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HomeMy Public PortalAbout6042 CLOVERLY AVE_Electrical__ 16A666 CE866460 APPLICATION FOR ELECTRICAL PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS Ld✓� �, JOHN A LAMBIE, COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING LOCALITY •��4,z t2 J► FOR APPLICANT TO FILL IN CROSS ST 1'13 A L-Q 1 PERMIT FEES OWNER ITEM NUMBER EACH FEE MAIL OUTLET $ $ oL� ADDRESS 5Mg: LIGHTS RECEPT BW lo LIGHTING FIXTURES to 10 CITY TEL NO i ELEC RANGES CLO DRYERS ELECTRICIAN C PIEC 1 C b A T E R HEATERS SO ADDRESS Q(7 �I� Y LEC SPACE HTRS DISHWASHERS CITY EA. OT "� �TEL NO C7 GARBAGE DISPOSERS AUTO. STATE D 9 J( WASHERS BTA COOKING UNITS 25 1 LICENSE NO t h MOTORS OVER INC H P C DISTRICT GR P P ED y° O — '/2O / 25 �S JT_ Q V2 — 2 so - _4 INSPEdCTION RE/-CORD 2 — 5 100 5 — 1s ISO p sem. -4 4d he OV I5 — SO 2 SO / ,.�rt.r9� Yx1i1s1�� GYd Q SO — 200 Boo , `1 (/ NO TRANS �7 d f ( y, 'L� W { SIGNS NO LAMPS / � ��� G /L��Lv �R IV) //l/ SERVICE O 600V too ? �� � -�> .r f,,�j'' r✓ ll���'' %' SERVICE OVER 600V Soo A MISC 1[ i WIRING PERMIT Too d 1 FIXTURE PERMIT 100 O© 1 SUPPLEMENTARY PERMIT SO L�SIDENT OTAL FEE S BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALSDATE INSPECTOR'SSIGNATURE ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYCONDUITLL COUNTY ORDINANCES AND STATE LAWS REGULATINGCAL WIRING WIRING l 1 t 1,–v ` i'd/�EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES NIA OR THAT M THE LEGAL OWNER OF THE ABOVE ED RESIDENT L ROPERTY POWERURE �.� UTILITY CO NOTIFIEDMITT FINAL (DATION ARTHUR V CK Mo CASH SUPERVISING ELECTRICAL ENGINEER -0 8 1 0 6 FEB 8 2 iD , 6.3�0 T, 76A663 CE806 4 65 APPLICATION FOR ELECTIfICAL PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING 6042 Cloverl Road BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE COUNTY ENGINEER Temple City' COLEMAN W JENKINS SUP T OF BUILDING LOCALITYNEARE FOR APPLICANT TO FILL IN CROSS ST Garibaldi RECEPTACLE TOTAL No I EACH FEE 2 ouTLETs FIRST 20 r20 $ OWNER LIGHT 1./,--SII , ADD L 10 ADDRESS Same SWITCH 2 OVER TOTAL-' CITY T • C • TEL NO AT 69416 LIGHTING 1 FIXTURES FIRST 20 20 f+o FIXTURES I 2 ADD L 10 CONTRACTOR Robinson Electric Co. OVER 20 RANGES CLO DRYERS WTR HTRS 100 ADDRESS 335 N Canyon Blvd GARB DISP 1 STA COOK -CITY MonroviaQ TEL NAL 8— DISHWASH AUTO WASH STATE 27063 SPACE HTRS 1 STA APP ('/.H P MAX ) 2 50 1 0O LICENSE NO MOTORS OVER NOT OVER HP DISTR GROUP ZONE P ESSED BY O 1 100 1 3 150 INSPECTION R CORD s s 200 8 15 250 18 50 300 0 50 100 Soo V CC SIGNS NO TRANS O NO LAMPS r SERVICE O 600V NOT OVER 200A 100 h SERVICE O 600V OVER 200 A 200 Z SERVICE OVER 600V 500 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 200 2 00 SUPPLEMENTARY PERMIT ISSUING FEE 100 TOTAL FEE $ APPROVALS DATE INSPECTOR S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATION UNDERSLAB WORK ^ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ ELECTRICAL WIRING WIRING 'I: CIO& 1 Z( (aa A—" I HEREBY CERTIFY THAT I AM PROPERL REGISTERED AND/OR FIXTURES r I A LICENSED AS REQUIRED BY L S ANGEL UNTY AND STATE OF CALIFORNIA OR THAT I AM T LEGAL W R OF AND INTEND TO POWER REST DE IN THE ABOV IBED RE D IALVROPERT SIGNATURE UTILITY CO NOTIFIED /]/ OF PERMITTEE (/FINAL / 0 AS UCK IDATION JOSEIPH C ROOHAN H. A. Robinson• MOCASH SUPERVISING ELECTRICAL ENGINEER - LAU0 8 1,6 9� DEC 2,0 2 D 4.8 0- 17 `1• ' F WORKERS'COMPENSATION DECLAttATION' CE 80rM%2 80) APPLICATION FOR,ELECTRICAL_ PERMIT J I hereby affirm that 1 have a certificate of consene 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,) 1 �. �/ -YYlV.1L_ FOR APPLICANT TO FILL IN JOB Policy NoCompany EACH NO FEE ADDRESS a New Residential Bldgs &Pools Certifiedcopy is hereby furnished 1 &2 Family,Sq Ft $ $ LOCALITY 7 Multi family Sq Ft — NEAREST ., Certified copy is filed with co ty mg inspection CROSS ST Residential Swimming Pools department OWN E Date_ Applicant Outlets Rec�tLightk S. (0- ` - AIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No lil-6\ Additional CITY, Tel No COMPENSATION INSURANCE r PLAN CHECK d 4 - *� APPLICANT U (This section need not be completed if the work involved Lighting Fixt res' First 20 �J ADDRESS µ by the permit is for one,hundred dollars ($100)'or less) — Additional O `Total No ` 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 V so as to become subject to the Workers' Compensation Laws Range_Heater_D W APPLICANT l 4 J(f)per, Oven — Dryer!W M J ADDRESS ' Z Date Applicant Top ____ FAU _W H CITY Tel No Hood — Fan _Other_ t NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Air Cond_ LICENSE OR r Exemption, you should become subject to the Workers' REG NUMBER lass Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO 1I i PROCES D BYti+Nt with comply with such provisions or this permit shall be Size&Type HP,KW, KVA or KVAR - deemed revoked - } -- Up to 1 Incl - FINAL �. Over 1 to 10 IncIJ DATE r2 VALIDATION LICENSED CONTRACTORS DECLARATION )Over,10 to 50 Incl I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL/ BY 9 (commencing with Section 7000) of Division 3 of the Bust Over 100 ness and Professions Code, and my license is in full force and effect Services r License N Lic Class��� 0 200 Amp Un8er 600 V /� 201 1000 Amp Under 600 V x Contract Date!3 ill, . S4 Over 1000 Amp or Over 600 V J 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, Bust y^9 4 2 7.9 A ness and Professions Code) . I Mise Conduits&Conductors =o"o'0 0 0 I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— d # 1 `` 2 structure is not intended or offered for sale (Section 2`0 ° 4.2 7 5 7044, Business and Professions Code) a CONSTRUCTION LENDING AGENCY 11 oho o 42 756 ci J I hereby affirm that there is a construction lending agency 1 for the performance-of the work for which this permit is PERMIT FEE (Sub Total) t T #, A9 1 9-84 issued (Sec 3097,Civ C) - I - - Lender's Name PLAN CHECKING FEE (One Fourth Permit Fee) 1 Lender's Address PERMIT ISSUING FEE p I c at I have read this application and state that the TOTAL FEE a ve info, tion is correct I agree to comply with all County o n ces aW�d �petty regulating Electrical wiring, and h b thortves of this County to enter upon r the enfor inspectionpurposesSEE-REVERSE FOR EXPLANATORY LANGUAGE Date ' r