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76A663-CE806 9-64 QppUCAUMN FOR EL CUMC AL - C�G°3n�n1�4 U
COUNTY OF LOS ANGELES
`DEPARTMENT OF COUNTY ENGINEER BUILDING a
BUILDING AND SAFETY DIVISION ADDRESS `je 0 Lu L0 a
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. L.
RECEPT, TOTAL NO. EACH FEE
OUTLETS FIRST 20 $20 S OWNER 11 i 4�
72 1
LIGHT MAIL
ADD'L 10 ADDRESS Z'7An iR
SWITCH. OVER 20 ' r �c.
LIGHTING TOTAL i IF`IRST 20I T .20 CITY, 6..bn y�P"' TEL. NO. '- O
FIXTURES } I ADD'L OV R 20 10 ELECTRICIAN
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DISP. STA.COOK
CITY TEL. NO.
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(yi H.P.MAX.) .50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTNO. GRR JP NE PR C D BY
O 1 1.00 / 0 --�
1 3 1.50 INSPECTION RECORD
3 s 2.00 a
O
8 15 2.50 V
15 50 3,00 p.
50 100 5.00 4 Y
V
NO.TRANS- UJ
SIGNS: NO.LAMPS H
Z
SERVICE 0.60OV-Nor OVER 200A 1.00
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY f CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
7p v�1 /
I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES / Je/ 'G /!I
j. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE-LEGAL OWNER OF, AND INTkND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE -
- - - - FINAL �/ <.,�j.
VALIDATIO JOS9PH C. ROOHAN '
CK MO
SUPERVISING ELECTRICAL ENGINEER '
CASH
LAC
,.7 1. NOV 8 2 D 6.0 0- 1