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CE 9 66
O APPLICATION FOR ELECTRICAV PERMIT
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING prn
BUILDING AND SAFETY DIVISION ADDRESS 77
JOHN A LAMBIE COUNTY ENGINEER r
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY s
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPT TOTAL NO IEACH FEE
11 OUTLETS FIRST 20 $ 20 $ L�� _OWNER T L 1 r
LIGHT j , MAIL
SWITCHJ ADD L ADDRESSP
OVER 20 10 ,7 q t L`
TOTAL FIRST 20 20 /1 CITY c�'/ L NOS 9_ [ 7 l /
LIGHTING 1 F]TOTAL RES C/
FIXTURES Jr ADD L
OVER 20 10 CONTRACTOR y
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RANGES DRYERS WTR HTRS 100 ADDRESS P V
,GARB DISP STA COOK
� CITY TEL NO O
ISHWASH AUTO WASH STATE
ACE HTRS STA APPL 50 LICENSE NO
OTORS OVER NOT OVER H P DISjRbZ G r Z ED
O 1 100 r
1 3 150 INSPECTION REC RD
3 8 2 00
1 8 15 2 50
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15 50 3 00 D_
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50 100 5 00 O
N5 NO TRANS O
f NO LAMPS 0
(VICE O 600V NOT OVER 200A 1001
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nVICE O 600V OVER 200 A 2001 Z
0
.9RVICE OVER 600V 5001
OTHER (SEE COMPLETE FEE SCHEDULE) I
'PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100 APPROVALS DATE INSPECTOR 8 SIGNATURE
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK
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AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING r
ELECTRICAL WIRING WIRING �.,+ Sff� �r -t„ �•^"�
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES 1
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT1 THE LEGAL ER OF AND INTEND TO POWER
RESIDE IN THE ABOVE A SCRIBED RES EN OF PROPERTT l 7 t Y/ l /l` K�(V,4 A-"61GNATURE .� .1 UTILITY CO NOTIFIED J J
OF PERMITTEE GGGCCC///+++"'�WWIJ FINAL ✓ 411 yV
VALIDATION JOSEPH C ROOHAN
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
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