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HomeMy Public PortalAbout5024 CLOVERLY AVE_Electrical__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J FOX, County Engineer FOR APPLICANT TO FILL I DISTRICT NO. GROUP ZONE PERMIT NO. 3 ELECTRICIAN RECEIVED BY READY FOR DATE ISSUED ADDRESS /f/� FIRST INSPECTION —a CITY q TEL NO ` (j COUNTY LICENSE NO EXPIRE- BUILDING © PERMIT FEE FEES ADDRESS SQ y w NUMBER EACH LOCALITY LIGHT OUTLETS NEAREST RECEPTACLES CROSS ST WALL SWITCHES OWNER 43 TOTAL OUTLETS SC s MAIL ELEC RANGES 28 ADDRESS ELEC HEATERS 25 tis CITY TEL NO FIXTURES 5 V 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS L 5' J AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW Mv0 HP OVER INC FACH OF THE RESIDENTIAL P OPERTY DESCRIB D A VE I/2 & LESS 111 28 HIGNATURE OF I/2 2 50 PERMITTEE 2 B 1 DD INSPECTION RECORD s is 1 50 is s0 250 50 700 Soo _ 200 500 1000 J 5013 1000 1500 6 a OVER 1000 2000 0 M G SET/FREQ CHANGER-HP a WELDERS AC-KVA _ GENERATORS - KW TRANSFORM—RS- KVA TEMP MOTORS (75% OF ORIG) MOVED MOTORS (75% OF ORIG) MISC SIGNS NO NO TRANS NO NO LAMPS APPROVALS FOR EACH PERMIT DA INSPECTOR'S NAME WIRING $1 013 0,0 CONDUIT /J� FIXTURES _$1 OO �_ 900 WIRING SUPPLEMENTARY 50 FIXTURES POWER _ TOTAL FEE ® UTILITY CO NOTIFIED p Q FINAL a 76A663 DBS#5A 4-52 WORKERS COMPENSATION DECLARATION 8663. lOsBd r APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE CE806G insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) I _ \ Policy No 230735 Company DCKKXXXEX FOR APPLICANT TO FILL IN JOB L� Certified copy is hereby furnis&aC. Ins. CO New Residential Bldgs 8 Pools EACH NO FEE ADDRESS �/ • $ _ $ LOCALITY /�7 Certified copy is filed with the cou ty u ldi nspec- 1 8 2-Family Sq Ft r C/T NEAREST tion department Multi-family Sq�Ft CROSS ST eA Date Applica it -424 Residential Swimming Pools OWNER OR FIRM NAME S, `/�+d a✓.` CERTIFICATE OF EXEMPTION FROM R ERS Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE ADDRESS /2/ Q section need completed if the work involved ' - First 20 �0/ fire permit is for one hundred dollars ($100)or less ) (This tn d not b p �b Y Total No Additional CITY Tel No .2x'5-6-0,711 I certifythat the performance of the work for which this PLAN CHECK at in e P APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Total No Additional CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP; PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICANT G. & .S. ELECTRIC Exemption, you should become subject to the Workers Range_ Heater_D W — Compensation provisions of the Labor Code, you must forth Oven _ Dryer — W M — ADDRESS 531 S. AtlantlC Blvd. with comply with such provisions or this permit shall be Top _ FAU —_W H deemed revoked CITYOrit@r@y Park Tel No576-8180 Hood Fan _Other_ LICENSED CONTRACTORS DECLARATION _ LICE I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond — REG NUMBER OR 248057 Class C10 (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROCESSED BY >_ and Professions Code and my license is in full force and effect IL Size &Type HP KW KVA or KVAR 0 License Number 248057 Lic C1assC1O U to 1 Incl �^ FINAL V ce ContractorG e & S• ELECT$,,P Over 1 to 10 Incl Ac DATE VALIDATION 0 ❑ Over 10 to 50 Incl FINAL ~ U I am exempt under Sec Over 50 to 100 Inc BY CLW B&P C for this reas n Over 100 1 _ Services, Swbd , MCC & Ponelboards S cY� , ° 0 -200 Amp Under'600 V Signature /201 - 1000 Amp Under 600 V 2 5 5 7J A ❑ eg Over 1000 Amp or Over 600 V Exemption for RMa lett # o o o o o-2 SINGLE FAMILY Temp Power Pole&Appurtenances 0- ' HOME OWNER-BUILDER DECLARATIONSign with One Branch Circuit ° 0 1 8 I hereby affirm that I am exempt from the Contractor s License 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 } Other (See Complete Fee Schedule)_ ► 0 7,r0 6--8 4 7044 Business 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 PERMIT FEE (Sub-Total) (Sec 3097 Civ C ) ` PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE L0 Lender s Address I certify that I have read this application and state that the TOTAL FEE Z,� above infor anon is correct I agree to comply with all County ordinance an State jaws re lating Electrical wiring and hereby a ho iz represent, v s of this County to enter upon the obo - ioned prop for ins ction purposs SEErREVERSE FOR EXPLANATORY LANGUAGE " , S no re o Per Tee ate b- � r