The URL can be used to link to this page

Home My Public Portal About5751 CLOVERLY AVE_Electrical__ 76A663A-CE806A 4/72 APPLICATION F R ELECTRICAL PERMIT LJ COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEERBUILDING f BUILDING AND SAFETY DIVISION ADDRESS J 7,S p(/{ LOCALITY �^ NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS NO EACH FEE �+ OWNER RECEPT $ Is MAIL LIGHT TOTAL FIRST 20 ADDRESS CITY _c_ TEL NO SWITCH OVER 20 'y'' PLAN CHECK LIGHTING TOTAL FIRST 20 APPLICANT FIXTURES OVER 20 ADDRESS RESIDENT AL APPLIANCES CITY TEL NO PERM T RANGE DRYER_WTR HTR APPLIICANT STA COOK DI SP F A U ADDRESS SPACE HTRAIR COND CITY _ _ TEL NO CLOTHES WASH DISHWASH LICENSE NO W f_7 8' CLASS C^ G FAN OTHER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY C:) MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND HEATERS ETC HP KW KVA ELECTRICAL WIRING SIZE & TYPE OVER TO HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF V CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO Q_ RESIDE IN THE ABOVE DESCRIFED RESIDENTIAL PROPERTY d' 1 - 10 y SIGNATURE 10 - 50 OF PERMITTEE 50 - 100 DISTRICT NO CLASS ZONE OCES BY 100 - 500 `j - d 6 SIGN GAS SIGN AND ONE CIRCUIT NOTES TUBE OR MARQUEE ADDITIONAL CIRCUITS SERVI CENOTOVER 600 VOLTS OR 200 AMP APPROVALS DATE INSPECTOR'S SIGNATURE SERVICEOVER 600 VOLTS OR 200 AMP TEMP POWER POLE TEMP SERVICE,POLE, &APPURTENANCES UNDERSLAB WORK TEMP LIGHT OR RECEPT SYSTEM ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO NOTIFIED � PLAN CHECK FEE r� FINAL PERMIT ISSUING FEE TOTAL FEE 9 910 i PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION cK M o CASH 1 2"9 ro-SEP 10 2 u 9.8 0 Asa WORKERS COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have G4aertificate of consent to self CE BO6G2, 'ensure or,a cerhficcite,of Wotkers Compensation Insurance COUNTY OF LOS ANGELES _ BUILDING AND SAFETY or a 6erhfied copy thereof (Sac 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN 1 JOB !"/ �/ Certified co lis hereby furnished EACH NO FEE, ADDRESS J pY Y New Residential Bldgs &,Pools ❑ 1 & 2-Family S Ft $ _ $ LOCALITY Certified copy is filed with the county building inspec Y 9 tion department Multi-family Sq NEAREST Ft CROSS ST U 1 Residential-Swimming Pools OWNER OR Date -Applicant _ - ` FIRM NAME.. CERTIFICATE OF EXEMPTION FROM WORKERS'' � MAIL Outlets Rec Light SwlADDRESS Z 0`L(~ COMPENSATION INSURANCE ' D v A This section`eeed not be completed if the work involved b First do ( p Y Total No Additional CITY Tel herpermit is for one hundred dollars ($100)or less ) I certify that in the performance of'the work for,which this PLAPUCANTK permit is issued, I shall not employ any person in any manner so as to become subject to the Workers CompensotionP'Laws Lighting Fixtures First 20 ADDRESS -7 Total No Additional CITY Tel No Date pplicant Fixed Appliances Not Over 1 HP PERMIT 'NOTICE TO APPLICANT If, after this Certificate of APPLICANT f!� 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 —WH J deemed revoked - a I Hood Fan _Other_ CITY (,t.F Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 IDisp — Room Air Cond REG NUMBER v Class (commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCESS D BY Power Apparatus`& Large Appliances and Professions Code and my license is in full force and effect d qy `� �L Size &Type HP, KW KVA or KVAR ! �t License Number Lic Class Up to 1 Incl FINAL Over 1 to 10 Incl DATE Contractor I�bl�� (b Date - G _-VALID !ON Over 10 to 50 Incl FIN ❑ ~ I am exempt under Sec Over 50 to 100 Inc BY B&P C for this reason Over 100 Services Swbd MCC & Ponelboards v Date 0 - 200 Amp Under 600 V a # 7 4 1 Signature 201 - 1000 Amp Under 600 V o 0 o 0 o GGj FOver 1000 Amp or Over 600,-V, Exemption for Reg Mamt Eject \ �J° - 3225 SINGLE FAMILY Temp Power Pole & Appurtenances o o • 2 _ HOME OWNER-BUILDER DECLARATION 7,O U 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 Professions Code) ❑ I as owner of the property will do the work nd the Misc Conduits &Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044 Business and Professions Code) L r 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 Lender s Address I 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 herebL au home representatives of this County to enter upon /- Cbjengneclw - property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Si atu ermittee - Date