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76A663-CE806 12-65 APPMCAMN FOR. MECO° PAL p��°3�0� � _
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER ate®
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY i
NEAREST
FOR APPLICANT TO FILL IN
CR ST.
RECEPT. TOTAL -
OUT EACH $- FEES OWNER /�'t �- IJ
LIGHT�- ��- I FIRST 20 .20 MAIL
ADD'L ADDRESS
SWITOH OVER 20 .10
TOTAL FIRST 201 .20 ,/�, CITY _ '. TEL. NO. J„��1`'� r✓
LIGHTING FIXTURES V yy
FIXTURES i. ADD'L 10 CONTRACT R
OVER 20
RANGES DRYERS WTR.HTRS. 1.00 ADDRESS \
GARB.DISP. STA.COOK
CITY TEL.NO.
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA. APPL. .50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISC N P P O
O 1 1.00
1 3 1.50 INSPECTION RECORD D_
O
3 8 2.00 V
8 15 2.50r-
15 50 3.00 - lJ
W
0-
50
50 100 5.00 N
Z
SIGNS: NO.TRANS. _
NO.LAMPS
SERVICE 0.60OV-NOT OVER 200A 1.00
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATUR¢
TOTAL FEE
I HEREBY ACKNOWLEDGE THAT 1 HAVREAD THIS APPLI ATI N UNDERSLAB WORK
E
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT .. ��
WITH ALL COUNTY ORDINANCEeA D STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM P OPE R€GISTERED AND�OR FIXTURES
LICENSED AS REQUIRED BJf�LOs GE Sc NTY AND_ ATE OF
CALIFORNIA OR THAT I A' E GAL N OF,A/ND " TEND TO POWER
RESIDE U THE ABOVE D��Stfl.BE/� i}E EW Lr SPE Y. J
SIGNATURE /V,11{' ]U?`d UTILITY CO.NOTIFIED
OF PERMITTEE— Y o
FINAL 12 - t
VALIDATPPd--1 JOSEPH
/�i SUPERVISING
CK MO ELECTRICAL
TRICAL ENGINEER
CASH
L 5 8_2 3 Z8 NOV 15 2 U 4 o4 0