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Home My Public Portal About4848 CLOVERLY AVE_Electrical__ 76A66C CE#'806 5 61 APPLICATION FOR ELECTRICAL PERMIT ffi��Jll COUNTY OF LOS /ANGELES DEPARMENT OF COUNTY ENGINEER BUILDING a : 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 t 'O SR PERMIT FEES OWNER Or/�/Y 0 I T E M NUVBERI EACH F E MAIL OUT L $ S ADDRESS LIGHT RECEP 6 10 CITY TEL NO LIGHTING ORES 10 LGES CLO DRYERS ELECTRICIAN H E A T E R S 50 CJ ADDRESS 6! i -19"LEC SPACEH DISHWASHERS O� CITY TEL NO Q GARBAGE DISPOSERS ' AUTO STATE WASHERS STA COOKING UNITS 25 LICENSE NO MOTORS OVER INC H P DISTRICTG Z NE PRO SED-BY O— 1/2 25 ] 1/2— 2 50 INSPECTION RECORD [ 2— 5 100 O. 0 5— 15 ISO V IS— 50 250 OC 0 50— 200, 506 U W SIGNS NO TRANS H NO LAMPS z SERVICE O 600V 100 SERVICE OVER 600V 500 MISC WIRING PERMIT 1 00 FIXTURE PERMIT 100 SUPPLEMENTARY PERMIT ' 50 r TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATC LAWS REGULATING CONDUIT ) �jpy�//��7 ELECTRICAJE WIRING 7 [/SV 11ffAV+'�II " \' I HEREBTHAT I AM PROPE Y REGISTERED AND/ORLICENSEE- BY LOS ANGEL COUNTY AND STATE OF FIXTURESCALIFORN1 AM THE LEG OW R OF T ABOVEDESCRIBEL PROP RTYPOWERSIGNATUUTILITY CO NOTIFIED FINAL J ✓ ��b ID ARTHUR C VETT Molv. CASH SUPERVISING ELECTRICAL ENGINEER Uo 7 6 7 0 JAN 31 2 D 13.10 7GA663-CES06 3-69 -'1 � C" J� 19 APPLICATION FOR I LECTRICA PERMIT COUNTY OF LOS ANGELES /DEPARTMENT OF COUNTY ENGINEER BUILD NG BUILDING AND SAFETY DIVISION ADDRESS TU `r' L'I(OUGV' JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY 1� i NEAREST // ` FOR'APPLICANT TO FILL IN CROSS ST /-o NO EACH FEE / $ $ OWNER O/ C RECEIPT MAIL T'a O LIGHT TOTAL FIRST 20 20 ADDRESS L' CITY TEL NO SWITCH OVER 20 10 PLAN CHECK LIGHTING TOTAL FIRST 20 20 APPLICANT FIXTURES OVER 20 10 ADDRESS RANGE_DRYER_WTR HTR CITY TEL NO ` STA COOK_DISP F A U CONTRACTOR 'L--1 - wd /-- 1 f SPACE HTR AIR COND ADDRESS 3 7 Z3 vl - 71tta C a eL CITY o —A - E! a.0 TEL NO Z&o- 2GG_ CLOTHES WASH _DISHWASH / FAN OTHER 1 00 LICENSE NO 2 2- 7 Z CLASS MOTORS TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION IND HEATERS ETC HP KW KVA AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING /L ELECTRICAL WIRING 0 - 1 1 00 / 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -ICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND 5TATEOF 1 - 10 3 00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO d RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY O 10 - 50 5 DO V SIGNATUREr' V— F- 50 - 100 10A0 OF PERMITTEE �-G_/� Q H 100 - 500 1500 DISTRICT NO GROUP ZONE PROCESSED BY W SIGN,GAS SIGN AND ONE CIRCUIT 3 00 Q v7 TUBE OR z MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES 7-,Z o- d t SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 /AIA L, � + SERVICE OVER 600 VOLTS OR 200 AMP 5 00 1 1 TEMP SERVICE, POLE, &APPURTENANCES 3 00 APPROVALS DATE INSPECTORS SIGNATURE TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PERMIT ISSUING FEE 2 00 UTILITY CO NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE f}r) JOSEPH C RO AN SUPERVISING ELECT ENGINEER PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CASH 57099 JUL 7 2 D 3.00 a SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) I hereby affirm that I have a certificate of consent to self insure, 76A663 APPLICATION FOR ELECTRICAL PERMIT 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. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE ❑ _ 1 &2-Family,Sq. Ft. $ $ LOCALITY Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec._Light Sw. OWNER OR COMPENSATION INSURANCE g FIRM NAME (This section need not be completed if the work involved by the First 20 MAILTotal 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. is issued, I shall not employ any person in any manner so as to 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 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT 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 Tel.No. 11 Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. O LICENSE Cl Over 50 t0 100 Incl. REG.NUMBER Class. V License Number Lic.Class Over 100 DISTRICT NO, PROCESSED BY Ill ,J Services,Swbd.,MCC&Panelboards LL Contractor Date 0-399 Amp.Under 600 V DATE INAL >_ ❑ 400-1000 Amp. Under 600 V VALIDATION Q I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL cc B.&P.C.for this reasonBRANCH CIRCUIT FEES sv a Date: 15A,or 20A, 120V, Lighting or Recept. 1 To 10 Branch Circuits W Signature 11 To 40 Branch Circuits i— ❑ 41 Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION 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 Code): ❑ I, 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) , 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) Civ. C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE