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HomeMy Public PortalAbout5909-5927 CLOVERLY AVE_Electrical__ 76A663GE•806 NF 6/78 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY ' � IJ FOR APPLICANT TO FILL IN JOB New Residential Bldgs.&Pools EACH NO. FEE ADDRES G j 0 1 &2-Family,Sq. Ft. $ — $ LOCALIT Multi-family Sq. Ft. — CROSS NEARES � Residential Swimming Pools OWNER FIRM NAM Outlets: Rec Light Sw. MAIL First 20 U /v ADDRESS Total No. - t Additional CITY Tel. No. PLAN CHECK APPLICANT Lighting Fixtures First 20 0 v ADDRESS Total No.- Additional CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT Range_Heater_D.W. APPLICANT —C lLTticf Oven_Dryer_W.M. ADDRES illibf,4441-1— 5--7-7 Top _FAUW.H. _ CfT�� Tel. No. Hood—Fan 7-Other_ LICENSE O Disp.—Room Air Cond. — REG.NUMBE I / Clas Q I HEREBY_ACOWL EDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS a REGULATING ELECTRICAL WIRING. Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 Over 1 to 10 Incl. LICENSED A QUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl. CALIFO A O H IAM THE LEG WNE OF THE ABOVE o DESC EXIL PROPERTY. 0 Over 50 to 100 Inc. PERM EE Over 100 SIG NA 6 Services �© DISTRICT NO. PR ESSED Y 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V �I M Over 1000 Amp.or Over 600 V Z O Temp. Power Pole&Appurtenances Q Sign with One Branch Circuit Additional Sign Branch Circuits INSPECTION > INFORMATION U Misc.Conduits&Conductors LU ON REVERSE x LJJ 4 6 2 4 A Other(See Complete Fee Schedule) SIDE u Qf� a a o o o 2 0.J 2pP61r50 PERMIT FEE (Sub-Total) a o 2 6 1.5 0 6 Z PLAN CHECKING FEE (One-Fourth Permit Fee) O Oa30•-79 PERMIT ISSUING FEE o J TOTAL FEE S > INSPECTION FINALED W date:Q2�J V r By`. � ©s By .e. tiw��e:-�-i..c.-f! mac✓' � ��/ .. _ 76A663G6 Ii 1 /78) - _ • APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB �} q�✓ New Residential Bldgs.&Pools EACH NO. FEE ADDRESS 1 &2-Family,Sq. Ft. $ 025 — $ LOCALITY Multi-family Sq. Ft. 02 NEAREST CROSS ST. Residential Swimming Pools 25.00 OWNER OR �... s FIRM NAME Outlets:Rec Light Sw.• _ MAIL / First 20 50 ADDRESS-74U74 Total No._ "L Additional 30 CITY �i ;25' Tel. N 6_ . PLAN CHECK 6�+��'_�L9 APPLICANT �{�d Lighting Fixtures First 20 .50 ADDRESS Additional .30 Total No. CITY Tel. No. Fixed Appliances Not Over 1 HP. PERMIT APPLICANT : s � Range_Heater_D.W. r I�it�T Oven—Dryer—W.M. ADDRESS Top _FAU _ W.H._ CITY y Tel. No _ Hood—Fan _Other_ 1 LICE SE OR Disp._Room Air Cond. 2.50 REG. NUMBER - Class. I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS APPLI A- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE-'L'AWS vti' Size&Type HP, KW,KVA,or KVAR REGULATING ELECTRICAL WIRING. a Up to 7 Incl 2.50 1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl.' 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF C1 Over 10 to 50 Incl. 1250 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 25.00 DESCRIBED RESIDENTIAL PROPERTY.. Over 50 to 100 Inc. PERMIT EE _ 40.00 !q��o� Over 100 SIGNATURES eU, Com' Services DISTRICT PROCES D'BY 0-200 Amp.Under 600 V 12.50 201-I000-Amp. Under 600 V 25.00 --�16 Over 1000 Amp,or Over 600 V 50.00 Z ' O Temp. Power Pole&Appurtenances 10.00 Q Sign with One Branch Cil'cuit 10.00 Additional Sign Branch Circuits 2'00 INSPECTION > Misc. Conduits&Conductors 10.00 INFORMATION bud ON REVERSE z Other(See Complete Fee Schedule) SIDE W Z -2828,0A P. 0 0 0 0 0 2 PERMIT FEE (Sub-Total) O 0 0 0 PLAN CHECKING FEE (One-Fourth Permit Fee) C 2 9 5 PERMIT ISSUING FEE $7.00 C o 0 0 0 9 J C v a 1217-79 'TOTAL FEE > INSPECTION FINALED W date: es ' By ©s WORKER'S COMPENSATION a certificate of consent to 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affirm that I have a certificate of consent to self insure, 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.) Policy No. Company FOR APPLICANT TO FILL IN JOB /')/ -e A O ADDRESS 7 6 'C Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY + ❑ 1 &2-Family,Sq. Ft. — $ $ Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR COMPENSATION INSURANCE FIRM NAME First 20 MAIL (This section need not be completed if the work involved by the ADDRESS permit is for one hundred dollars(3100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY Tel.No. Exemption, you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisionscomply of the Labor Code, you must forthwith I with such PERMIT p I provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 >_(commencing with Section 7000) of Division 3 of the Business and Over 3 to 10 Incl. CITY Tel.No. CL Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Over 50 t0 100 Incl. REG.NUMBER Class. U Over 100 DISTRICT NO. PROCESSED BY W License Number Lic.Class _J r Services,Swbd.,MCC&Panelboards LL Contractor Date 0-399 Amp. Under 600 V FINAL DATE CC} ❑ 400-1000 Amp. Under 600 V I am exempt under Sec. VALIDATION � Over 1000 Amp.or Over 600 V FINAL B.&P.C.for this reasonBRANCH CIRCUIT FEES BY a Date: 15A,or 20A, 120V,Lighting or Recept. Signature 1 To 10 Branch Circuits LLI 11 To 40 Branch Circuits ~ ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 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 Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ 1, as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ' and Professions Code). 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 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.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy,is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE A $ $. LOCALITYp ❑ Certified co Is filed with the count building inspection 1 &2-Family,Sq.Ft. PY Y 9 department. Multi-family Sq.Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools ASSESSMAPBOOR PAGER PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.,�Light Sw. J OWNER IRM NAME COMPENSATION INSURANCE First 20 / (This section need not be completed if the work involved by the MAIL s permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Ligh[ing Fixtures First 20 APPLICANT R f Total No. Additional ADDRESS Date 1 Applicant i NOTICE TO AP LICANT: If, after mak' g this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT (Cult r provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICANT J LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS e. I I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY - Tell ID .No`�f 9j Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. } Over 50 t0 100 Incl. LICENSE O ykv REG.NUMBER C Class. 6 G D Over 100 DISTRICT NO. R SSED BY License Number 1/ Lic.Class n U Services,Swbd.,MCC&PanelboardsG' �L�G cc G 2,, 1 0-399 Amp.Under 600 V FINAL O Contractor �• 2`�� Date ` DATE / H ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V W Over 1000 Am or Over 600 V � VALIDATION P• FINAL d B.&P.C.for this reason - BRANCH CIRCUIT FEES By Date: 15A,or 20A, 120V,Lighting or Recept. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits F-141 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits S:- SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits J Code): [TIE d &C i d Conuts Conductors I,as owner of the property,will do the work and the structure Misc. `•H'- is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). 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 (Sec. 3097, PERMIT FEE (Sub-Total) d I [ _i'i;; Civ. C.) .0-AL; _ s PLAN CHECKING FEE i~ 1•-. �f3° Lender's Name `" - PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE 12 1 that the 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 ins ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE t/SI URE OF RMITTEE ATE As— r