HomeMy Public PortalAbout6229 CLOVERLY AVE_Electrical__ 76AGS3 DBS SA 3-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN
DISTRICT
. GROUP ZONE PERMIT NO.
ELECTRICIAN R. F. Walton �Z- � �
RECEIVED BY READY FOR DATE ISSUED
ADDRESS 5134 N. Acacia St, FIRST INSPECTION
CITY San Gab, TEL. NO. AT 68583
COUNTY LICENSE NO. 1104 EXPIRES BUILDING
PERMIT FEES
ADDRESS 6229 Cloverly Ave. _
NUMBB.ER EACH FEE LOCALITY TgDple City
LIGHT OUTLETS 'SD NEAREST
RECEPTACLES 24 CROSS ST.
WALL SWITCHES 19 OWNER Meeker -
TOTAL OUTLETS 58 Sc $ 2 90 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 1 25 25 CITY TEL. NO.
FIXTURES 15 5 75 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUM6ER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY PROPERTY DESCRIBED ABOVE.
%p @ LESS $ .25 25 SIGNATURE OF 1
'/2 2 .SO PERMITTEEIle
2 6 1'00 INSPECTION RECORD
5 15 1.513
16 50 2.50
_ SO 2013 � / /'1/,.'_:14 �!g J `�
200 500 10.00 J
5OO 1000 15-00 Z
OVER 10130 20.00 jf
_M.G. SET/FREQ. C'FiANGER-HP _ / ` '� '& d -- -- Q�
WELDERS: AC-KVA
GENERATORS - KW
TRANSFORMERS - KVA
_ TEMP. MOTORS (75% OF ORIo.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
ND. NO.LAMPS
FOR EACH PERMIT: DATE �I�N�9PECTOR'B NAME
WIRING $1.00 1 OO CONDUIT D l%t
1,4
FIXTURES $1.00 1 00 WIRINGw.
,�1,�,t,1�7 ,
SUPPLEMENTARY ,Sp FIXTURES �' :.6i-F ')
t
_ 6 155 POWER
TOTAL FEE $ UTILITY CO.NOTIFIED
FINAL
V
WORKERS'COMPENSATION DECLARATION CE 806G (2-80) 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'Co ensation Insurance,or
ace 'fid opy tt�reAfSe�.
5 FOR APPLICANT TO FILL IN 3pg
Policy o. Compal EACH NO. FEE ADDRESS L� c:
New Residential Bldgs.&Pools (
�r
Certified copy is hereby furnished _ v 1 &2-Family,Sq. Ft. $ — $ LOCALITY `G 67,
Multi-family Sq. Ft. — NEAREST
Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST
department. OWNER OR
FIRM NAME
Date Applicant Outlets: Rec._Light Sw. MAIL
First 20 ADDRESS �2
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No.
COMPENSATION INSURANCE >_
PLAN CHECK CL
(This section need not be completed if the work involved APPLICANT 0
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Additional cc
Total No. 0
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. a.
permit is issued, I shall not employ any person in any manner PERMIT / L)
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT JC,4 L
COM✓ /'t)s�C/ty l6'��j 0-
Oven
Oven _ Dryer_W.M. ADDRESS '</ U)
Date Applicant Top _ FAU __W.H.._
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. P E 49t BY
with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR ! (/
deemed revoked. tj
Up to 1 Incl.
� Over 1 to 10 Incl. / INAL
VALI DATIO
LICENSED CONTRACTORS DECLARATION ATE
Over 10 to 50 Incl. r�
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
gY 7
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. erv'
License Number?a;qe� S
Lic.Class- /6 0-200 Am Under 600 V 52,
/� 7 r 201-1000 Amp. Under 600 V
Contractor. /Dioy , °Dal*e Over 1000 Amp.or Over 600 V z 0 8?t 1 A
^4_
HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances
# 0,00002
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 2 - 2550
ness and Professions Code):
Misc.Conduits&Conductors o - 255050
1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section 0 a 2,0 7-81
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)
issued(Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE '(One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE
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
her y uthorize representatives of this County to enter upon
th ab v -mentioned property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date