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76A669-CE506-11-57 A P P L I C A.TION FO R �E�L E C T R I C PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER B U I L D I N G
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LANBIE, County Engineer
CASSATT D. GRIFFIN, Supt of.Building LOCALITY
FOR APPLICANT TO FILL IN CROSS Sr'
PERMIT FEES
ITEM NUMBER EACH FEE OWNER
OUTLET $ $ MAIL
LIGHT RECEPT. SW. .10 ��r' ADDRESS
LIGHTING FIXTURES .10 CITY TEL
ELEC.RANGES CLO.DRYERS ELECTRICIAN 1 •� ,
W A T
ER HEATERS .50 - . 1
ELEC.SPACE HTRS. DISHWASHERS Mg ADDRESS _ __ _ . ' ,�J �� r
' GARBAGE DISPOSERS AUTO- - CITY TEL NO,
WASHERS STA.COOKING UNITS 25 STATE
LICENSE NO
MOTORS: OVER INC. H.P.
O —. 1/2 25 DISTRICT NO. IUP I ZONE READY FOR INSPECTION
g 2i
I/2 - 2 5.0
2 - 5 100, INSPECTION RECORD
'- 5 — 15 1.50
15 — 50 2.50
50— 200 5.00
SIGNS: , NO TRANS.
NO LAMPS
;-SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MI
t
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
�. SUPPLEMENTARY PERMIT .50.
r TOTAL FEE $ APPROVALS
I HEREBY ACKNOWLEDGE"THAT I HAVE READ THIS APP ICATION ` DATE , INSPECTOR'S SIGNATURE'
j, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUITI I),4
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. - WIRING '
t I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES -
" CALIFORNIA OR THAT 1 AM THE GAL OWNER OF T E ABOVE POWER
DESCRIBED RESIDEN A PROPERTY
SIGNATURE UTILITY CO NOTIFIED
OF PERM ITT Eel ofl.A'vvl
FINAL' gg&f� 1' A w'......_
ACASH TION ARTH URC.V EIT'4
O .'
SUPERVISING ELECTRICAL ENGINEER
CK M '
AUG 21 2 A 7.0 0