HomeMy Public PortalAbout5447TEMPLE CITY BLVD_Electrical (2) 7e•663-cce0e 1-ee F
APPLICATION FOR ELECTRI L ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COLJNTY ENGINEER BUILDING �[
BUILDING AND SA TY 'VISION ADDRESS T 17 �i
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKIN3, SUMIIINTENDCNT OR BUILDING LOCALITY A
NEAREST
FOR APPLICANT TO KILL NOICROSS ST ?
C
RECEPT _ S OWNER
MAIL
LIGHT_ TOTAL FIRST 20 20 ADDRESS
SWITCH_ OVER 20 10 CIT TEL NO _ 15
PLAN CHE
LIGHTING iTOTAL FIRST 20 20 APPLICANT
FIXTURES /( OVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR _ CITY TEL NO
STA COOK_DISP _F A U — CONTRAC iOR
SPACE HTR —AIR COND
ADDRESS
CLOTHES WASH _DISHWASH CITY Ad TEL NO
FAN—OTHER 10O LICENSE NO CLASS
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREbY ACKNOWLEDGE THAT I HAVE READ THI! APPLICATION
SIZE ! TYPE OVER TO AND STATE THAT THC ABOVE I! CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND !TATE LAW! REGULATING
ELECTRICAL WIRING
0 - I 1 00
I HEREBY CERTIFY THAT I AM PROPERLY RE013 TERED AND/IDR
I - 10 3 00 LICENSED AS REQUIRED BY LOS AN OELES COUNTY AND b TE OF
CALIFORNIA ON THAT I AM THE LEO AL OWNER OF AND I END TO a
10 - b0 6 00 RESIDE IN TXE EICa IKED(�.H`ESIDENTIAL OPER Y O
SO - 100 10 00 SIGNATUAE fC% V
OF PERMITTE OL
Ioo - Boo IB o DISTRICT NO RO P N P O Y r
SIGN GAS SIGN ANO ONE CIRCUIT 3 00 J I IY�
TUBE OR
4
MARQUEE ADpl T10, CIRCUITS 1 00 NOTES Z
SERVICE NOT OVER SOD VOLTS OR 200 AMP 2 00 Od ,-
SERVICE OVER BOO VOLTS OR 200 AMP S 00
TEMP SERVICE POLE Be APPURTENANCES 3 00 APPROVALS DATE INSKCTOR S SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
opi
PERMIT ISSUING FEE 200 UTILITY CO NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE O JOS P C ROOHAN
SUPERVISING ELECTRICAL ENGINE
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATION CK M 0 CASH
5 6 9 6� JM31 2 D 4.00-
ME BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE