J. FOX. Cavaty Exalawr
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP Zr3hlK PERMIT NM-
ELECTRICIAN G @ct- O/`! O
ADDRESS IE- k [IV
PIKAMY FOR
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CITY TIL N0. � a 7� dpfeAI ZZ le
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PERK= FEES D°
NUMBER EACL
H DOALITY
LIGHT OUTLETS NEAREST ✓� /
I:wOa�s Sr. �J
R ED�fAO L n
WALL CWITOHO OWNER •''I �J
TOTAL O LrrLiTs sa MAIL
[L[0. RANSn as ADDPJCM
ELE0. H[AT[Rf 16 CITY T[I- NO.
FIXTI.IRn s
I HERESY ADKNOWLmGt THAT I HAVE READ THIN
APPLICATION AND STATE THAT THE ANOV[ 12 OORR[OT
NUMBER OF LIGHT CIROUITE AND AGRI[ TD COMPLY WITH ALL COUNTY ORDINANOII
NUMBER OF R[OEPTAOLIC OIROUITf AND STAT[ LAWS RMULATING 12EM-FUDA- WIRING-
MOTORS I OmTIFY THAT I POsfOf T14[ ASOVE VALID LO■
NuMaim HORS[POW[RFi[ [ M.ANGELIM COUNTY UDNfi. OR 1 AM THE L[ L OWNER
N[w MVD. HP CrrKR INa. GAN OT THE RMID[NTL4L rRDPXR Y D311110RISER AfOV[-
• Lir 26 EIGNATLRI OF
yl f .80 PERMI TTKK �S �f
s s 1.0a INSPECTION RECORD
s Is 1.813
is so S.eO
SO sDD 5.00
zoa 60o IC.OD J
6430 1 1000 IS.OU Z
OVER 1000 20.00 p
M.s. ar-r/rRicti, OHANG[R-HP It
WELDERII AD-KVA O
G[N[RATORE - KW
TRANWORMKM - KVA
TEMP. MOTORS 75OF DRIo.)
MDVlLp MOTORS (78 of apildo
MISC.
81GN8
N0. NO.TwAN<
N APPROVALS
FOR EACH P[gMITI DAT[ INOP[OTOR'f NAM[
WIRING 1111.00 Q CONDUIT Z
FUCTURn IS 1.00 WIRING
EW"LE FIXTLRn
POWER
=AL FEE S Il Q LTILJTY O0. NOT1FIm
J FINAL
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_ /VJORKf7tS'COMPENSATION DECLARATION ,o,ai APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that.,, have a certificate of consent to self
Insure, or aterff�lcate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
-or a certified
/copy
�there-of
f((Seejc. 3800, Lob. Com)/ [ d �-
Policy NoNg.A {CaC6ri P?My ii/T,i' "APPUCANTTO Rl W �
co Is here furnished. dg ADDRESS L�
PY by New Residential BI d Pools p �
FAO-I NO. FEE
�Certffl&dcopy Is filed with the county building Ire pec- 1 d 2-Family, Sq. Ft.�� — $ LOA;tESTY � C, �- 4 7`
tion d rtment. Multi-family Sq. Ft. — t�ST
02055 ST.
Date Applicant Residential Swimming Pools OWNER OR
FICATE OF EXEMPTION FROM WORKERS' Outlets: R+c_L1ght . Sw._ L
COMPENSATION INSURANCE ADDR&�S
First
(Phis section need not be completed if thevdork Inr/oinvolvedb� CI Tel. No.
the permk Is for one hundred dollars (;100)or less.) Total No Additional
PLAN CHECK
I certify that In the performance of the work for which this APRk-ANT
permit Is Issued, I shall not employ any Person In any manner
so rn to become subject to the Workers C6.mpensatlon Laws. Lighting Fixtures First 20 ADDRESS
``// �/�r total No. Additional CITY Tel. No.
Date Ilcant �� �7'Tr �-
ty
�^—r--2� Fixed Appliances Not Over 1 HP PERMITs
NOTICE APPLICANT; If, after making.this Certificate of. APPLICANT
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 0t 6;�-N t-1 iq C-4-,
with comply with such provisions or this permit shall be Top FAU —W.H. —
deemed revoked. CITY P� Tel. No. "`j 7
LICENSED CONTRACTORS DECLARATION Hood — Fan _Other— uKMN.E OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REO. NUMBER 417 l`-fL Close -
(commencing with Section 7000)of Division 3 of the Businew pp
Power Aaratus 8 Large Appliances DISTRICT NO. P Y
and Professions Code,and my license Is In full force and effect. 4
Size d Type HP, KW, KVA, or KVAR' CVZ
License Number�LLf- / r Llc. Class Up to 1 Incl. FINAi0
J Over 1 to 10 Incl. DATE VALIDATION O
Contractor s Date Over 10 to.50 Incl.
❑ FINAL
I am exempt under Set. Aver 50 to 100 Inc. BY
B.BP.C. for this reason Over 100
Services, Swbd., MCC d PonoIboa rds -
0 -200 Amp. Under 600 V
Date: i—
Signature 201 -1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Malnt. Elect. r_
SINGLE FAMILY Temp. Power Pole d Appurtenances
H�
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit �y+�
I hereby cr flrrrt thqt I am exempt from the Contractor's License AMA
A
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 3347 25M
Professlons Code): .].w gyp
k 1 I
u I, as owner of the property, will do the work and the Mlsc.Conduits 8 Conductors
structure Is not Intended or offered f« sale (Section - Other (See Complete Fee Schedule)_ , �� ' �
��yy�A/+L
7044,Business and Professions Code) y 25
.50
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for / {rl1771i •�
the performance of the wgrk for which this permit Is Issued PERMIT FEE (Sub-Total) S to
(Sec. 3097, CIv. C.} _
PLAN CHECKING FEE 000D-Ml Ay"� 4�
Lender's Name PERMIT ISSUING FEE d 3511 1 AM11121
Lender's Address
I certify that I have read this application and state that the TOTAL FEE _
above Information Is correct. I agree to comply with all Coynty
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-m Honed property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature Dat