The URL can be used to link to this page

Home My Public Portal About5628 CLOVERLY AVE_Electrical__ 76A663 DSS-SA 3.55APPLICATION ®PLICATION FOR ELECTRIC PERMIT MIT 1- DIVISION OF BUILDING ARID SAFETY Department of County Engineer County of Los Angeles BUILDING % / r WM.J. FOX. COUNTYENGINEER ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING �[' LO 77 C FOR APPLICANT TO FILL IN NEAREST PERbW FEES CROSS ST. 10 l_ NUMBER EACH FEE OWNER (L L L ` TG LIGHT OUTLETS RECEPTACLES MAIL ADDRESS WALLSWITCHES TOTAL OUTLETS 5¢ $ CITY TEL.NO. ELEC. RANGES 25 ELECTRICIAN O � r_ELEC. HEATERS 25 _ADDRESS KW EA CITY 7'r o s rtl a-a Q TEL. NO. FIXTURES 5 LICENSE NO. 7 17 NUMBER OF LIGHT CIRCUITS - DISTRICT,P,O. I GROUP 10 READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS ,� ^yy"_ MOTORS NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH _ Ih a LESS $ .25 1/Z 2 .50 2 5 1.00 5 15 1.50 15 50 2.50 50 200 5.00 MISC. NO.SIGNS NO.TRANS. NO.SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ la DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT,1 HAVE READ THIS APPLICATION CONDUIT a AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING I `S Ccs , ll1eA.+.Ct? ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE,-LEGA6,,RWNER OF THE ABOVE POWER DESCRIBED RESIDEty , GE/ SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL u' WILLIAM J. FOX, COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR C01 4 5 8 JAN 4 2 1 .2 5 �' 76A663 CE8061258 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS r�o l/Li JOHN A LAMBIE,COUNTY ENGINEER CASSATT D GRIFFIN,SUPT GF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS T PElWT FEES -- OWNER L. I —^ O/ 1 T E M NUMBER EACH FEE OUTLETS g g 1 6 MAIL LIGHTS RECEIPT SW 1Q oj.Q ADDRESS ,r LIGHTING FIXTURES / 10 �� CITY TEL NO ELEC RANGES CLO DRYERS ELECTRICIAN W A T E R HEATERS 50 ADDRESSJ _c9 ELEC SPACE HTRS DISHWASHERS CITY G TEL NO GARBAGE DISPOSERS AUTO STATE //t1 WASHERS STA COOKING UNITS 25 LICENSE NO V MOTORS OVER INC H P DISTRI T NO G OU N P ESSED BY O— 1/2 25 1/2— 2 3 50 INSPECTION RECORD 2— 5 100 5— 15 150 15— 50 250 50-200 500 �. DT SIGNS NO TRANS NO LAMPS E S' -7 10/Ai'ct--j4f FiP) SERVICE O 600V 100 SERVICE OVER 600V 500 MISC WIRING PERMIT 1 00 FIXTURE PERMIT 1 00 SUPPLEMENTARY PERMIT 50 b7"Od2 Cr IJAIL17SC TOTAL FEE g y(l ffp jFj/*SAPPROVALS 0&,VL 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY /Jn WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING /! ✓WIRING Of v— I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR CEBY LICENSED AS REQUIRED OS NGE S COUNTY AND STATE OF f-IXTURES CALIFORNIA OR THAT 1 T L ER OF THE ABOVE DESCRIBED RESIDENTIA OP POWER SIGNATURE UTILITY CO NOTIFIED OF PERM ITTE FINAL YY JY71 t 6F.(l6sa�T ®� ALMATION S ARTHURERVISING ELEICTRICAL ENGINEER CK MO CASH LsIL10 5 4 7 2 API( 21 2 A 2 .8 0 M 76A669 A-PPLICATION FOR ELECTRIC ■ ERMI ■ DBS-5A 12-54 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles B U I LD I N G ' WM. J. FOX, COUNTY ENGINEER ADDRESSen CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN Locnury PERMIT FEES NEAREST CROSS ST. NUMBER EACH FEE OWNER •� I LIGHT OUTLETS RECEPTACLES MAIL ADDRESS WALL SWITCHES TOTAL'OUTLETS 516 $ CITY TEL. NO. ELEC. RANGES y 25 ELECTRICIAN ELEC. HEAT/E'^R�S �!i 25 L'C�. ADDRESS KW EA c � CITY TEL. NO. FIXTURES / /Q 5 LICENSE NO. NUMBER OF LIGHT CIRCUITS DISTRICT NO. GROUP Z� READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS _ 1 MOTORS ✓ P C L'C h NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH 112&LESS $ .25 1/2 2 .50 - 2 5 1.00 5 15 1.50 15 50 2.50 50 200 5.00 MISC. NO. SIGNS NO. TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: - WIRING $1.00 FIXTURES $1.00 _ SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ ® DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ'THIS APPLICATION CONDUIT p AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. 1HEREBY 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 DESCRIBED RESIDEN PRO. TY. SIGNATURE �• f UTILITY CO. NOTIFIED OF PERM ITTE FINAL WILLIAM J. FOX, COUNTY ENGINE VALIDATION 7.2 0 m 6 2 APR 1.5 2 DEY W,OR4FRS' (LOMPENSATION DECLARATION 76A663 10/81 hereby affirm that I Navel rtific6te of consent to self CE-806G APPLICATION FOR ELECTRICAL PERMIT insure, ora certificate of worker's' CiSmpensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY oroilertiLfi�ed co y e�r]eof (Sec. 3800, Lab. C.) � �� ` �j j�'j3Li_�YJ FOR APPLICANT TO FILL IN JOB Policy No'. Company _ �{ EACH NO. FEE ADDRESS Certified copy is hereby furnished. New Residential Bldgs. & Pools �lv 1 & 2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the count building inspec- Y. q Ll�pplicantM Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR DateFIRMNAMEMPTIRKERS' Outlets: Rec_TLightw.�? MAIL v COMPENSATION INSURANCE Q� First 20 ADDRESS (This section need not be completed if the work involved by Total No. v Additional CITY Tel. No. S� 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 Fixture 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 / /� �U t(//'l�J/''�l J 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. — /y _1 deemed revoked. Hood Fan _Other_ CITY L/I PC Tel. No.P LICENSED CONTRACTORS DECLARATION LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER Class]j— (commencing with Section 7000) of Division 3 of the Business DISTRICT N PED BY and Professions Code,and m license is in full force and effect. Power Apparatus& Large Appliances ; Size &Type HP, KW, KVA, or KVAR' O License Number.. 0. � � Lic. Class Up to 1 Incl. FINAL U lSDate Over 1 to 10 Incl. DATE(/ �� VALIDATION 0 Contractor Over 10 to 50 Inc[. I.– FINAt U ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LU Over 100 B.&P.C. for this reason Date: Services, Swbd., MCC& Panelboprds 0 - 200 Amp. Under 600 V/ Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. 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): ❑ I, as owner of the property, will do the work and the Misc. Conduits & Conductors ;97310 A structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). #;o o a ® 0 2 CONSTRUCTION LENDING AGENCY ;I - 32_75 I hereby affirm that there is a construction lending agency for s the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ° °`° 3 2.7 5 c: (Sec. 3097, Civ. C.). PLAN CHECKING FEE 06.26-87 Lender's Name PERMIT ISSUING FEE D. 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 presentatives of this County to enter upon the above- e ' ned roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S' nature of ermittee Date