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76A663 CE,&O6 10/72 APPLICATION FOR ELECTRICAL PERMIT , r
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' COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
BUILDING AND SAFETY DIVISION ADDRESS A.
LOCALITY 1G� Q�
NEAREST v '
FOR APPLICANT TO FILL IN CROSS ST / 04,4 `'
OUTLETS NO EACHFEE WNER OR
RM NAME h 1P414 co
$ $
RECEPT_ FIRST 20 25ADDRESS / \ ARC
LIGHT TOTAL
OVER 20 CITY Li EL No-2 �,
SWITCH_ ,0 PLAN CHECK
LIGHTING ) FIRST 20 25 5 APPLICANT )
} TOTAL ADDRESS
FIXTURES ) OVER 20 10
RESIDENTIAL APPLIANCES CITY TEL NO
PERMIT /
RANGE DRYEP_WTR HTR_ APPLICANT /
STA COOK DISP F A U t ADDRESS
SPACE HTRAIR COND CITY TEL NO
CLOTHES WASH DISHWASH RICENSE OR
EG NUMBER CLASS
,FAN OTHER 100 1 HENEBI ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THEjABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC HP KW KVA ELECTRICAL WIRING
SIZE & TYPE OVER TO t
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 — I 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
r 1 — 10 300 DESCRIPED RESIDENTIAL PROPERTY per,
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PERMITEE V
10 — 50 500 SIGNATURE �6a
50 — 100 10 00 O
cts
DISTRICT NO PROCESSED BY L+.1
100 — 500 1 j 00
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SIGN GAS SIGN AND ONE CIRCUIT 500
APPROVALS DATE INSPECTOR S SIGNATURE
TUBE OR
MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE
SERVICENOTOVER 600 VOLTS OR 200 AMP 300 UNDERSLAB WORK r v
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SERVI CE OVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT
TEMPSERVICE POLE &APPURTENANCES 500 WIRING + -77fe 2V �
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TEMP LIGHT OR RECEPT SYSTEM 3001 FIXTURES
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POWER AUTHORIZED r
\ UTILITY CO NOTIFIED
FINAL
PERMIT FEE J (SUB TOTAL) \ NOTES
PLAN CHECK FEE )
PERMIT-ISSUING FEE 300
JCAS TOTAL FEEPLANNCHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M o
M Y E
T I
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SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE - 6 5 79'-4-'AU& d6 , 21 1) 4.00 A*