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Home My Public Portal About5622 CLOVERLY AVE_Electrical__ DBS 5 9A 12 84 B DAPPLICATION FOR ELECTRIC PERMIT ], A DMSION OF BUILDING AND SAFETY Department of County Engineer _ County of Los Angeles BUILDING'�2_ WM J FOX COUNTY ENGINEER ADDRESS ' CASSATT D GRIFFIN SUP T OF BUILDING FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAREST CROSS ST FEE NUMBER EACH LIGHT OUTLETS OWNER RECEPTACLES MAIL ADDRESS WALL SWITCHES TOTAL OUTLETS 50 S Q_ r CITY TEL NO ELEC RANGES 25 ELECTRICIAN ELEC HEATERS 25 ADDRESS KW EA CITY NO FIXTURES 5 LICENSE NO NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP ZONE I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS MOTORS T NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD HP OVER INC EACH _ 1/2&LESS S 25 I12 2 50 -2 5 1 00 5 15 1 50 15 50 2 50 50 200 500 MISC 19 NO SI S TRANS NO NS NO LAMPS FOR EACH PERMIT WIRING S1 00 FIXTURES SI 00 SUPPLEMENTARY 50 _ f� APPROVALS TOTAL FEE S /` DATE INSPECTOR S SIGNATURE I 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 I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER �1 DESCRIBED RESIDENTIA tDPERTY UTILITY CO NOTIFIED 1 4 SIGNATURE OF PERMITTEE FINAL WILLIAM J FOX,COUNTY ENGINEER VALIDATION u-� 2 1 .1 X01 6 3 019 @BAR 16 _ E3Y - � ��DEPUTY DSAPPLICATION FOR ELECTRIC PERMIT D09S 5SAA 12 94 1 iDIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING WM J FOX COUNTY ENGINEER ADDRESS o CASSATT D GRIFFIN SUP T OF BUILDING 9� FOR APPLICANT TO FILL IN LOCALITY PERMIT FEES NEAR EST CROSS ST FEE NUMBER EACH LIGHT OUTLETS // OWNER �i� RECEPTACLES MAILADDRESS WALL SWITCHES TOTAL OUTLETS 5¢ S A#,- CITY TEL NO ELEC RANGES 25 ELECTRICIAN ELEC HEATERS 25 ADDRESS KW EA � �}y CITY 4/1- NO FIXTURES //J�55 l� LICENSE NO NUMBER OF LIGHT CIRCUITS DISTRICT NO �GROUPJ ZONE I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS -y-- MOTORS - --r =CAV NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD HP OVER INC EACH _ I/2&LESS $ 25 1/Z 2 ----P-O- 2 O2 5 1 00 5 15 1 50 15 50 250 50 200 �-5 00 MISC NO SIGNS NO TRANS NO,SIGNS NO LAMPS FOR EACH PERMIT WIRING $100 FI`CTURES $1 00 SUPPLEMENTARY 50 ` APPROVALS TOTAL FEE $ G D DATE INSPECTOR S SIGNATURE �I HEREBY ACKNOWLEDGE THAT 1HAVE 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSFD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 M THE GGWWL OWNER OF THE ABOVE POWER DESCRIBED RESI DEN RTY / p/ UTILITY CO NOTIFIED SIGNATURE OF PERMITTE , ! FINAL WILLIAM J FO)(. COUNTY ENGINEER VALID T O9 9 S MAY- 2 6.6 0 ® !/// DEPUTY CNm that I 'have a certificate* DECLARATION 76-663 10/$1 APPLICATION,FOR ELECTRICAL PERMIT I herebyCE-806G � . •affirm that I have a certificate•of consent to self insure, or a certificate of Workers' Compensation Insurance, or-a certiflRd COUNTY OF LOS ANGELES BUILDING AND SAFETY COPY there Sep.3800,Lab�. C.) Policy NO "' lAmpan FOR APPLICANT TO FILL IN - JOB - �! ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO, FEE ADDRESS b 1 & 2=Family,Sq.Ft $ _ $ LOCALITY yCf� Certified copy is filed with the county bu' g inspectio dee tment. Multi-family Sq.Ft. NEAREST CROSS ST. Date ApplicaYFROM Residential Swimming Pools OWNER OR FIRM NAM CERTIFICATE OF EXEMPTORKE MAIL COMPENSATION INSURANCE Outlets:Rec— Light Sw. — ADDRES Tel.No (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars ($100)or less.) Additional Total No. CITY 6 PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT 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 APPLICAN Exemption,you should become subject to the Workers'Compensation Range— Heater— D.W. — provisions of the Labor Code, you must forthwith comply with such Oven — Dryer — W.M.— ADDRE S 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 9Disp. — Room Air Cond. LICENSE O 'y.1�� — (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Clas Professions Code,and my license is in'full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY „ ''''77 Size&Type HP,KW,KVA,or KVAR License Num r oC� �� Lic.Class Up to'1 Incl. FINAL U Over 1 to 10 Incl. DATE p_ Contractor % Date _F �• VALIDATION 0 Over 10 to 50 Incl. U FINAL /� ❑ I a empt under Se Over 50 to 100 Inc. BY JLl C W Over 100 CL B.&P.C. for this reason ,� K Services,Swbd.,MCC& Panelboards e Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V El Exemption 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances 2 --.-- HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACUpJ+�h - I hereby affirm that I am exempt from the Contractor's License Law °v for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits +��y Code): 3307 d•J° ❑ MiscOther.Conduits& Conductors See Complete Fee Schedule &-E'11G1? -- -- I,as owner of the property,will do the work and the structure Y is not intended or offered for sale (Section 7044, Business ( p ) TOTAL 25.-50 --------and-Professions Code):----- _ _" _ _—� - GMK 25°5CI CONSTRUCTION LENDING AGENCY A nn 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 0000-0001 7/27$/°9 Lender's Name PERMIT ISSUING FEE 4735 1 M12*000 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 C>�2j t� representatives of County to enter upon the above-mentioned pro e y fSx'l?l- on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE, g ire of Permit te Date