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HomeMy Public PortalAbout4807 CLOVERLY AVE_Electrical__ "fl 768663 CE,806 I0/72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY'ENGINEER JOB i � �/ �,/ r r BUILDING AND SAFETY DIVISION ADDRESS V LOCALITY F N EAR'EST FOR APPLICANT TO FILL IN CROSS ST OUTLETS NO EACH FEE OWNER NAME RECEPT � S S ADDRESS i 2 ,.fig. MAIL LIGHT TOTAL FIRST 20 CITY ��/C tr; TEL NO SWITCHOVER 20 1p PLAN CHECK FIRST 20 APPLICANT LIGHTING TOTAL / , 25 ' OVER 20 ADDRESS FIXTURES � 10 RESIDENTIAL APPLIANCES CITY TEL NO PERIT RANGE DRYER WTR HTR APPLIICANT /,D I LFCY STA COOK DISP F A U ADDRESS .30eBFNJF SPACE HTR AIR COND CITY Qv jA1 TEL NO 33,Z9� CLOTHES WASH DISHWASH LICENSE OR CLASS REG NUMBER �,�� FAN OTHER 100 �\ 1 HEREBI ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Cl AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS ETC HP KW KVA ELECTRICAL WIRING I SIZE & TYPE OVER TO 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 00 LICENSED AS REOU IRE BY L05 ANGELES COUNTY AND STATE OF CALIFORNIA OR THAI AM THE LEGAL OWNER OF T,4E ABOVE r 1-- 10 300 DESfRIf ED RESIDENT AL PROPERTY -07 O PERMITElE 6.7 10 - 50 500 SIGNATURE CD 50 - 100 1000 DISTRICT PROCE 'ED BY ~ W 1 00 - 500 1500 SIGN GAS SIGN AND ONE CIRCUIT 500 APPROVALS C/ DA INSPECTOR'S SIGNATURE TUBE OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE SERVICENOTOVER 600 VOLTS OR 200 AMP r 300 G UNDERSLAB WORK SERVICEOVER 600VOLTS 0R200AMP 1000 ROUGH CONDUIT TEMP SERVICE,POLE &APPURTENANCES 500- WIRING T TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES POWER AUTHORIZED ' UTILITY CO NOTIFIED FINAL 7 PERMIT FEE (SUB TOTAL) NOTES 3 19 C/ beb IAI,5 A,,7,h6:`+ I PLAN CHECK FEE 4' ( fe_A V-07- N0�0- PERMIT ISSUING FEE 3.,QQO TOTAL FEE PLAN CHECK VALIDATION CK M D CASH ERMIT VALIDATION cK M 0 CASH 7 8 9 E-Z, a L23 2 D 11 ,1.7 0 ens SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE f DBS SA 12 54 APPLICATION FOR ELECTRIC PERMIT ], � DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING © � WM J FOX COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN $UP T OF BUILDING momimmm FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST CROSS ST FEE NUMBER EACH LIGHT OUTLETS .,/ OWNE RECEPTACLES MAIL ADDRESS WALL SWITCHES TOTAL OUTLETS 5d S CITY TEL NO ELEC RANGES 25 ELECTRI N ELEC HEATERS 25 ADDRESS KW EA CITY TEL NO FIXTURES 5 LICENSE NO NUMBER OF LIGHT CIRCUITS DISTRICT NOGR�JP /�ZOI I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS MOTORS �`� NUMBER HORSEPOWER FEE IN PECTION RECORD NEW MVD HP OVER INC EACH Ib&LESS $ 25 _ 1/2 2 50 2 5 1 00 5 15 1 50 15 50 2 50 50 200 500 MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING $100 FIXTURES $100 SUPPLEMENTARY 50 APPROVALS TOTAL FEE $ DATE INSPECTOR S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENT16,6 PROPER Y UTILITY CO NOTIFIED SIGNATURE OF PERM ITTE FINAL WILLIAM J FOX, COUNTY ENGINEER VALIDATION 1 2 5 O�n ►BAR 8 2 2.3 5 BY //� J ® 4�`-r�P U T�/ TEMPLE UTY 76A663-CE8G8-62 `'APPLICATION FOR ELECTRICAL PERMIT COUNTY-OF LOS ANGELES min DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS !7T 3 0`7 1 v G; JOHN A LAMBIE COUNTY ENGINEER I WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY l� L NEAREST FOR APPLICANT TO FILL IN CROSS ST - RECEPT TOTALNO EACH FEE OUTLETS FIRST 20 97 ffi 20 $ G `, �1 OWNER Ca LIGHT _ •G ci c� MAIL S1fCITCH , y _ ADD'L ` 11O ADDEtESB 1 I OVER 20 LIGHTING TOTAL F1RsT20 1 20 CITY =rsR-\TEL NO FIXTURES ADD'L 10 ELECTRICIAN FO,-,R`20 RANGER JCLO DRYERS WTR HTRS 1 OO ADDRESS GARB SP . STA COOK CITY TEL NO DISHWASH STATE SPACE HTRS WP MAX) 50 LICENSE NO Morons OVER NOT OVER HP DISTR T O _ GROUP RNE PR- SED BY 0 1 100 1 3 150 INSPECTION RECORD, 3 B 200 B 15 250 ` sA� 15 50 300 (6` ✓�• Aj 50 100 500 �" O V SIGNS NO TRANS a NO LAMPS IO SERVICE O 600V NOT OVER 200A too v W SERVICE O 600V OVER 200 A 200 a' to SERVICE OVER 600V 500 ? MISC Jg PERMIT ISSUING FEE 2 00 SUPPLEMENTARY PERMIT ISSUING FEE 1 00 J TOTAL FEE 18 �/ I OfA 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATION APPROVALS DATE INSPECTOR S SIGNATURE 1 AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT 1 LAFORNIA ALL COUNTY ORDINANCES AND STATE LAWS REGULATING RICAL WIRING WIRING 1 REBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORISED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES OR THAT i AM THE LEGAL OWNER OF THE ABOVEIBED RE91D ROPERTY POWER ATUREfUTILITY CO NOTIFIEDERMITT FINAL IDATION ARTHUR C VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER _tea :1,8 4-10 FEB 3 2 0 _ 1 5.40N x _ RS' COMPENSATION DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT fl I `iereby affirm that I have a certificate of consent to self insure, CE-806G o� a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,La�4.) -r n Policy No.D 5 11_ Company `'TA-r r AAA v FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS J New Residential Bldgs.& Pools ❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. �—� y< $ — $ LOCALITY department. Multi-family Sq.Ft. NEAREST 5y Residential Swimming PoolsCROSS OWNER T. W Date Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' f FIRM NAME Outlets:Rec�L Light +— Sw. I p MAIL COMPENSATION INSURANCE CjZ) ADDRESS (This section need not be completed if the work involved by the - First 20 permit is for one hundred dollars($100) or less.) Total No. l� Additional CITY .� Tel.No. Z � Z I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixture First 20 ADDRESS Total No. Additional CITY Tel.No. Date Applicant PERMIT + ' t NOTICE TO Fixed Appliances Not Over 1 HP APPLICANT: after making this Certificate of KISS Exemption,you should becomee subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT • C:�M4� �~fiON provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. _ ADDRESS off?1 -V-C—' provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITYTel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ 1 hereby affirm that I am licensed under provisions of Chapter 9 LICENSE R (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER '�' J- Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCES D BY 15-.( CL Size & Type HP,KW,KVA,or KVAR Q License Number Lic.Class Up to 1 Incl. FINAL 1 1 f>� Over 1 to 10 Incl. DATE VALIDATION 0 1 Contractor 41 � 4 Date r� Over 10 to 50❑ Incl. ` U FINA I am exempt under Sec. Over 50 to 100 Inc. gY J W BAP.C.for this reason Over 100 c ffn Services,Swbd.,MCC& Panelboards Z Date: 0- 200 Amp. Under 600 V Signature �� 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ Misc.Conduits & Conductors I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , 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(Sec.3097, PERMIT FEE (Sub-Total) S 5 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 above TOTAL FEE 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 prop7tyf inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatureof Permittee Date ` f- KERS COMPENSATION DECLARATION CE806 0/61 APPLICATION FOR ELECTRICAL PERMIT lv,014 affirrp that I have a certificate of consent to self insure CE 8o6G J�� certificate of Workers Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY cop thereof(S5p 3800 Lab C) Policy No� Ompany r�/L1/�_ J'1 FOR APPLICANT TO FILL IN JOB - ❑ Certified copy Is hereby furnished y New Residential Bldgs & Po�o+lsp EACH NO FEE ADDRESS o G 9.�s $ — $ LOCALITY , ® 1 & 2-Family, Certified copy is filed with the county building inspection y S q EiJ Ft ST department Multi-family Sq Ft NEARECROSS ST Date Applicant Residential Swimming Pools OWNER OR « , FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec i;�14 Light Sw '� MAIL COMPENSATION INSURANCE _01IADDRESS (This section need not be completed If the work Involved by the '�T First 20 Total No Additional CITY I No ,permit Is for one hundred dollars ($100) or less) �- I certify that Inrthe performance of the work for which this permit PLA EC is issued I shall not employ any person in any manner so as to APPLICANT' become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS 3 TAdditional Total No ' CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP NOTICE ,TO APPLICANT If after making this,,Certificate of PERMIT Exemption you should become subject to the Workers Compensation Range_ Heater_ DW APPLICANT pTvissons of the Labor Code you must forthwith comply with such Oven _ Dryer W M ADDRESS provision's or this permit shall be'deemed revoked Top — FAD WH _ CITY LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ Tel No-s- '--O I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR I (commencmg'wdh Section 7000)`of�Division 3 of the Business and Dlsp — Room Air Cond REG NUMBER Class ' Professions'Code and my license is in full force and effect DISTRICT NO PROCESSED Power Apparatus& Large Appliances pp Size& Type HP KW KVA or KVAR SC p License Number A X942 Lic Class f3 Up to 1 Incl FINALZ G n / /J �.4 Over 1 to 10 Incl DATE r7 yj Contractor / ��/p�i ! Date l 7- C/ VALID ION 0 El Over 10 to 50 Incl FINA U" ' I am exempt under Sec Over 50 to 100 Inc _ g s B&P C for this reason Over 100 C Services,Swbd MCC & Panelboards ® Z Date 0- 200 Amp Under 600 V i c' Signature 201 - 1000 Amp Under 600 V f Over 1000 Amp or Over 600 V ❑, Exemption for Reg Maint Elect 1 3 7.,0 A _ SINGLE FAMILY Temp Power Pole& Appurtenances # o 0'0,0 0 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit J ° o-36-25 I hereby affirm that I am exempt from the Contractors License Law Additional Sign Branch Circuits ° ° ° 3 Ci 2 5 c=i for the following reason (Section 7031 5 Business and Professions Code) " - I1 2 2 p 8 8 ❑ I as,owner of the property well do the work and the structure Misc Conduits & Conductors is not intended or offered for sale (Section 7044 Business Other (See Complete Fee Schedule) and Professions Code) - CONSTRUCTION LENDING AGENCY _ ti I hereby affirm that there is a construction lending agency for the ' Performance of the work for which tfiis permit is issued(Sec 3097 PERMIT FEE, - (Sub-Total Civ C) PLAN CHECKING FEE ; Lenders Name PERMIT ISSUING FEE Lenders Address I certify that I have read this application and state that the above TOTAL FEE 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 natur Permittee Date f ,