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APPLICATIO FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS �Q
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY ,
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. _Q,n
NO. EACH FEE
r
$ $ OWNER
RECEIPT._ MAIL
LIGHT TOTAL FIRST 20 ,20 ADDRESS
CITY TEL.N0.
SWITCH OVER 20 10 PLAN CHECK
LIGHTING TOTAL FIRST 20 ,20 APPLICANT
FIXTURES I-/- OVER 20 ,10 ADDRESS
RANGE_DRYER_WTR. HTR. CITY VL.Ng,
STA. COOK_DISP._F.A.U. CONTRACTO
SPACE HTR. AIR COND. ADDRESS 3
CLOTHES WASH._DISHWASH. CITY TEL.NO. i t
FAN_OTHER 1.00 LICENSE NO. CLASS.
MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
SIZE @TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
// ELECTRICAL WIRING.
0 - 1 / 1'00 , 4001 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
I - 10 3.00 CALIFORNIA OR THAT 1 AM HE LEGAL OWNER OF. AND INTEND TO Off.
RESIDE IN, THE ABOVE D ISE D RES EN TI OPERTY. C
10 — 50 5.00 L
SIGNATURE cm
50 - 100 10A0 OF PERMITTE ' C
100 - 500 15.00 DISTRICT NO. GROUP ZONE PROCESSED BY t
_ ^ e a
SIGNTUElET,OR SIGN AND ONE CIRCUIT 3.00 c ® ^ Z
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
POWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
PERMIT ISSUING FEE 2.00 2 Qb UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 1 11/0 FINAL 6
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION (:5p M.D. 40
Ar,4 6 8 0.R Ate27 2 D 3.40 '41-
SEE
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE