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MAIMS-CESO66-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIV19I ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SuP Tor SU ILOING LOCALITY
MMOMMONEAREST
lFM FI CROSS BT
RECEPT I TOTAL NO 6OWNER
AU I[t .
II/ OUTLETS FIRST 20 t 20 t �1
LIDNT J MAIL
ADD,L
•WRCH OVER 20 10 ADDRESS
LIGHTING TOTAL FIRST 20 Lc 20 CITY TF1. N0
FIXTURES }" ' (�_ OV R 2ADD'L 0 10 ELECTRICIAN
�—t
RAMGS• CLO DIIYOI• Wm NTIM too ADDREtt
OARS DIV •TA COON CITY TEL N I
DIWWA•H AUTO WA•N VLICEINBE
SPA=NTR• WA.APP (w N P MAX 1 50 NO
MOTORS, OVER NDTOVERNP O GROUP ONE P ES8ED B
q — 1 100
1 a ISO INSPECTION RECORD
a' a zoo
S 13 260
1S 00 30011 11Y
6
r So 100 300 0
t10Nt� NO TRAM•
DL
NO LAMM O
SERVICED 600V NOT OVER 200A 100
SERVICE O 600V OVER 200 A 200 d
N
SERVICE OVER SOOV Soo - Z
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE f00
TOTAL FEE t
1 nE Y AaagWL K THAT I HAW ARAD TMIE APPLIUTIOMAPPROVALIS DATE IM • TURS
Ano rtATE THAT THE ABOVE I• CORRECT AND AORQ TO COMPLY CONDUIT
WITH ALL COUNTY.DRDINANCEG AND •TATE uW RSDDUTIND
ELECTIHCAL WIRING WIRING
1 NXREBY =RTIFY THAT 1 AM PROPERLY RXOI•TXI� AND/oR
LN3lIELD Y •EGUIRED BY 1.0111 ANGEL[, wunrr AMD rtAT[ W FIXTURES �1
CAL1FOItl1IA OR THAT 1 AM Tn LEGAL WME OF TH[ AROV[
GE•CII=D ROIDENTIAL [ I POWER
SIGNATURE UTILITY CO OTI 1
OF PERMITTER
FINAL
VALID URC V
MO SUPERVISING
U RTH
CK CABN SI NO ELECTRICAL ENGINEER
Leo 8 0 9 5 G FEB 1 2 D 8.60- 9
a I.