HomeMy Public PortalAbout5029TEMPLE CITY BLVD_Electrical T'°^°°' CEBBG 10"2 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER AppREss .50a9 C
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
OUTLETS NO EACHI FE! OWNEI 11R1NAME /
RECEPT 2— S S
MAIL
LIGHT_ TOTAL
FIRST 20 25 ADO,ESS S L
OVER 20 CITY (0„ TEL NO
SWITCH 10 PLAN CHECK
LIGHTING 1 FIRST 20 'Z— 25 APPLICANT
T TOTAL
FI%TURES 10
OVER 20 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL NO
PER T
RANGE_DRVER_WTR HTR_ APPLICANT 14A J,
STA COOK_DISP _F A U _ ADDRESS
,,,Ps/+/t) d, y
SPACE HTR AIR CONO QI Ty TEL NO
CLOTHES WASH DISHWASH LICENSE OR
REG NUMBER CLASS
FAN_OTHERS 1 D D O IHEREBI ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ,
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC HP KW KVA ELECTR ICAL WIRING
SIZ
E ° TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR
0 - 1 1 00 LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OT
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE
1 - 10 300 OESCRI FED RESIDENTIAL PROPERTY oo
PERMITEE U
10 - s0 500 SIGNATURE
50 - 100 1000
DISTRICT NO � P EO BY W
100 - 500 1500 ( a � 1 CIL'
SIGN GAS SIGN AND ONE CIRCUIT 500 APPROVALS DATE INSPECTOR IVR[
TUBE OR
MARQUEE ADDITIONAL CIRCUITS f00 TEMP POWER POLE
SERVI CENOTOVER BOO VOLTS OR 200 AMP 300 UNDERSLAS WORK
SERVICE OVER 600 VOLTS OR 200 AMP 1°00 ROUGH CONDUIT
TEMPSERVICE, POLE &APPURTENANCES SOD WIRING
TEMP LIGHT OR RECEPT SYSTEM 3 G FIXTURES
POWER AUTHORIZED
UTILITY CO NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES
PLAN CHECK FEE
PERMIT ISSUING FEE 300 G a
TOTAL FEE
PLAN CHECK VALIDATION OK M o [ASH PERMIT VALIDATION CK M 0 CASH
4 2 4i"JAN 1s ,2 0 /^ I 62 5 AJd
SEE BACK OF APPLICATION FOR COMPLETE 9CXf0UL[
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