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HomeMy Public PortalAbout5338 CLOVERLY AVE_Electrical__ e IBA669 CES06 10 60 APPLICATION FOR ELECTRICAL PERMIT � COUNTY OF LOS ANGELES /Y ` PAr D BUILDING TOF COUNTY AND SAFETY DIVISION ENGINEER ADDRESSBUILD (�33- („//'o'1 vC�e ✓J JOHN A LAMBIE, COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING LOCALITY NEAREST O FOR APPLICANT TO FILL IN CROSS Sr PERMIT FEES OWNER 1 T E M NUMBER EACH FEE MAIL ADDRESS OUTLETS $ $ LIGHTS RECEPT� SW 10 O CITY TEL NO LIGHTING FIXTURES 10 Q ELEC RANGES f CLO DRYERS ELECTRICIAN (� Ci yy, WATER H E-A T E R S 50 '�� ADDRESS /V J� /I/ 7► �3�<� ELEC SPACE HTRS DISHWASHERS, -rl CITY /�� TEL NO GARBAGE DISPOSERS AUTO 4s,0 STATE WAbHER3 STA COOKING UNITS �• 25 LICENSE NO MOTORS OVER INC HP DISTRICT O GROUP NE PR SSED BY FAN0— Yz ' 2 2 5 7 ece ?40, 1/2— 2 / / So INSPECTION RECORD 2— 5 foo '7��/�Cs1 >- a. 5— 15 ISO 15— So 250 �'��� ITN Asea./✓1+ f � SO— 200 500 SIGNS NO TRANS NO LAMPS �. H SERVICE 0-600V 100 /,Do Z SERVICE OVER 600V 500 MISC i WIRING PERMIT 1 00 0 FIXTURE PERMIT 100 SUPPLEMENTARY PERMIT 50 TOTAL FEE g 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTORS SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING WIRING y� 1 HEREBY CERT FY LICENSED AS Y THAT I AM PROPERLY REGISTERED ATEAND/OR REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEG OWNER OF THE ABOVE DESCRIBED RESIDENTIA PER' POWER SIGNATURE UTILITY CO NOTIFIED ,tJ OF PERMITTEV FINAL /--l/ [DATION ARTHUR C VEIT cK MO CASH SUPERVISING ELECTRICAL ENGINEER �05957 :� „i'? 24 2 D 180 WORKERS COMPENSATION DECLARATION 806 10/81 APPLICATION FOR ELECTRICAL PERMIT {� i hereby affirm that I have a certificate of consent to self insure CE 806 1�CE G L J or a certificate of Workers Compensation I uranceior a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY >cpy thereof(Sec 3800 Lab C) Policy N ?37 'S70mpany FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS ) 33 P Certified copy is filed with y riding inspection 1 & 2-Family Sq Ft $ _ $ (LOCALITY 64/ de rt nt Multi-family Sq Ft INEAREST CROSS ST Residential Swimming Pools )OWNER OR Date Applicant r // FIRM NAME CERTIFI E OF EXEMPTION FR WORKERS Outlets Rec Light !SL Sw MAIL COMPENSATION INSURANCE t ADDRESS (This section need not be completed if the work Involved by the First 20 i CITY 0aNoZC:�' permit Is for one hundred dollars($100)or less) Total No Additional I certifythat in the performance of the work for which this permit PLAN CHECK P P APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Fixtures I First 20 ADDRESS17 Total No to Additional CITY Tel No �6 Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of Exemption you should become subject to the Workers Compensation Range_ Heater_ DW _ APPLICANT provisions of the Labor Code you must forthwith comply with such Oven _ Dryer _ W M _ ADDRESS provisions or this permit shall be deemed revoked Top — FAU _ WH CITY Tel No 8zt(d LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9Disp — Room Air Cond LICENSE OR Class (commencing with Section 7000) of Division 3 of the Business and REG NUMBER j Professions Code and my license is In'full force and effect Power Apparatus& Large Appliances DISTRICT O PROCD BY Size &Type HP KW KVA or KVAR 3 /i-) , 0- License Number Lic Class Up to 1 Incl FINAL U Over 1 to 10 Incl DATE /— ���/ O Contractor Date ! VALIDATION ❑ Over 10 to 50 Incl FINAL / I am exempt under Sec Over 50 to 100 IncU BY rF �. B&PC for this reason Over 100 IIIIJJJJ G. CO Services Swbd MCC & Panelboards ® Date 0 - 200 Amp Under 600 V r Signature 201 - 1000 Amp Under 600 V ❑ - Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit A a I hereby affirm that I am exempt from the Contractors License Law HC C T.a for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits Code) 3 307 30.10 ❑ ITEMS I as owner of the property will do the work and the structure Misc Conduits & Conductors 1 lT�" is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) and Professions Code) pol. TOTAL 30 ® 10 CONSTRUCTION LENDING AGENCY CHECK 30.10 1 hereby affirm that there is a construction lending agency for the CHANGE .011 performance of the work for which this permit is issued(Sec 3097 PERMIT FEE _ , (Sub-Total) , Civ C) I PLAN CHECKING FEE Lenders Name V1JQL—ll�70I °1 6190 PERMIT ISSUING FEEJ3 0 r23771 AM *17 Lenders Address 1 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 repres i of this-County to enter upon the above-mentioned pro rty for ec purposes SEE REVERSE FOR EXPLANATORY,LANGUAGE Sign ittee D � �-- WORKERS' COMPENSATION DECLARATION CE-806 10ie1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY / or a certified copy thereof (Sec. 3800 Lob. C. Policy No. Company` FOR APPLICANT TO FILL IN JOB 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 Residential Swimming Pools CROSS ST. i/ Date ' Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight Sw. MAIL COMPENSATION INSURANCE ADDRESS This section neenot be completed if the work involved b First 20 ( tid p y Total No. Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) ;.' I certify that in the performance of the work for which this APPLICANTPLAN K 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 Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT 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 with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood Fan _ Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO. PROCESSED BY > and Professions Code, and my license is in full force 9nd effect. Power Apparatus& Large Appliances 0 Size &Type HP, KW, KVA, or KVAR V License Number Lic. Class Up to 1 Incl. FINAL LU J Over 1 to 10 Incl. DATE LL./f Contractor Date VALIDATION ❑ Over 10 to 50 Incl. FINAL p� I am exempt under Sec. Over 50 to 100 Inc. BY Q B.&P.C. for this reason Over 100 0 Date: Services, Swbd., MCC & Ponelboards ► 0 - 200 Amp. Under 600 V W Signature 201 - 1000 Amp. Under 600 V H ❑ Exemption for Reg. Mainz. Elect, Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ Misc. Conduits&Conductors I, as owner of the property, will do the work and the v w structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY e 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 I Lender's Address 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 tl,�e above-mentioned property for inspection purposes. �r SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS COMPENSATION DECLARATION CE 863 1o,B1 APPLICATION FOR' ELECTRICAL PERMIT /nsure ereby affirm that I have a certificate of consent to self CE 806(1 or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY a certiiffied copy thereof (Sec 380 ab C )oicy MS 3'�� �C�mpan � ��� ty�f� FOR APPLICANT TO FILL IN JOB Ce❑ rhfied copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE e ADDRESS Cl �Q rtified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ ` LOCALITY tion department Multi-family Sq Ft — 'NEAREST CROSS ST Residential Swi ming Pools yDate S Applicant WNER UK FFIIRM NAME Q• CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw TG IL COMPENSATION INSURANCE L ADDRESSInv e (This section need not be completed if the work involved by Total No First 20 5 CITY Tel o �j n the permit is for one hundred dollars ($100)or less ) Additional I certify that in the performance of the work for which this PLAN CHECK APPLICANT permit is issued I shall not employ any person in any manner p so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS -:g3S- Total STotal No Additional Date - Applicant CITY © Tel No ` Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICANT Exemption you should become subject to the Workers Range_ Heater_D W A4 ff Al Compensation provisions of the Labor Code you must forth- Oven _ Dryer _ W M — ADDRESS S,3 with comply with such provisions or this Permit shall be Top FAU —W H •�� ,� , deemed revoked CITY Tel No Q LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— _ Room Air Cond LICENSE OR L/ Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER J (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO OCE BY and Professions Code,and my license is in full force and effect / f� Size &Type HP, KW KVA, or KVARJ157 0 ense Number?a 7�v a Lic Class y_ Up to 1 Incl 4 FINAL U ConCd tractor Q r Date �� - S-I 3 Over 1 to 10 Incl DATE�� _?���' ALIDATION Q 6 Over 10 to 50 Incl FINAL G ~ ❑ 1 am exempt under Sec Over 50 to 100 Inc BY W B&P C for this reason Over 100 y Services, Swbd , MCC& Panelboards Date ►^-�— /'� 0 -200 Amp Under 600V I C Signature 201 - 1000 Amp Under 600 V l ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole&Appurtenances I HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits Law for the following reason (Section 7031 5, Business and c 7 3 0 A Professions Code) ❑ Misc Condu 1, as owner of the property, will do the work and the # 0 0 0 o a� structure is not intended or offered for sale (Section r (See Complete Fee Schedr e 2 2 5 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY C 1 O O o 0 o 2 6 2 5 c=> 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) �� _ ) 2 05 —8 3 (Sec 3097, Civ C ) j PLAN CHECKING FEE Lender s Name 0PERMIT ISSUING FEE Lender s Address I " .-� I certify that I have read this application and state that the TOTAL FEE L r - Z above information is correct I agree to comply with all County ordinances and State jaws regulating Electrical wiring and hereby authorize representatives of this County to enter upon above mentioned ro rty Jlbr inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of VrAitteDate WORKERS COMPENSATION DECLARATICM',�Q" 76A663 10/81 y CE 806G APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that have a eertificate of consent to self insure or a certificate of Workers Compensation Insurance, 'I COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab C ) d PolicyNo Company - FOR APPLICANT TO FILL IN ti JOB r ,/ 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 I NEAREST CROSS ST Residential Swimming Pools OWNER OR Date Applicant FIRM NAME To/A V 45�5-3c CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec-40—Light Z SwAL MAIL LfV�ir�/iivr COMPENSATION INSURANCE ADDRESS 5*14 Lj / ,�,, (This section need not be completed if the work involved by First 20Total No Additional CITY � G Tel No�,�6��" the permit is for one hundred dollars ($100)or less )` � PLAN CHECK I 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 / Total No Additional p�p�l/ lel X71 f CITY Tel No ' Date -Lt) Applicant1//''IV/a Fixed Appliances Not Over 1 HP PERMIT p�� NOTICE TO APPLICANT "If, afte"r making this Certificate of APPLICANT 7W l �U��re?fZf 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 with comply with such provisions or this permit shall be Top _ — FAU —W H � deemed revoked CITY �`/!a/{fJ 1/l Tel No�0'�^L18 Hood — Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp '— Room Air Cond - REG NUMBER S 77 -1 Class (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 1 ,{ Size &Type HP KW KVA or KVAR 0 License Number /� � Lic Class - Up to 1 Incl FINAL t.7 R� ( Q)�r��� Over 1 to 10 Incl DATE CL Contractor, V J91 _ Date 6 VALIDATION 0 ❑ Over 10 to 50 Incl A V FINAL I am exempt under Sec Over 50 to 100 Inc BY ;6 d B&P C for this reason Over 100 N Services, Swbd , MCC& Panelboards Date n 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 FAMILY1 -:2Temp Power Pole &Appurtenances � 2 1 I.7 A HOME OWNER-BUILDER DECLARATION Sign with One Branch,Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o,o 0 o 0 2 Law for the following reason (Section 7031 5 Business and – #i Professions Code) C r 2i 2 2.5 0 Misc Conduits& Conductors � _ o e I as owner of the property will do the work and the structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 0 0 0 2 2 5 p �a 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY _ 0-523-83 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 'y/. ® ` PERMIT ISSUING FEE Lender s Address i I certify that I have read this application and state that the TOTAL FEE ti 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 J f COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EC-0508'9705280004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE (818) 285-0488 EXT LEGAL ID FEES PMD- BUILDING TR 17190 LT 1 BL• .0015338-CLOVERL-Y—AV�—� FEE DESCRIPTION QUANTITY UOM AMOUNT- TEMP-CA`917803105 ASSESSORWMATTWOOMBER NEAREST CROSS STREET OLIVE 8590-005-003 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE. 596 GRID A LOCALITY TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 15 00 OUT 29 25 TENANT G2 LIGHTING FIXTURES 5 00 LGT 9 75 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON TOTAL FEES 66 75 05/28/?7 TC 05/28/98 OWNER TEL 0 FINAL DATE FINAL BY CODE VESSEY THOMAS E,MARY B 5338 CLOVERLY AV TEMP 917803105 UnTR PION OF WORK ELECTRICAL FOR ENCLOSING ACCESSORY STORAGE BUILDING APPLICANT TEL NO DONALD BOLINE (818) 287-4845- SPECIAL CONDITIONS CONTRACTOR TEL NO U/� APPROVALS DATE INSPECTOR SIGNATURE DONALD BOLINE (818) 287-4845- (�//l 951 MAYNARD DR L I C NO /�^ TEMPORARY POWER POLE DUARTE, CA 91010 643751 B E� O UNDERGROUND CONDUIT ARCHITECT OR ENGINEER- 0: - I` nUFER GROUND LIC NO D `11�11� ROUGH CONDUIT AIRING f _ �U O Lll '1 � MAIN WATER INE 11 1 PLASTIC Y/N METAL Y/N COMPANY O 0 ED I foo 0 REPORT ID DPR265 ROUTE TO BS0508