HomeMy Public PortalAbout4910AGNES AVE_Electrical (10) EMPLE CITY INS� I
76A663A CE806A 4/72 APPLICATION FOR ELECTRIE'Al WERT u
r COUNTY OF LOS ANGELES
'DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS RII.li
r LOCALITYI TEMPLE CITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
OUTLETS NO EACH FEE
OWNER WINDHAUSEN, JERRY
RECEPT_ $ $ MAIL ABOVE
LIGHT TOTAL FIRST 20 ADDRESS
SWITCH_ OVER 20 CITY TEMPLE 01M 285-2303
PLAN CHECK
LIGHTINGTOTAL FIRST 20 APPLICANT
FIXTURES
OVER 20 ADDRESS
RESIDENTIAL APPLIANCES CITY nANE HCC TEL NO
RANGE DRYER_WTR HTR PERMIT 2034 NORTH PECK IWA
TRANE� APPLICANT
STA COOK DISP F A U ADDRESS
SPACE HTR AIR COND CITY SO EL MQNT -
CLOTHES WASH DISHWASH LICENSE NO CLASS C-2Q
FAN OTHER IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V
IND HEATERS ETC HP KW KVAS ELECTRICAL WIRING
SIZE & TYPE OVER TO
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER(OF AND INTEND TO
1 - 10 RESIDE IN THE ABOVE DESCRIPE2 RESIDENTIAL PROPERTY ti
SIGNATURE
10 - 50 OF PERMITTEE
50 - 100
DISTRICT NO Z NE PROLE S D BY
100 - 500 �-00 T /
SIGN GAS SIGN AND ONE CIRCUIT NOTES
TUBE OR
MARQUEE ADDITIONAL CIRCUITS
SERVICENOTOVER 600 VOLTS OR 200 AMP
APPROVALS DATE INSPECTOR S SIGNATURE
SERVI CE OVER 600 VOLTS OR 200 AMP
TEMP POWER POLE
TEMP SERVICE POLE &APPURTENANCES
TEMP LIGHT OR RECEPT SYSTEM UNDERSLAB WORK
ROUGH CONDIUT
WIRING(01
FIXTURES
OWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO NOTIFIED
PLAN CHECK FEE -
�
PERMIT ISSUING FEE FINAL
v �
TOTAL FEE / OCKMO
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CASH
818 11'0� JUL 1 0.5 0 ®9
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