HomeMy Public PortalAbout4828 CLOVERLY AVE_Electrical__ 6A663-CE806 5-62 APPLICATION F®R ` LECTRICAC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPT ° TOTAL NO ESACH FEE
OUTLETS FIRST 20 20 $ MWNER oLIGHT /
AIL
SWITCH ,o (,�/��j OADD'L 1O ADDRESS
OVER 20
TOTAL Q CITY TEL NO
LIGHTING FIRST 20 20
FIXTURES ADD'L 1D ELECTRICIAN
OVER 20 /
RANGES CLO DRYERS WTR HTR9 1100 ADDRESS
GARB D P STA COOK CITY TEL NO
DISHWASH AUTO WASH STATE
SPACE HTRS erfA APP (1/.H P MAX Z 50 LICENSE NO
MOTORS OVER NOT OVER H P DISTRICT NO UP ZO E PR SSED BY
o
0 1 1 00 �/
1 3 150 1 INSPECTION RE OIRD
s S 200 !�V' �d�. �T` �1 �. .c• II /'�I'
a 15 250CL
O
15 50 300 (,)
SO 100 Soo
SIGNS NO TRANS V~
NO LAMPS W
a
_ N
SERVICE O 600V NOT OVER 200A 100 It Z
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V 500
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LICATI N APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING A /�
ELECTRICAL WIRING WIRING l�
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES f.
CALIFORNIA OR THAT�ATEGAL OWNER OF THE ABOVEDESCRIBED RESIDENTIPOWER �y,I
SIGNATURE Qa
UTILITY CO NOTIFIED �/�/ -41 v Z�✓i F? 9
OF PERMITTEE I XI 13
FINAL
LI ARTHUR C VETT '
CK MOO CAS CASH SUPERVISING ELECTRICAL ENGINEER
L.-Co 6 5 0 0 NOV 5 2 D 1 2.9 0
WORKERS COMPENSATION DECLARATION 76A663
10/81
CE6o6G APPLICATION FOR ELECTRICAL PERMITI hereb�i.affirm that I have a certificate of consent to self insure
or a certificate of Workers Compensation'Insurance or a certified M COUNTY OF LOS ANGELES BOILDING AND SAFETY °
copy thereof,(Sec 3800 Lab C) r, + - a
Policy No Company .J FOR APPLICANT,TO FILL IN _. JOB c�t�
❑ Certified copy is hereby furnished f r New Residential Bldgs & Pools EACH NO, -FEE ADDRESS 7 V.
^,,, ,• 1 , $ — $ LOCALITY a ,,
F-1 Certified copy is filed with the county building inspection 1 & 2 Family Sq Ft n
o ydepartment 4 , ° Multi-family,Sq Ft r — NEAREST.
CROSS ST-
f s ° Residential Swimming PoolsOR
m
r Date Applicant r� FOIRM NAME I
CERTIFICATE OF EXEMPTION FROM WORKERS 4 ^"V 'MAIL a s
'> COMPENSATION INSURANCE Outlets Rec Light Sw ADDRESS
(This section need not be completed if the work Involved by the' t+ * First 20,
' w Total No Additional I CITY T Tel No
perTit,Is for one hundred dollars ($1'0o),or less) x i "
+ PLAN CHECK r
"I certify that m the performance of the work for which this permit, d " 'APPLICANT s
,is issued I shall not employ any person in gany manner so as'1to s t
become subject to the Workers Compensation,Laws r Lighting Fixtures First 20^ ADDRESS a ;
Additional �.
Total No p CITY' Tel No
Date � » Applicant
• Fixed Appliances Not Over 1 HP i, n
a
r �, PERMIT
NOTICE' TO APPLICgoLAI?
" A T If aftemkig this 'Certificate of, � �' �» ,
a_ a 1, APPLICANT
EExemption you should become subject to the Workers Compensation Range= Heater_ D W
provisions of the Labor Code you must'forthwith comply with such Oven`=rr Dryer'_ W M °- ', . `ADDRESS
provisions or this permit "shall`be deemed revoked` Top,
e' LICENSED CONTRACTORS DECLARATION f —'tlFAU W H CITY _� -Tel N � s d,
Hood Fan Other_ '
I hereby affirm that I am'licensed'under provisions sof»Chapter 9 Disp Room Air Cond i i LICENSE OR st3l
(commencing with Section 7000)'of Division 3 of the,Business and REG NUMBER l> Class 16.Z,Q
mlicense is in g
y j
c
Professions Code,and , full force and ffec " 1,
DISTRICT NO r PR SSED BY -
Power Apparatus& Large Appliances /—•`D(, °
3� � Size& Type'HP KW KVA,or KVAR ✓1f Jv� 0
License Number Lic Class U Up to'1 Incl FINAL o p V'
,Over 1 to 10 Incl , DATE ,� Jn—a� VALIDATION W
Contractor Date — Over 10 to 50 Incl r'�"`� �� JJJ U
❑
Over 50 to 100 Inc FINAL
I am exempt underZec BY W
B&PC for this reasona Over,100 " e �-
1" Services Swbd MCC &Panelboards Dollop. 3 Z,
Date
0- 200 Amp Under 600 V r''
Signature ' 20,11.,}1000 Amp Under 600 V - --
❑ " Over 1000 Amp or Over 600 V
Exemption for Reg Mamt Elect # , - I. '+
-1112
i`
SINGLE FAMILY Temp Power Pole& Appurtenances
Ap
HOME OWNER-BUILDER DECLARATION i - }w✓� Z_
Sign,wdh One Branch Circuit ,. __ _ w`o _ �,e —y�-,--�--^-,—,
I hereby affirm that'l am,exempt from the Contractors'License Law M r - r p
for the following reason (Section 7031 5, Business and Professions' ,+ *Additional Sign Branch,Circuits
Code) !�
`- a Misc Conduits &,Conductors, .' -; l1_,j
I,as owner of the property,will do the work and the structure n @�
isnot intended or offered for sale (Section 7044 Business,I Other (See Complete Fee Schedule) _ TOTAL 2!!,
T� t
and Professions Code) CHE4, - - �C�
CONSTRUCTION LENDING AGENCY JV
"I herebyaffirm that there is a construction lending agency for the
performance of the,work for which this p"ermd is issued(Sec 3097, "' PERMIT FEE -.
r ,.(Sub-Total) _ ' a _ , �,-
av, C) -i r'.nr - s r 9 ✓
PLAN CHECKING'FEE °-'r k >'�w �k' �'+` 9/ "
Lenders Name
+ ' PERMIT ISSUING FEE'
Lenders Address I
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
- Signature of Pe fittee Date
r