HomeMy Public PortalAbout9078ACASO DR_Electrical 4 65 APPLICATION FOR ELECTRICAL�ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS I1 CC
JOHN A LAMSIE COUNTY ENGINEER > i
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPTACLE TOTAL N EACH FEE ,
LIGHT OUTLETS FIRST 20 $20 $ OWNER ' 4
lR�
SWITCH ADD L MAIL
ADDRESS
I OVER 20 10
TOTAL FIRST 20 20 CITY I✓YV �� C✓ TEL NO
LIGHTING FIXTURES
FIXTURES ADD L 10 *CONTRACTO �
OVER 20
RANGES CLO DRYERS WTR HTRS 100 .ADDRESS
GARB DISP STA COOK
CITY N
DISHWASH AUTO WASH ?STATE
APP (%H P AX )
SPACE HTR9 M50 O LICENSE NO
MOTORS OVER NOT OVER HP DIST T N GR1JP Z E7 PR D Y
O 1 100 C/ �� G
1 s 150 INSPECTION RECORD
P
8 S 200
8 15 250
15 50 8 00
� ' V
50 100 500
SIGNS NO TRANS D `O
NO LAMPS y,
W
SERVICE O 600V NOT OVER 200A 1100
N
SERVICE O 600V OVER 200 A 1200 ?
SERVICE OVER 600V 5 00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 200 f
SUPPLEMENTAIRY PERMIT ISSUING FEE 100
TOTAL FEE $ APPROVALS DATE INSPECTOR B SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AN:L[E
+
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STA
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTERESIDE IN THE ABOV DESCRIBED RESIDENTFA OPERTYSIGNATURE NOTIFIEDOF PERMITTEE L
VALIDATION JOSEPH C ROOHAN
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
1 1 1
r
- � 6097* NOV30 2 D 2.70K.
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