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HomeMy Public PortalAbout6038 CLOVERLY AVE_Electrical__ DSS SA 25M SIMS 1-48 E� BUR �p�� .�}� SATE .p PLICATEM FOR PEtfl��yf� DEPARTMEW OF IIDQ.li1L�HY�.LEV AM SATE g 19C L�l� it Hi Ply SVY rL+�1�848 COUNTY OF LOS ANGUXS ELECTRIC FOX. CHIEF ' - DWiR NO. GROUPS I ZONE �ERmrr NO. ADDRWSS Ci TEL VED BY READY FOR DATE ISSURD 1 FIRST INSPECTION ( 2 A"LICAW FlLL ffN EWAVMY OBD POKMN ONLY DON OE WOR JOB RKSS (o C D V L NUMEIER OF OUTLwm ON Cumum FOCALITY T LOCATION IDY ROOKS NHARSE3T JLMXHT OUTLJCTS lsw PLUw lmxT C am CIRCUIT A-18 C D E F 6 i H I C NAME Z MAIL ADDRESS O CITY TEL NO 1 AM THS LOSAL. POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CEii<iT1FICATE OF QUALIFICATION. EL 7--IAN T AM THIS LL'GAL OWNER OF THE PROPERTY DESCRIBED AJ3OVE r, OWNER CORREMOINS Q Z t� 0 TqT L NO OF OUTLETS s n APPROVALS PIO OF FIXTURES U DATE INSPECTOR'S NAME NO OF MOTORS HIM $ CONDUIT NO OF SIGNS TRANS $ WIRING NO OF RANGE:9 OR HFATERS n $ FIXTURES MISC L U $ POWER PERMIT FEE $ UTILlTYCJ NOTIFIED ' TOTAL LE INA —WORKER S'COMPENSATIONDECLARATION 'CE 806G (280)1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or, / a certified copy thereof(Sec 3800, Lab C) FOR APPLICANT TO FILL IN ,JOB Policy No Company EACH NO FEE ADDRESS Q New Residential Bldgs &Pools Certified copy is hereby furnished 1 &2 Family,Sq Ft $ — Is LOCALITY I 4 1 AREST Certified copy is filed with the county building inspection Multi family Sq Ft CROSS ST Q�`\�AL Residential Swimming Pools department � � � � OWNER OR //!!' FIRM NAME LVV kS- Datz Applicant - Outlets Rec�L,ght_61 Sw 6d ADDRESS w�A . First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITYC, I I Tel No COMPENSATION INSURANCE 17-77 PLAN CHECK a � I + APPLICANT (This section need not be completed if the work involved LiFixtures First 20 O Lighting res by, the permit is for one hundred dollars ($100) or less) ADDRESS U Total No Additional X I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No permit is issued, I shall not employ any person in any manner PERMIT U so as to become subject to the Workers' Compensation Laws Range_ Heater_D W I APPLICANT ' LU Oven _ Dryer_W M ADDRESS tU) o Date y Applicant �.(//_!/� Top FAU _WH _ CITY Tel No Z Hood Fan —Other_ Q NOTICE TO APPLICANT If, after making this Certificate of Disp Room Air Cond_ LICENSE OR Exemption, you 'should become subject to ,the Workers' REG NUMBER Class Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO PROC SED BY with comply with such provisions or this permit 'shall be Size&Type HP KW,KVA or KVAR deemed revoked b Up to 1 Incl FINAL Over 1 to 10 Incl DATE LICENSED CONTRACTORS DECLARATION i Over 10 to 50 Incl .2, VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL, 9 (commencing with Section 7000)of Division 3 of the BusiOver 100 BY ness and Professions Code, and my license is in full force and effect Services License Number- Lic Class 0 200 Amp Under'600 V T— 201 1000 Amp Under 600 V Contractor Date `Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances I - I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit Additional Sign Branch Circuits 1 License Law for the following reason (Section 7031 5, Busi ness and Professions Code) I I - Misc,Conduits&Conductors _f4_1_Jas owner of the property, will do the work and the Other (See Complete Fee Schedule)— 2 4 Q3 A structure is not intended or offered for sale (Section 7044, Business and Professions Code) # 0 0 010 o2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency > 2 0�0 21 1 0 for the performance of the work for which this permit is PERMIT FEE (Sub Total) issued (Sec 3097,Civ C) o 0 m 2 1. 1 Q Lender's Name PLAN CHECKING FEE (One Fourth Permit Fee) r 12 8 ` I 1 - Lender's Address PERMIT ISSUING FEE �V " I certify that I have read this application and state that the TOTAL FEE V 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 j SEE REVERSE FOR EXPLANATORY LANGUAGE A Al Signatuurre`o-f Permittee Date WORKERS'COMPENSATION DECLARATION 76A663 CE 806G (2 80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES r BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or A a certified copy thereof(Sec 3800,Lab C) FOR APPLICANT TO FILL IN ,JOB / �h Policy No Company ADDRESS aO _ New Residential Bldgs'&Pools EACH NO FEE i �•.!! Certified copy is hereby furnished 1 &2 Family,Sq Ft $ — $ LOCALITY NEAREST 4, Certified copy is Bled with the county building inspection Multi family Sq Ft CROSS ST department Residential Swimming`Pools - OWNER OR Giid ` W MAIL—` FIRM NAME ji YIS >_f Date Applicant Outlets Rec=Ligt First 20 ADDRESS - Q CERTIFICATE OF EXEMPTION FROM WORKERS' J Total No ..'�'. Additional CITY, ���' s Tel No - �'� 777 U COMPENSATION INSURANCE PLAN CHECK/ J r .) ,.,, APPLICANT (This section need not be completed if the work involved Lighting Fixtures First 20 "� ADDRESS LL by the permit is for one hundred dollars ($100) or less), Additional } Total No I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No ;� Q permit is issued, I shall not employ any person in any manner PERMIT cc so as to become subject to the Workers' Compensation Laws Range_ Heater—i.D W APPLICANT a�f O Oven _ Dryer_W M ADDRESS � � f r 4 1 r �. .r Top — FAU _W H f W Date Applicant CITY Tel No F- Hood _ Fan _Other NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Air Cond_ LICENSE OR Exemption, you should become subject to the Workers' t REGINUMBER Class Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO PROCESSED BY with comply with such provisions or this permit shall be r deemed revoked Size&Type HP KW, KVA or KVAR j ` c �. Up to 1 Incl e FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATE /��2� ®Y VALIDATION `Over_10to50Incl I hereby affirmsthat I am licensed under provisions of Chapter Over 50 to 100 Inc BY AL 9 (commencing with Section 7000) of Division 3 of the Busi * Over 100 `�- ness and Professions Code, and my license is in full force and , effect - Services 0 200 Amp Under 600 V License Number Lic Class ` 201 1000 Amp Under 600 V Contractor Date Over 1000 Amp or Over 600 V HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances Sign with One Branch Circuit I hereby affirm that,I am exempt From the Contractor's Additional Sign Branch Circuits ' ,License Law for the following reason-(Section 7031 5, Busi ness and Professions Code) I Ir Misc Conduits& Conductors Fr+as owner of the property, will do the work and the Other (See Complete Fee Schedule)= } 1 f+ structure is not intended or offered for sale (Section r 1 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY ~ii j jt I�ereby affirm that there is a construction lending agency ts t i + t f the performance of the work for which this+permit is ( i PERMIT FEE (Sub Total) issued (Sec 3097,Civ C ) Lender's Name PLAN CHECKING FEE (One Fourth Permit Fee) J1Lender's Address PERMIT ISSUING FEE c d - 4 " X39 ii certify that I have read this application and state that the TOTAL FEE �/ l 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 I 6 i the above mentioned property for inspection purposes 5 SEE REVERSE FOR EXPLANATORY LANGUAGE _ r Signature of Permittee ¢t Date l l � QRS'COMPENSATION DECLARATION ' 76CE 806G (2 80)63 APPLICATIO!"iOR ELECTRICAL PERMIT � 'CE 8 � I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES ` BUILDING AND SAFETY \ i insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) FOR APPLICANT TO FILL IN JOB Q Policy No Company EACH NO FEE ADDRESS New Residential Bldgs &Pools Certified copy is hereby furnished 1 &2-Family,Sq Ft $ — $ LOCALITY Multi family Sq Ft — NEAREST Q Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST department OWNER OR Q FIRM NAME J Date Applicant Outlets Rec_Light_Sw MAIL C ^ First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY C a_r-.- c...� Tel No COMPENSATION INSURANCE CL PLAN CHECK c a, APPLICANT O (This section need not be completed if the work involved Lighting Fixtures First 20 U by the permit is for one hundred dollars ($100) or less) ADDRESS Total No Additional O 1 certify that in the performance of the+work for which this Fixed Appliances Not Over 1 HP CITY Tel No t H permit is issued, I shall not employ any person in any manner I PERMIT o »X . so as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT W 0. Oven Dryer_W M ADDRESS _ Ito Date Applicant Top FAU _W H I Hood _ Fan _Other_ CITY Tel No NOTICE TO APPLICANT If, after making this Certificate of Disp Room Air Cond_ LICENSE OR Exemption, you should become subject to the Workers' REG NUMBER Class Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO ©� PROCESSE BY with comply with such provisions or this permit shall be Size&Type HP, KW, KVA or KVAR deemed revoked Up to 1 Incl , FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATEIZ— I? �� VALIDATION Over 10 to 50 Incl FINAL I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc Vrt/1 BY 9 (commencing with Section 7000) of Division 3 of the Busi Over 100 f`� ness and Professions Code, and my license is in full force and effect Services ;9 1 6 4.8 A License Number Lic Class 0 200 Amp Under 600 V o,0 0 0 2 201-1000 Amp Under 600 V # o Contractor' Date Over 1000 Amp or Over 600 V 2 0'0 1 9,5 0 HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances o,0 0 1,9 5 0:= U I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit - License Law for the following reason (Section 7031 5, Busi Additional Sign Branch Circuits 1 0221-81 ness and P ofessions Code) Misc Conduits&Conductors owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 7044, Business 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 PERMIT FEE (Sub-Total) J` issued(Sec 3097,Civ C) Lender's Name PLAN CHECKING FEE (One Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 7 I certify that I have read this application and state that the TOTAL FEE 9� 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 ove mentioned pro1pe�ty for inspection purposes Q SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date —�---WORKERS COMPENSATION DECLARATION 76A663 lo��, " APPLICATION FOR ELECTRICAL PERMIT hereby affirm that I have a certificate of consent td self CE'806G w ''insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS Y q 1 & 2-Famil S Ft $ _ $ LOCALITY El Certified copy is filed with the county building inspec tion department Multi-family Sq Ft NEAREST CROSS ST Residential Swimming Pools I Date FIRM NAM Applicant OWNER M E l�Cl +f ��]yy CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec _L Light Sw MAIL .� 4 COMPENSATION INSURANCE ^. ADDRESS , ' First 20 (This section need not be completed if the work involved by Total No Additional CITY Tel No the permit is for one hundred dollars($100)or less ) PLAN CHECK Xii 44 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 Fixtures First 20 ` ADDRESS J *� i ' Total No Additional - CITY , Tel w Lr Date Applicant "" IT NOTICE TO APPLICANT If after making this ertificate of Fixed Appliances Not Over 1 HP l APPPERLICANT Exemption you should become subject to the Workers' Range_ H DW �/ Compensation provisions of the Labor Code, you must forth- Oven _ D ADDRESS , U with comply with such provisions or this permit shall be Top — FAU —W H CITY Tel Na ' ` deemed revoked Hood Fan _Other— LICENSED CONTRACTORS DECLARATION LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond REG NUMBER Class (commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO PRQ� ED BY and Professions Code and my license is in full force and effect GIL Size &Type HP KW KVA� or KVAR © O License Number Lic Class Up to 1 Incl FINAL V 1139 Over 1Over 1 to 10 Incl to 50 VALIDATION O 0 DATE Contractor Date 0 InclFINA, H I am exempt under Sec Over 50 to 100 Inc BY V W d Over 100 H B&P C for this reason Date Services, Swbd , MCC & Panelboards 0 -200 Amp Under 600 V Signature 201 1000 Amp Under 600 V ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pole& Appurtenances =6 4A 3 A 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 L o -162 2 5 Professions Code) 1 Misc Conduits&Conductors " I I as owner of the property, will do the work and the o 0 0 (j 2,2 3 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 7044 Business and Professions Code) 1028-83 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for J the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec 3097, CGv C ) PLAN CHECKING FEE Lender s Name ���} — –'� PERMIT ISSUING FEE _ IC2 n 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 representatives of this County to enter upon J the above-mentioned property for.i pection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of O4rmittee Date