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Home My Public Portal About4824 CLOVERLY AVE_Electrical__ A663-CE806 5-62 APPLICATION FOR E.LECTRICA PERMIT I COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS , �s�OV�/9z 1 JOHN A. LAMBIE. COUNTY ENGINEER Q �- WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. 05.A RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 $.20 $ OWNER �� . 11�A�� LIGHT MAIL �1 ADD'L .10 LIGHTING ADDRESS i- � ! G40il)6 //J�.A SWITCH. OVER 20 TOTAL FIRST 20 .20 CITY � ,4F CA T TEL. NO. I p 0 I FIXTURES } I ADD'L 10 ELECTRICIAN OVER 20 RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL. NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(%z N.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DIST ICT GRRk1P Z N P D BY O 1 1.00 C� 1 3 1.So INSPECTION RECORD 3 S 2.00 8 18 2.50 0- 0 15 50 3.00 U 50 too 5.00 cw SIGNS: NO.TRANS I NO.LAMPS C. In SERVICE 0-60OV-NOT OVER 200A r 1.00 z SERVICE 0.600V-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ 1 LESIDENTIAL BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT LL COUNTY ORDINANCES AND STATE LAWS REGULATING Q CAL WIRING. WIRING EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR �- D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES NIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ED RESIDENTIAL PR Y. POWER ,gg A URE '�� UTILITY CO.NOTIFIED ~"'�� ' ✓tel' MITTEE i FINAL ALIDATION A HU C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER LiCo4 1 7 1 N SEP 11 2 D 3.0 0'" Iq WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm t11at I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereec. 3•g00 Lab. C.) //�^l �j Policy No.;�Company t CJL�C� FOR APPLICANT TO FILL IN JOB ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE — $ $ LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq. Ft. NEAREST pn department. Multi-family Sq.Ft. CROSS ST. Dat e��`S Applicant 7/'C "/ 1�� Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sv �_f OWNER OR 2 _ ✓r�� 7 V�`W COMPENSATION INSURANCE /;7 U FIRM NAME First 20 MAIL (This section need not be completed the work involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY �� -�� Tel.No. S � is issued, I shall not employ any person in any manner so as t0 PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT Power Apparatus&Large Appliances APPLICANT /� TdPc� /!Y C- LICENSED or this permit shall be deemed revoked. _ LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY /fJl�jl/ �'//� Tel.No.�i�7��3/° Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. _ vv LICENSE OR X7-2 �Y ? Over 50 to 100 Incl. REG.NUMBER �5 S 4 [) Class.4 O ^�,� / `V Over 100 DISTRICT NO. Q P O ED BY U License Number 25�z- Lia Class C�� / D Q - /f/GL'i'��ia!�t� c Services,Swbd.,MCC%aan�elboarddss /f� n R t1� 1 Z�31 J 0-399 Amp.�[Jrf e_ 00 V - C/ FINAL 0 Contractor ^� � � �' Date DATE ❑ I am exempt under Sec. 400-10b0 Amp.Under 600 V ` W Over 1000 Am or Over 600 V VALIDATION P• FINAL a- B.&P.C.for this reason BRANCH CIRCUIT FEES BY U) Date: 15A,or 20A, 120V,Lighting or Recept. ✓ Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 1 SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION �;(;�,g I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3307 74.33 Code): ITEMS ElI,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , TOTAL 74 ® ,3_1.P3 and Professions Code). CHECK 74.133 CONSTRUCTION LENDING AGENCY t1l��9 I hereby affirm that there is a construction lending agency for the CHANGE performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEEf�l�0l7-I��{�� 1 .1 kP' Y�1� Lender's Nam PERMIT ISSUING FEE /� � f Ar 9.`576 Lender's Address 1 certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 iPURE on purpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNF R ITTEE DATE • COUNTY OF LOS ANGELES' TEMPLE CITY #0508 ELECTRICAL PERMIT DEPARTMENT Of PUBLIC WORKS 9701 LAS TUNAS EL 0508 0309190026 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91,780 PHON (€.•`626.2W 0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 11454 LT: 26 4824 CLOVERLY AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803808 ASS SSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8590-020-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 17.00 OUT 33.15 TENANT: G2 LIGHTING FIXTURES 4.00 LGT 7.80 ISSUED ON: PROCESSED Y: PLAN BY: EXPIRES ON: TOTAL FEES 68.70 09/19/03 VG 03/17/04 OWNER: TEL. N0: FINAL DATE EX�/pI -R Y: CODE: JACKSON BELZORA TR BELZORA JACKSON (626) 285-9717- 4824 CLOVERLY AV TEMP 917803808 DESCRIPTION OF WORK ELECTRICAL FOR ADDITION APPLICANT: TEL. NO: SMITH (909) 605-6691- 4055 GUASTI RD.#106 SPECIAL CONDITIONS: ONTARIO, CA 91761 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE o ENTERPRISE BUILDERS (909) 621-7455- 4045 GUASTI RD., SUITE 203 LIC. NO t y TEMPORARY POWER POLE ONTARIO, CA 91761 808254 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: - U ER GROUND LIC. N0: _ - - ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLAST-IC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 oB6DFPARTMENT OF BUILDING AND SAFETY APPLICATYON FOR PERNIIT COUNTY OF LOS ANGELES ELECTRIC WM J FOX CHIEF ENGINEER z DISTRICT NO. GROUP I ZONE PERMIT NO. NAME p U ADDRESS e.B11 IU CITY TEL NO Rr;CsIVED FIRST INSPECTION DY FOR DAT E W CCRT NO EXPIRES a cn COUNTY c APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION W WORK —ADDRESS egg& NUMBER OF OUTLETS ON CIRCUITS LOCALITY ` LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW PLUGS ICROSSSTCIRCUIT A 13 C D E F G HK NAME 4 9 I z MAIL ' < 3 ADDRESS O CITY TEL NO 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. ELECTRICIAN I AM THE LEGAL OWNER OF THErePROP! DESCRIBED ABOVE OWNER CORRECTLONS J TOTAL NO OF OUTLETS $ APPROVALS I NO OF FIXTURES $ [i1 DATE INSPECTOR'S NAME NO OF MOTORS H P $ CONDUIT NO OF SIGNS TRANS $ WIRING NO OF RANGES OR HEATERS $ FIXTURES v ' MISCELLANEOUS (� $ v9 POWER PERMIT FEE /,-o" _ t�J $ Gy� UTILITYCO NOTIFIED TOTAL F E ® FINAL, -l"y� dN WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) Policy No. I ZZ17 J /3 Company "' FOR APPLICANT TO FILL IN JOB 7- 9 ADDRESS f- El Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ❑ Certified co s filed with the co t uildin 1 &2-Family,Sq.Ft. _ $ $ t C copy pection NEAREST ;2 department.. .¢oQ Multi-family Sq.Ft. CROSS ST. Date A�- AppIica t Residential Swimming Pools ASSESSOR SS SSOK Yr1, PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outle Rec._/_ 9 FIRM NAME Light Sw. OWNER s COMPENSATION INSURANCE / (� aro L9�p (This section need not be completed the work involved by the First 20 MAIL ((_l L permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS I certify that in the performance of the work for which this permit CITY !'Z. Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHE II become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICA 0 IC.LQ Total No. Additional ADDR SS 1C•-, 1 7 -,IF 4 "-4t- Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. -7 �l NOTICE TO APPLICANT: If, after-making this Certificate of CITY p S�y� Tel.No. -Z-7 `Z"] Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT p y APPLIC T provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADORE S I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE >�G�J Class. a 1 c� Over 50 t0 100 Incl. REG..NUM NUM R / 7 3 License Number `I 1 Lic.Class Over 100 DISTRICT NO. f� PROCESSED BY 0 c Services,Swbd.,MCC&Panelboards Q (J cc FINAL Contractor • yn �(LT- 6 1 0-399 Amp.Under 600 V DATE 0 El 400-1000 Amp.Under 600 V I am exempt under Sec. �'Y-4 3 VALIDATION V Over 1000 Amp.or Over 600 V FINAL W B.&P.C.for this reasonBRANCH CIRCUIT FEES BY __�JCn Date: 15A,or 20A, 120V,Lighting or Recept. Aa— Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits i SINGLE FAMILY Temp.Power Pole&Appurtenances a g HOME OWNER-BUILDER DECLARATION i{.t•t na I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit _ for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits no_ I vo cU Code): 66 Misc.Conduits&Conductors I S S E _ I, as owner of the property,will do the work and the structure -?o� _I_I[_ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) j NL 2 S � and Professions Code). CHCHEC,�: .4 z t EC �>a.L_ CONSTRUCTION LENDING AGENCY CHANGE •y I hereby affirm that tfje�e is a cons coon lending agency for the performance of the 6/lc for whic is permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE 0000-0001 71/26/9r Lender's Na PERMIT ISSUING FEE € 9-77 AMO'.46 Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize represen s of thisQ, my to enter upon the above-mentioned property for ii purp s SEE REVERSE FOR EXPLANATORY LANGUAGE NATURE F PERMITTEE DATE WORKERS' COMPENSATION DECLARATION vDPW aie7 APPLICATION FOR ELECTRICAL PERMIT O 76A66 J`hereby affirm that I have a certificate of consent to self 76A663 CE-806G insuFe, or a certificate of Worker%' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certir`ied copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB D JI ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS Certified copy is filed with The county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST CROSS ST. n� Residential Swimming Pools OWNER OR J Date Applicant FIRM NAME �! CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light 2 Sw. MAIL �� 'w COMPENSATION INSURANCE D ADDRESS ;;;A (This section need not be completed if the work involved by First i l Total No. Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in ;he performance of theA�Workers' s APPLICANT permit is issued, I shall not employ any panner so as to become subject to the Workers' Lighting Fixtures First 20 o ADDRESS 9 Additional �_ Total No. 1Z CITY Tel. No. Date ApplicantFixed Appliances Not Over 1 HP PERMIT I NOTICE TO APPLICANT: If, afte akinate APPLICATION �> � ®^J; LB Exemption, you should bec a subjer ers' Range— Heater—D.W. — Compensation provisions of the Labor C forth- Oven — Dryer —W.M.— ADDRESS t(C f S with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. 7�Ll —�� '3 Hood — Fan —Other— CITY T.I. No.�""�� '' LICENSED CONTRACTORS DECLARATION LICENSE OR p Disp. — Room Air Cond. — REG. NUMBER (0 �y� Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR SED BY and Professions Code,and my license is in full force and effect. 0- �j` Size&Type HP, KW, KVA, or KVAR �CC•✓,�Gmr—ee(ra/ Q License Number & J�7�Lic. Class Up to 1 Incl. FINAL U Contractor Over 1 to 10 Incl. DATE ) 14� VALIDATION 0 ❑ Over 10 to 50 Incl. FINAL / — I am exempt under Sec. Over 50 to 100 Inc. BY U Over 100 LU B.&P.C. for this reason 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 HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit i':i. :a 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 aFP 11 structure isnot intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , T,'!T .-a , Business and Professions Code). •rs CONSTRUCTION LENDING AGENCY I hereby affirm that there is.a construction lending agency forIr i; 5 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) d CH ii (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name 3i1l l�-10C;131 PERMIT ISSUING FEE / Lender's Address rj+t Fitt ,q�Y., I certify that I have read this application and state that the TOTAL FEE �pZ• �� above information is correct. I agree to comply with all County ordinances and State I egulating Electrical wiring, and hereby authoriz presentati sof this County to enter upon the above- nt oned prop r inspecti n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu IIt Date