HomeMy Public PortalAbout6223 CLOVERLY AVE_Electrical__ CRTY
76A6G3-CE606 8-62 A0 0 p
PERNU
COUKtY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
.BUILDING AND SAFETY DIVISION i. ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER 1
WILLIAM A. JENSEN, SUP'T OF BUILDING LOCALITY
=''-_� NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
ECEPT. TOTAL NO. EACH FEE
R
�' OUTLETS FIRST 20 $20 $ OWNER
LIGHT)(�"Zy _ MAIL �I
SW.17cH. !�/ ADD'L 10 ADDRESS
OVER 20
'-. LIGHTING ]10TAL - p1Rsr 20I .20 �� CITY �Y TEL. NO.
FIXTURES AOD'L
OVER 20 10 ELECTRICIAN
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS �����"
GARB.DISP. STA.COOK �16&3
CITY !v ` v TEL. NO.I�
DISHWASH. AUTO.-WASH. STATE �+y�
F SPACE HTRS._ STA.APP.(yi H.P.MAX.) .50 LICENSE NO. ��J V C/ •�
f �
MOTORS: OVER NOT OVER H.P. DISTRICj•NO GROUP XNE .1 PR:)C SIE BY
0 1 1.00 _Z_
i 3 1.so INSPECTION RECORD
3 6 2.00 3
S 15 2.50 -
0_
15 50 3.00
50 100 5.00 / O
SIGNS: NO.TRANS - OL
NO:LAMPS O
SERVICE 0.60OV-Nor OVER 200A 1.00 W
SERVICE O.600V•OVER 200 A. 2:00 a'
to
SERVICE OVER 600V 5.00 z
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
$
-TOTAL FEE
•
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
APPROVALS DATES INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY w,. CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIREDBY LOS ANGELES COUNTY AND STATE OF FIXTURES '
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER C //
OF PERMITTEE ' ���� �'� UTILITY CO.NOTIFIED��I�. n ? �j4iyl'l
FINAL D !' P elit '!. I��✓�' .
VALIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
t_icy
7. 7 3. '7"D i SIR 6 D 6.60—
—
76A663 DBS 5A 1r4D - APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES.
16 W �I
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN, DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN R. F. Walton
.RECEIVED BY READY FOR - .DATE ISSUED .
ADDRESS 5134 No Acacia $to FIRST INSPECTION
CITY San Gaboo TEL. NO.AT '68583
COUNTY LICENSE NO. 1104 EXPIRES ABUILDING
DDRESS 6223 Cloverly'AVee '
PERMIT FEES
NUMBER EACH FEE LOCALITY Temple City
LIGHT OUTLETS 15 - NEAREST
CROSS ST.
RECEPTACLES 22
WALL SWITCHES 20 OWNER Meeker
TOTAL OUTLETS 51 Sc' $ 2 85 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 1 25 25 - -
CITY TEL. NO.
FIXTURES 15 5 . 75 '
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE_ IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. '
MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR 1 AM THE, LEGAL OWNER
FEE
NEW MVD. HP OVER INC. EACH
OF THE RESIDENTIAL PROP DESCRIBED ABOVE.
•I
4 1/2 6 LESS $ .25- 5 SIGNATURE OF
1/2 2 .50 PERMITTE
Ef� .2�al��
2 5 1.00 INSPECTION RECORD`"'
5 15 '1.50
15• 50 2.50 -
50 200 5.00
200 500 10.00 „J
Soo 1000 15.00 Q
1Z
OVER 1000 20:00 (�
M. G. SET/FREQ. CHANGER-HP d'
WELDERS: AC-KVA - 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%OF ORIG.) C
MOVED MOTORS (7S%OF ORIG.)
MISC.
SIGNS
No. No. TRANS.
APPROVALS
NO.NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT: CONDUIT I D ci-
WIRING' $1.00 1 11 OO WIRING
FIXTURES $1.00 .1 .00 -
SUPPLEMENTARY - .50 FIXTURES
. C 10 POWER
TOTAL FEE $ V UTILITY CO. NOTIFIED
0 r//1 FINAL ,
WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION
FOR ELECTRICAL.
n ECTRIC p PERMIT
"1I t ereby$affirm that I have a.certificate of consent to self insure, CE-806G. If✓L� l4� II�J L�I� �v II L Loa LS
or a certificate of Workers' Compensation Insurance, ora certified COUNTY OF LOS ANGELES BUILDING'AND SAFETY
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 EACH NO. FEE _ / Q
. �J .,
Certified 'co 1�& 2-Famil Sq.Ft. $ — $ •LOCALITY
py is filed with":the 'county. building,.inspection y.
department. • Multi-family Sq.Ft. NEARESTNAQ s�
Date Applicant
Residential Swimming Pools
CROSS ST.' �l)-
ER
.-. ...... ... .... - FOIRM NAME,; .-
CERTIFICATE OF EXEMPTION FROM WORKERS' AIL', w
Outlets.."Rec Light Sw.
COMPENSATION INSURANCE' ADDRESS It
( not be.completed:if,'the work involved by`the', " First 20 CITY Tom(–{iJ�
(This,section need undyed dollars ($•100)":or less.)
Total No. Additional `
,perm is4or one•h
- ,PLAN CHECK - ``
C�lS�
( certify,that in the,performance'of the work f r which tnis,permit ' • ° APPGCANT,"..
,s'issued, I shall',not,'.employ any`person i I n manner},sous to,
become subject to the Workers Compensa' 'Lightin'g' First 20 ADDRESS
Additional
Total No. 'CITY Tel No.•.
Dat l � pplicant Fixed AppliancesiNdt Over 1,HP PERMIT
NOTICE .TO •APPLICANT:, If, aft e-,mak ing• "this Certificate of APPLICANT '
Exemption;You should become:su ct to_the Workers'Compensation - Range
Heater D W
provisions of the.Labor Code,.you must forthwith comply with such Oven Dryer W.M._+ 7 "ADDRESS
all be deemed revoked. , Top:. FAU..— W.H —; CITYC
17 53
provisions,'or this permit sh
:r LICENSED CONTRACTORS.DECLARATION Hood, Fan. Other
(;hereby affirm that.( am licensed under provisions of Chapter 9 H d•
Disp - Room Air Conde j d� �� 'Class-�
LICENSE OR
( g 7000)'.of Division 3 of the Busirjess and'
(co wdh Section
Professions Code,and my license Is in full force and effect. Power.Apparatus& Large,Appliances ,
a.•
.,REG.NUMBER - _
"DISTRICT'NO P E ED'BY "
u• , i - w
'Size&.,Type HP; KW KVA,or KVAR'
License Number Lic:Class ^' lJp to„1,Incl. FINAL
DATE
O 1 to O Incl ; VALIDATION•: 0
<'Contractor Date Over 10 t 50 Ind.
e oFINA
r
I am exempt',under Sec. Over 50 to 1,00 Inc BY
BAP.0 for this reason N
r i .. :.
Services,`SwbdOMCC &oPanelboards z
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
A
.
HOME OWNER-BUILDER DECLARATION Sign with One,Branch Circuit 21'
• I hereby.affirm'that I`am exempt from the Contractor's License Law «' -
,
for.the following reason'(Section"7031Additional.'Sign Branch Circuits`.
:5, Business and Professions ;• �•� '. '- - - `F�.'•1.:��:a4 . --
Code):,
3%3@7 _ 28
p Y, Misc Conduits& Conductors " '
e,work and the structure' ITEMS
is not intendedEl: 1,as owner of oroffered fort!alethSection 7044,Business' ... Other(See Complete"Fee�Schedule) 1 F
(
and Professions Code).", 25
_ .
•
AL.
CONSTRUCTION LENDING AGENCY n
I hereby affirm that there..is'a'construction lending agency for'the
CHECK � a+:•_ ,
ERMIT FEE• (Su'
performance of.,the work for which this permit is issued(Sec.3097;: r �i
P b Total) 4 a I
- PLAN CHECKING FEE'
Lender's Name :r�14/
" PERMIT ISSUING FEE
0
Lender's Address. . =ter ,
I certify that.l,nave"read this applicationland.state that the a8�
bove. TOTAL FEE' � j
_..
information is correct.,l agree to comply with all County"ordinances r'
and State-law regulating Electrical-wiring, and'hereby authorize.r '
_.
representati " of this.County to enter upon`the,above-mentioned
property i , urposes.
7 SEEREVERSE,;FOR EXPLANATORY,LANGUAGE
nature of P rmitte Date