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HomeMy Public PortalAbout5022 CLOVERLY AVE_Electrical__ 76A663_CESO6_I I_57 A P R L I C T I.O N FOR ELECTRIC PERMIT - 1° COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ��� BUILDING AND SAFETY DIVISION ADDRESS IOHN A. LAMBIE, County, Engineer , CASSATT D. GRIFFIN, Sup t of Building LOCALITY NEAREST ,r FOR APPLICANT TO FILL IN CROSS ST. PERNUT FEES ITEM NUMBER EACH FEE OWNER OUTLETS:. $ $ /� MAIL LIGHTS RECEPT. SW. .10 (J ADDR ES LIGHTING FIXTURES .10 j CITY j.. , TEL. NO 1 ELEC.RANGES CLO.DRYERS +• ELECTRICIAN W A T E R HEATERS .50 ADDRESS ELEC.SPACE HTRS. DISHWASHERS GARBAGE DISPOSERS AUTO.- - CITY TEL.NO. STATE WASHERS STA.COOKING UNITS :25 LICENSE NO. MOTORS: OVER INC. H.P.Y2 .25 DISTRICT NO. GRQO_.U�P_ply, ZONE READY FOR INSPECTION 1 1/2 — 2 .50 _. INSPECTION RECORD 2 — 5 1.00 5 — 15 1.50 I� 15 — 50 2.50 a r SO— 200 5.00 NO.TRANS. SIGNS: NO.LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 E FIXTURE PERMIT 1.00 f SUPPLEMENTARY PERMIT .50 TOTAL FEE ��j� APPROVALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOIFS SIGNATURE `i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT ;k WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ' r ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -". LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES f 3' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE , POWER DESCRIBED RESIDENTIAL OPE TY. SIGNATURE � UTILITY CO. NOTIFIED OF PERMITTE FINAL VALIDATIOU, ARTH U R C.V EIT, SUPERVISING ELECTRICAL ENGINEER CK MCI 5 2'-&Z 9 :.. .. o6:5 ;; heS' COMPENSATION DECLARATION 20-0019 DPW 3/87 •I hereby affirm affirm ttAPPLICATION FOR ELECTRICAL PERMIThat I have a certificate of consent to self CE_806G O insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS orb certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 2 LrV s ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS45- Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY8 tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST.OWNER OR Wu—Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_L_Light--LSw. MAIL COMPENSATION INSURANCE First 20 D Q ADDRESS (This section need not be completed if the work involved by Total No. 3 Additional CITY Tel. No.' a� the permit is for one hundred dollars ($100)or less.) PLAN CHECK 1 certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Dote plicant Total No. CITY Tel. No. Fixe NOTICE A LI A T: If, after king t i C rtificate'of d Appliances Not Over 1 HP PERMIT "1. Exemption, you should become subject the Workers Range— Heater—D.W. _ APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer W.M.— ADDRESS 13 4- f V1'Y i yL ,rA A-At- with comply with such provisions or this permit shall be Top — FAU J—W.H. — / deemed revoked. Hood — Fan —Other_ CITY A,L�W�N P Tel. No. 9f LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER -I �j 3 Class. O (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. / R ESSED BY and Professions Code,and y hcens is in full force and effect. n �/ /9 , Size &Type HP, KW, KVA, or KVAR '!J D � � Q _Ucense NumSber i�i Lic. Classl�v Up to 1 Incl. FINAL 9 pC 0 e J Over 1 to 10 Incl. DATE �`// // VALIDATION atractor Over 10 to 50 Incl. FINAL O I am exempt and r Sec. Over 50 to 100 Inc. BY ` 0 Lli B.&P.C. for this reason Over 100 t1 Z Date: Services, Swbd., MCC & Panelboards Z 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Req. 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 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 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— Business and Professions Code). , 20 = a0 CONSTRUCTION LENDING AGENCY f riY#i 2C).o t I hereby affirm that there is a construction lending agency for _ the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name ^ _ `t f_Ir<J1 `''Fr; 41 PERMIT ISSUING FEE Lender's Address 1 i ; I certify that I have read this application and state that the TOTAL FEE -' 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 pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ature of er ittee ate ©s WORKERS' COMPENSATION DECLARATION 76663 CEA-806G 10/81 APPLICATION FOR ELECTRICAL PERMIT -1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 3800,Lab. C.) Policy No. - .Company _ FOR APPLICANT-TO FILL IN JOB �� �' n Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS A 1 & 2-Family,Sq.Ft. $ — $ LOCALITY El Certified copy is filed with the county building inspection — NEAREST department. Multi-family Sq.Ft. CROSS ST A Date Applicant Residential Swimming Pools OWNER OR r' FIRM NAME �' W i, Outlets:Rec_Y— Light CERTIFICATE OF EXEMPTION FROM WORKERS' tet' � Sw. � ' MAIL COMPENSATION INSURANCE ADDRES Q R This,section need not be completed if the work involved b First 20 ( p Y the CITY" Tel.No. permit is for one hundred dollars($100)or less.) Total No. Additional ✓ 6dS 1 certify' ertif that in the performance of the work for which this permit PLAN CHECK Y P P .y APPLICANT is issued, I shall not employ any person in any manner so as to C/J5 become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. � CITY Te. Date a Applican A, •Fixed Appliances Not Over 1 HP PERMIT NOTICE TO A PLICANT: If, after King this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT 41 provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS AG provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that.I am licensed under provisions of Chapter 9LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY /' Size& Type HP,KW,KVA,or KVAR t V Q License Number Lic.Class Up to 1 Incl. FINAL n �j,✓y U Over 1 to 10 Incl. DATE IX ,—, yYS (/(/ VALIDATI ❑ Contractor Date FINAL O Over 10 to 50 Incl. I am exempt-under Sec. Over 50 to 100 Inc. BY W BAP.C, for this reason Over 100 p Services, Swbd.,MCC& Panelboards , N Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V .2.0007A ❑ Over 1000 Amp.or Over 600 V o o,o 0 0 2 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole'& Appurtenances ( o - 2625 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o. 0 2 2 5 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): 062'8-88 Misc.Conduits & Conductors I� 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) 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 . property for inspection pur�es SEE REVERSE FOR EXPLANATORY,LANGUAGE 64q + � Signature erm t e Date