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Home My Public Portal About6032 CLOVERLY AVE_Electrical__ 7GA663 D88 SA 11-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC �� COUNTY OF LOS ANGELES WILLIAM J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT GROUP I ZONE PERMIT NO. ELECTRICIAN 1�r RE IVED BY READY FOR DATE ISSUED ADDRESS L1— 3 FIRST INSPECTION CITY TEL NO 6162 T IVV COUNTY LICENSE N D'410— EXPIRES ABUILDING DDRESS O CJ 1 PERMIT FEES FEE NUMBER OUTLETS EACH LOCALITY LIGHT Sc $ NEAREST 1 CROSS ST RECEPTACLES 5 /J/► C FIXTURES 5 OWNER 641,"l 1 y, \ L WALL SWITCHES 5 MAIL ELEC RANGES 25 ADDRESS ELEC HEATERS 25 CITY TEL NO MISC I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS NUMBER OF CIRCUITS INSTALLED TOTAI APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING NumsER HORSEPOWER FEE I CERTIFY THAT I POSSESS THE ABOVE VALID Lob NEW MVD HP OVER INC EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIA PROPERTY DESCRIBED ABOVE �p S LEBB $ 25 / V2 2 so SIGNATURE OF 1�� 2 s 1 00 PERMITTEE 5 15 1 so INSPECTION RECORD 15 s0 250 so 200 Sao zoo 500 1000 s00 1 oo0 is DO J OVER 1000 2000 Z M G BET/FREQ CHANGER-HP (7 WELDERS AC-KVA Q' GENERATORS - KW 0 TRANSFORMERS - KVA TEMP MOTORS (75% OF ORIG) MOVED MOTORS (75% OF ORIG) MISC SIGNS TYPE NO TRANS TYPE NO LAMPS APPROVALS FOR EACH PERMIT DATE INSPECTOR'S NAME WIRING $1.00 , U (� CONDUIT FIXTURES $100 WIRING SUPPLEMENTARY 50 FIXTURES POWER TOTAL FEE $ UTILITY CO NOTIFIED FINAL 1 WORKERS COMPENSATION DECLARATION 76A663 CE-806 ,D/e, APPLICATION FOR ELECTRICAL PERMIT {� "`I hereby affirm that I have a certificate of consent to self insurCE-806G e �J or a ceRificate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY _ copy thereof(Sec 3800 Lab C) Policy NO Company FOR APPLICANT TO FILL IN` J JOB ❑ Certified copy is hereby,furnished EACH NO FEE, ADDRESS :Z C Y New Residential Bldgs & Pools 1 & 2-Family SFt $ — $ LOCALITY Certified Copy is filed with the county bud - amiyq ding inspection _ NEAREST, °❑ department r Multi-family Sq Ft y CROSS ST � Residential Swimming Pools OWNER OR Date Applicant FIRM NAME =' CERTIFICATE OF EXEMPTION FROM WORKERS c Outlets Rec Light,— Sw MAIL � - COMPENSATION INSURANCE , ADDRESS '(This'section need not be completed if the work Involved by the ' First 20 CITY Tel No' permit is for one hundred dollars($100)or less) Total No Additional� ' LI cern that in the performance of the work for which this permit - PLAN CHECK fy' p P 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 1 Date f e le �Applicant R r' Total No CITY el No ti ,Fixed Appliances Not Overtl HP PERMIT m ' NOTICE, TO APPLICANT If after ak g this o Exemption you should become,subject to the Workers Compensation Range_ Heater_ DW W _ APPLICANT _ provisions of the Labor Code `you must forthwith comply with such Oven Dryer _ W M _ ADDRESSAr provisions or this permit shall,be deemed revoked I Top FAU _ WH _ CITY i Tel No ' LICENSED CONTRACTORS DECLARATION Hood Fan _ Other_ I herebyraffirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond - N8E OR REGClass (commencing with Section 7000) of Division 3 of the Business and REG NUMBER Professions Code and my`license is in full force and effect ,, Power Apparatus& Large Appliances DISTRICT NO PROCE BY Size& Type HP KW KVA or KVARf v CLO License Number Lic Class Up to 1 Incl FINAL U - Over;1 to 10 Incl DATE , ��y7 W Contractor Date FINAL vvv VALI TION 01 Over 10 to 50 Incl ❑_ I an exempt under Sec Over 5 �8935A 0 to 100 Inc BY U &P C for this reason Over 100 d J B Y Services Swbd 'MCC& Panelboards { # 0 ,0 0 0 0 2 Z ` Date 0-200 Amp Under 600 V / rs Signature 201 - 1000 Amp'Under,600 V Over 1000 Amp or Over 600-V ❑ Exemption for Reg Mamt Elect a - ` ' !'o o 4o SINGLE FAMILY Temp Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATIONSign with One Branch Circuit 0209-88 1 hereby affirm that I am exempt from the Contractors License Law Additional'Sign Branch Circuits for the following reason (Section 7031 5 Business and Professions a ' Code),` I'as owner of the property will do the work and the structure Misc+Conduits& Conductors r 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 4 ,performance of the work for which this permit is issued(Sec 3097 PERMIT'FEE (Sub-Total) ` Civ C) PLAN CHECKING FEE ` Lenders Name "`- _ n f /f > PERMIT ISSUING FEE Lender's Address l d 3 w^ �� NO I certify that I have read this application and Ate that ttZ above TOTAL FEE "' a' ,V _ 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 1 1 � ,L/-fir') ignatur of,Permdtee Data WORKERS'COMPENSATION DECLARATION -663 10/81 APPLICATION'FOR ELECTRICAL PERMIT ' I hereby aff�r;that I lave' CE a certificate of,consent to self Insure CE-806G ? or a certificate of Workers Compensation Insurance, or a certified COUNTY OF LOS ANGELES - BUILDING AND SAFETY~ `^ copy thereof(Sec'3800 Lab C) r + ` " FOR APPLICANT TO FILL IN J " ' Policy No - Company' OB, t ❑ Certified copy,Is hereby furnished New Residential Bldgs &Pools q EACH' NO FEE }ADDRESS $ LOCALITY ,T, Certified copy, is filed, with the'county budding Inspection 1 & 2-Famdy'Sq Ft $ _ department Multi-family Sq Ft NEAREST _ CROSS ST f -r Residential Swimming Poolsl� , t OWNER OR FIR Date Applicant t, j\ M NAME 1 CERTIFICATE OF EXEMPTION FROM WORKERS, ^ a t"-). �^ a '` MAIL, COMPENSATION INSURANCE Outlets Rec Light t 2 + ADDRESS This section need not be completed if the work Involved b the First 20 c1Q ( p y Total No Additional CITY } , Tel No permit is for one hundred dollars($100),or less) , PLAN CHECK (,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 'E _ become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS ` al oZ Total No Additionx CITY ' I o Date O Applicant Flxed,Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after ak this Certificate o � o'm" _ Ran e'er Heater ' DW APPLICANT Exemption you should become subject to the'Workers Compensatron 9 - provisions of the Labor Code you must forthwith comply with'such Oven Dryer _ W M _ ADDRESS provisions or this permit shall be deemed revoked Top FAU',_ W H � , t LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY Tel No I hereby affirm.,that,l am licensed under pro'visions,of,Chapter 9 __Disp — Room Alr Cond LICENSE OR Class (commencing with Section 7000) of Division 3,of the Business and REG NUMBER Professions Code and my license Is in full force and effectDISTRICT NO PROCESSED e Power Apparatus& Large Appliances a Size& Type HP,KW KVA or KVAR 9 A I License Number Lic ClassUp FINAL to 1 Incl # � 1 0 0 0 Over 1 to 10 Incl DATE ��9� VAL ON , 0 Contractor Date Over 10 to 50 II ncl !/ ❑ FINAL I am exempt under Sec ' Over 50 to 100 IncBY o 0 2 9 5 2 W B&P C for this reason Over 100 C. o 0 0 2 C�'255 Services Swbd MCC& Panelboards s Z Date 01- 200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V 04.2 8--88 ' , r - - -'- { `Over'1000 Amp or Over 600 V - Exemption for'Reg Maint Elect SINGLE FAMILY ' Temp Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r ,I hereby affirm that I am exempt from the Contractors License Law Additional Sign Branch Circuits, r F a for the following reason (Section 7031 5 Business°and Professions Code) Misc Conduits & Conductors LJ I as owner of the property will do the work and the structure is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) ,and Professions Code) r CONSTRUCTION LENDING AGENCY ` r - - r. - 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 FEEF-Nk — y(Sub-Total) u 4 Cm C) PLAN CHECKING FEE Lenders Name ' PERMIT ISSUING FEE f „ Lenders Address ' I certify that I have read this application and state that the above TOTAL FEE �� T 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 v y�P� Sr6patdre of P rmittee Date