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APPLICATION E,LEC R�r11A T
T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FNEAREST
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER `
WILLIAM A.JENSEN, SUPT OF BUILDING ,..
FOR APPLICANT TO FILL IN . ( � '.
RECEPT. O TOTAL NO. EACH FEE
OUTLETS FIRST 20 $20 $ f y) OWNER' J`
LIGHT <!� MAIL
'^� ADD'L ., 10 ADDRESS
SWITCH/? � OVER 20 -
LIGHTING TOTAL FIRST 20 ` 20 CITY
FIXTURES � ADD'L 10 ELECTRICIAN
1111 O V R 20 l�
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DISP. •STA.COOK
CITY TEL.NO.
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. A.APP.(1/a H.P.MA ,50 LICENSE NO.
MOTORS: OVER - NOTOVER H.P. DISTRI T N GROUP] kONE P CESSED BY
0 1 1.00 I L
1 3 1.50 INSPECTION RECORD r
3 s 2.00 -� f`�'.�"• 0
8 15 2.50 / Ao _ Ct,t J
/ � � O
15 SO 3.00 f PC_. - 6 f� H
� V
SO 100 5.00
a. to
SIGNS, NO.TRANS "� Z
NO.LAMPS
SERVICE 0.600V-NOT OVER 200A 1.00 r
SERVICE 0.60OV-OVER 200 A. 2:00
SERVICE OVER 600V 5.00 B
MISC.
p�A
1
PERMIT ISSUING FEE 2.00
F
SUPPLEMENTAFtY PERMIT ISSUING FEE 1.00
TOTAL FEE $
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP CATI N APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING /
ELECTRICAL WIRING. / WIRING I I "It—b
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR /
LICESED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM TH , LEGAL OWNER OF THE ABOVE w
DESCRIBED RESIDENTIA - OP Y. POWER
SIGNATURE EE UTILITY CO�NOTIFIED —q-4-f,
OF PERMITT
FINAL .�
Cj� IDATION ARTHUR C. VEIT ' !{/,
' MO CASH SUPERVISING ELECTRICAL ENGINEER
L, Lj'o 6 6 2 7 DEC 9 2 D 1 4.90- "-