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76A663-CES0612-65 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING /r?v
BUILDING AND SAFETY DIVISION ADDRESS 77
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPT TOTAL NO EACH FEE {
LIGHT OUTLETS FIRST 20 $20 $ 1 OWNER
NAIL
SWITCHADD L 10 ADDRESS �Q
Y I OVER 20
TOTAL FIRST 20I 20 CITY4;76 TEL NO
LIGHTING FIXTURES '
FIXTURES �� ADD L
OVER 20 10 CONTRAC OR '
I ,
RANGES DRYERS WTR HTRS 100 ADDRESS
GARB DISP STA COOK
CITY TEL NO
DISHWASH AUTO WASH STATE
SPACE HTRS STA APPL 50 LICENSE NO I
MOTORS OVER NOT OVER HP ! DISTRICT NO GROUP ZONE PROCESSED BY
O 1 100 ;,7/O
1 3 150 INSPECTION RECORD 0
3 B 200, V
8 15 250 d — Cr I/
'15 so 300 G
W
50 100 500 a
N
Z
SIGNS NO TRANS
NO LAMPS
SERVICE O 600V NOT OVER 200A loo 1 64l
SERVICE O 600V OVER 200 A 200
SERVICE OVER SOOV 500
OTHER (SEE COMPLETE FEE SCHEDULE) f�
1
PERMIT ISSUING FEE 200 7— did -
SUPPLEMENTARY PERMIT ISSUING FEE 1001 I APPROVALS DATE INSPECTOR 8SIGNATUR6
TOTAL FEE $ /
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION { UNDERSLAB WORK
LRESIDEIN
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I ROUGH CONDUIT7111
`
L COUNTY ORDINANCES AND STATE LAWS REGULATING
AL WIRING 1 WIRING
Lf 17
BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR I FIXTURES '
AS REQUIRED BY L08 ANGELES COUNTY AND STATE OF
NIA OR THAT I AM THE LEGAL OWNER F AND INTEND TO POWER
THE ABOVE SCRIBED RE�NTIA P PERTY
URE UTILITY CONOTIFIEDMITTEE
FINAL
VALMO QT H JOSEPH C ROOHAN
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
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