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HomeMy Public PortalAbout6053 CLOVERLY AVE_Electrical__ �( 76A663CE-806(11'/78) APPLICATION R ELECTRI L P RM1T .COUNTY OF LOS ANGELES =BUILDING AND SAFETY µ FOR APPLICANT TO FILL IN JOB �� O L/`�J2 r New Residential Bldgs. Pools EACH . NO. FEE ADDRESS d5 r ,, ---• 1 &2-Family,Sq. Ft. $ .025 — $ LOCALITY Multi-family Sq. Ft. .02 — NEAREST 25.00 CROSS ST. Residential Swj ming Pools OWNER OR FIRM NAME "'V Outlets: Rec�L4Light Sw. AIL /D First 20 .50 DDRESS Total No. l • Additional .30 CITY _ ,j el.-.No. PLAN CHECK APPLICANT. Lighting Fixtures First 20 .50 ADDRESS Additional 30 `Total No. CITY TeI.'No. Fined-Appliances Not Over 1`H'P PERMIT •• Range_Heater_ D.W. _ APPLICANT Oven_Dryer_'W.M. ADDRESS �"� - lo �Z w Top —FA U- W.H. CITY ��Tel;•,No_ Hood_Fan _Other_ LICENSE OR DisP>—Room Air Cond. 2'50 REG.NUMBER Class. . I HEREBY,ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&T COMPLY WITH -ALL COUNTY-`ORDINANCES"AND"STATE'LAWS' Type HP, KW, Knd. or KVAR. REGULATING ELECTRICAL WIRING. Up to 1 Incl. 2'5p I HEREBY CERTIFY THAT]AM PROPERLY-REGISTERED AND/OR 00 Over 1 to 10 Incl. 5. LICENSED AS REQUIRED BY LOS,ANGELES COUNTY AND STATE OF � Over 10 to 50 Incl. 12.50 CALIFORNIA OR'THAT I AM THE LEGAL,OWNER,OF_THE ABOVE- _ DESCRIBED RESIDENTIAL PROPERTY. C= Over 50 to 100 Inc. 25.00 40.00 PERMITEE. Over 100 SIGNATURE Services DISTRI r, PR D"B 0- 200 Amp. Under 600 V 12.50 v e 201'-1000 Amp. Under 600 V 25.00 Over 1000 Amp.or Over 600 V 50.00 Z O Temp. Power Pole&Appurtenances. 10.00 Q Sign with One Branch Circuit 10.00 G Additional Sign Branch Circuits 2'00 INSPECTION > INFORMATION v S 0?% 2,6 A Misc.Conduits&Conductors 10.00 ON REVERSE :_ Other(See Complete Fee Schedule) SIDE v ft o o o:o o 2 2 . J 2 O o o !•5 O, a7,50f2 . PERMIT FEE (Sub-Totol) Z . 0'Q, p�.77 PLAN CHECKING FEE (One-Fourth Permit Feel O PERMIT ISSUING FEE $7.00 0 J Q . TOTAL FEE. > r INSPECTION FINALED date: - > By c ✓� �. ©s l �- .. 111 � � WORKER'S COMPENSATION DECLARATION 9 DPW 9/89 APPLICATION f6R ELECTRICAL PERMIT 76A66 ]-hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF-PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB I `, ADDRESS _ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE$ _ $ LOCALITY �-��yl ❑ Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft. PY Y 9 P — P Le NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ry 4 ASSESSOR - PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' 7j FIRM N OR COMPENSATION INSURANCE Outlets:Rec. Light Sw. FIRM NAME �! •e First 20 v � MAIL (This section need not be completed if the work involved by the permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS kJo S- !C 0 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 G PLAN CHECK a�" become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH `}. LICENSED CONTRACTORS DECLARATION 15 OR 20A,208V TO 277V LIGHTING EACH ADDRESS CL I hereby affirm that I am licensed under provisions of Chapter 9 0 (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. 0 Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR cc Power Apparatus&Large Appliances REG,NUMBER class. Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PROC ED BY License Number Lic.Class ._ Up to 3 Incl. O C 2 vLLI Over 3 to 10 Incl. FINAL O" Contractor Date DATE ❑ Over 10 to 50 Incl. �J_ n I am exempt under Sec. Over 50 to 100 Incl. [ (� VALIDATION Over 100 FINAL B.&P.C.for this reason BY Services,Swbd.,MCC&Panelboards Date: 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 p r•+^> HOME OWNER-BUILDER DECLARATION = = I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit r for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): t d &C it d Conus Conductors I, as owner of the property, will do the work and the structure Misc. = � is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY f:E si's 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 ('f i''t' Lender's NameAt PERMIT ISSUING FEE p75 Lender's Address I certify that I have read this application and state that the above TOTAL FEE (� 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 propertyyq for inspection purposes. ,- SEE REVERSE FOR EXPLANATORY LANGUAGE �� ,— kpe.....d , q=r I 1 — 7 Lam• SIGNATURE OF APPLICANT OR AGENT I DATE