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78A889 CE808 70 69
APPLICATION FOR ELECTR C PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERIM PEER CROSS ST
1 T E MNUMBER EACH FEE OWNER
OUTLET $ $ MAIL
LIGHTS RECEPT BW ,0 +� ADDRESS
LIGHTING FIXTURES 10 L CITY TEL NO
ELEC RANGES CLO DRYERS ELECTRICIAN r
H E A T E R S 50 ADDRESS
ELEC SPACE HTR DISHWASHERS CITY TEL NO /
FGARBAGEDISPO Y� AUTO STATE /
WASHERS STA COIKING UNITS 25 LICENSE NO
MOTORS OVER INC H P DIST ICT NO GROUP I ZONE I PROC SED BY
0- 1/2 25 ZlrO
3
1/2— 2 50 / INSPECTION RECORD
2— s 100
5— 15 ISO
Is- 50 250
50-200 5 00 - .�1' Z
en
SIGNS `c �fes//
NO TRANS --% A--Ano D �"" �w�.M"`d-A'
NO LAMPS
SERVICE O 600V 100
SERVICE OVER 600V 500 �I ga go �h/,25MISC A
WIRING PERMIT 100
FIXTURE PERMIT 100
SUPPLEMENTARY PERMIT 50
TOTAL FEE S
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICA ION APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING N
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM TH LEGAL OWN�ROFHE ABOVE FIXTURES
DESCRIBED RESIDENTI PROP TY POWER
SIGNATURE UTILITYCO NOTIFIED
OF PERMITTE d"
FINAL
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
DATION
AC06021EP 7 42- G 11 75