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Home My Public Portal About5616 CLOVERLY AVE_Electrical__ 76A6631'CL806 11/70 APPLICATION FOR, ELECTRICAL PERMIT - " COUNTY,OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEERBUILDING BUILDING AND SAFETY DIVISIONJ� l ADDRESS COLEMAN W JENKINS SUPERINTENDENT OF BUILDILOCALITY NEAREST ,+ FOR APPLICANT TO FILL INCROSS ST OUTLETS NO EACH I FEE` _ OWNER RECEPT - _ MAIL /' ADDRESS / LIGHT / TOTAL FIRST 20 - 26 a CITY TEL NOf'� SWITCH OVER 20 10 _ PLAWCHECK - LIGHTING TOTAL FIRST 20 / 25 �+ - /s,�' APPLICANT < - ✓�--��J+ FIXTURES OVER 20 10 -ADDRESS APPLIANCES CITY TEL NO T PERMIT RANGE DRYER_WTR HTR _ APPLICANT. STA COOK DISP F A Uj � a r ADDRESS SPACE HTR AIR-CONO j,,CITY TEL NO CLOTHES WASH DISHWASH }� LICENSE NO (ji � CLASS V a FAN OTHER I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION . AND STATE THAT THE ABOVE JS CORRECT,AND AGREE TO COMPLY MOTORS TRANSFORMERS RATING ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING b' IND HEATERS ETC HP KW`K,V A' _ ELECTRICAL WIRING SIZE & TYPE OVER TO - I HEREBY CE R3 IFY THAT, I AM'PROPERLY REGISTERED AND/OR 0 —+1 100 +LICENSED AS REQUIRED' 13Y LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 4AM,THE LEGAL OWNER OF AND INTEND TO �- /� RESIDE IN THE A�DESIFEDDENTIALPROPERTY1 — 10 =300 - O 10 - 50 SIGNATURE _ � V z 500 OF PERMITTEE 50 - 100 1000 DISTRIC``T��N CLASS , ZO PR ESS ED Y U s,V' /_ Ud 100 — 500 1500 CL SIGN GAS - , - Z SIGN AND ONE CIRCUIT 500 NOTES _ TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 .x^ SERVI CE NOT OVER 600 VOLTS OR 200 AMP 300 3 , APPROVALS DATE INSPECTOR'S SIGNATURE S ERVI CE OV ER 600 VOLTS OR 200 AM P _1000 11 , TEMP POWER POLE - TEMP SERVICE,POLE &APPURTENANCES 500 _ UNDERSLAB WORK TEMP LIGHT OR RECEPT SYSTEM e 300 ` ROUGH CONDIUT _ WIRING FIXTURES r - ' PERMIT FEE POWER AUTHORLZED ISUB TOTAL) ' UTILITY CO NOTIFIED PLAN CHECK FEE t w _ _ � FINAL PERMIT ISSUING FEE 300 „ C) ` .r JOSEPH C ROOHAN TOTAL FEE - C) ev f- �� SUPERVISING ELECTRICAL,ENGINEEP _ PLAN CHECK VALIDATION CK, M O r CASH ;PERMIT VALIDATION011 M o CAS �i 2 3;4-n-, 5 i' 13 'z' o - 1 '0.7 5-f - SEE BACK OF APPLICATION FOR COMPLETE SCHEDUL-E 8 DBSS 5SA f2,S4 Y AP1 LICA ION FOR ELECTRIC PERMIT DA DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County Of Lob Angeles ,BUILDING WM J FOX COUNTY ENGINEER ADDRESS t% CASSATT D GRIFFIN SUP T OF BUILDING FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST CROSS ST NUMBER EACH FEE ' I LIGHT OUTLETS + OWNER RECEPTACLES MAILADDRESS WALL SWITCHES TOTAL OUTLETS 5! S CITY TEL NO ELEC RANGES 25 D ELECTRICIAN J ELEC HEATERS Zi 25 ADDRESS - KW EA 01, CITY tollL NO FIXTURES 5 O LICENSE NO NUMBER OF LIGHT CIRCUITS DISTRICT NO `{II GROUP ZEN READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS I MOTORS �' G NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD HP OVER INC EACH 4'u / o /r - I�&LESS $ 25 ��/1-d 2 50 SS // _ 2 5 1 00tn M�eI _ 5 15 1 50 _ 15 50 2 50 50 200 500 MISC r ' `r ! �.] v NO SIGNS - NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING $1 00 ELM ' FIXTURES $1 00 SUPPLEMENTARY 50 APPROVALS TOTAL FEE S DATE INSPECTOR S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA ORTHAT I THE ECAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIA R UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE / FINAL WILLIAM J FOX. COUNTY ENGI EER VALIDATION B.'3 5 m . G q,�NfAY 19 2 _ 0 /o / DEPUTY WORKER S COMPENSATION DECLARATION 20 DPW 9/89 76A663 APPLICATION FOR ELECTRICAL PERMIT hsnss3 I hereby affirm that I have a certificate of consent to self Insure _ I ve 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) i Policy NO Company FOR APPLICANT TO FILL IN _ JOB ADDRESS El Certified ° atyCertified copy Is hereby furnisEACH NO FEE hed New Residential Bldgs &Pools I —.�"A OuC C ❑ _ - LOCALITY�Iii `copy Is filed with the county building Inspection i $ $t 1 &2 Family Sq Ft NEAREST department Multifamily Sq Ft CROSS ST Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK PAGE PARCEL I OR CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec —Light Sw FFIIRM NAME COMPENSATION INSURANCE , First 20DRESS , IL (This section need,not be completed If the work Involved by,the Total No Additional � �! AD � permit is for one hundred dollars($100)or less) I certify that In the performance of the work for which this permit CITY"�,l Tel No '7-"'3 I+ Is Issued I shall not employ any person In any manner so as to PLAN CHECK become subject to the Workers CompenSallQn I awr Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date C1pphcan 15 OR 20A 120V BRANCH CIRCUITS - - ' NOTICE TO APPLICANT If after me Ing this Cer I Icate of CITY Tel No Exemption you should become subject to the Workers Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code you must forthwith comply,with such 11 TO 40 INCLUSIVE EACH PERMIT �� APPLICANT EL EZJ1104 provisions or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH M } LICENSED CONTRACTORS DECLARATION 'a ADDRESS 1'✓ jZ I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A 208V TO 277V LIGHTING EACH Tel No (commencing with Section 7000) of Division 3 of the Business and _ CI �1�1{�� `J � Professions Code and my license Is In full force and effect RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR 3��Z-7� Class G,O L � MM Power Apparatus&Large Appliances _ _ REG NUMBER 0 36327 G V Size&Type HP KW KVA or KVAR DISTRICT NO PROCE SED BY i— License Number Llc Class L V Q Up to 3 Incl 0 a �' � a4 CL C r 1 Date ' 1 _ Over 3 to 10 Incl FINAL DATE - U) ❑ - - Over 10 to 50 Incl �Q Z I am exempt under Sec Over 50 to 100 Incl VALIDATION - - FINAL B&P C for this reason Over 100 i By ` Services,Swbd MCC&Panel 'AjrvT 8 Date 0 200 Amp Under 600 ri1 °s Signature 201 1000 Amp Under 600 V 3307 59.5E ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect 1 ITEMS SINGLE FAMILY Temp Power Pole&Appurtenances _ TOTAL 59 - 55 HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit ~ I hereby affirm that I am exempt from the Contractors License Law CHECK r 9. for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits CHANGE �u-� f5 Code) L HANGE I as owner of the property well do the work and the structure Mlsc Conduits&Conductors - Is not Intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) 0000-cool t t and Professions Code) ® i �+I�r�i1�n/��r CONSTRUCTION LENDING AGENCY _ 5075 1 AM 10:52 1 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 I ` PERMIT ISSUING FEE �Gf 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 represen es of th s untl ter u on the above mentioned property for pectin ce SEE REVERSE FOR EXPLANATORY LANGUAGE � /� Z SIGNATURE OF A DATE