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76A663-CES06 10-62 [I'llll ll LS�C[r'11IMN U OII�1 `LJ-L EV�Ir11�1�V-[/ L 11 .ISl1Hl1 T
COUNTY OF LOS ANGELES
DEPARTMENT,OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE -
OUTLETS
LIGHT FIRST 20 i1� $20 $ D OWNER '
N/ MAIL
ADD'L ADDRESS '
SWITCH. OVER 20 .10 F.
fi
LIGHTING l TOTAL FIRST 20 .20 CITYac
TEL.
FIXTURES 1 ADD'L r
111 OVER 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.(%H.P.MAX.) ,50
LICENSE NO. i
'
MOTORS:'. OVER NOT OVER H.P. DISTRLC�NO. 'GRO P ,NE PROCMSEMY
O' 1 1.00J� 1 ,
1 3 1.50 INSPECTION RECORD
a.
3 8 2.00 I Q
8 15 2.50 - V
15 50 3.00 ` Q
50 100 5.00 q� l
SIGNS: NO.TRANS.
N0.LAMPS
SERVICED-60OV-NOT OVER 200A 11.00 rfif"Y
SERVICE 0-60OV-OVER 200 A. 2.00 '4/�✓
SERVICE OVER 600V - 5.00 f'! .✓
misc.
PERMIT ISSUING FEE
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
o '
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 CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. - - WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY GISTERED AND/OR '
LICENSED AS REQUIRED BY LOS ANGELES C NTY AND STATE OF o FIXTURES
CALIFORNIA OR THAT I A L G E ABOVE
DESCRIBED RESIDENTIAL - POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE -
FINALj
IDATION ARTHUR C. VEIT
_
(CKMO CASH SUPERVISING ELECTRICAL ENGINEER
9 1 ii 4`' I"'
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