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76A663 CE806 10 62 APPLICATION FOR LECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER /O
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY C-�
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPT TOTAL NO EACH FEE
OUTLETS FIRST 20 $20 $ OWNER r'
LIGHT
4 MAIL
SWITCH ` OVERAD. 10 10 ADDRESS
LIGHTING TOTAL FIRST 20 20 CITY T NO
FIXTURES ADD L
OVER 20 10 ELECTRICIAN
RANGES CLO DRYERS WTR HTRS too ADDRESS
GARB DISP STA COOK V
CITY - i/ TEL N'0'al
DISH WASH AUTO WASH STATE
SPACE HTRS STA APP (/ H P MAX ) 50 LICENSE NO
MOTORS OVER NOT OVER H P DIST ICT 91g GROUP NE P O ESSED B
O 1 100 � }S
3 1 so ( INSPECTION RECORD
3 S 12 00
S 15 250 f0
Gvl U
15 50 300 AC
50 100 5 00 0
SIGNS NO TRANS d
NO LAMPS h
z
SERVICE 0 600V NOT OVER 200A 100
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V 500
MISC t
PERMIT ISSUING FEE 200 p
SUPPLEMENTARY PERMIT ISSUING FEE too
TOTAL FEE IS 50
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING tA 1
1 HEREBY CERTIFY THAT I AM PROPE Y REGISTERED AND/OR i pit-
LICENSED
AS REQUIRED BY LOS ANGE S COUNTY AND STATE OF FIXTURES (/"/
CALIFORNIA OR THAT I AM THE LE OWNER OF THE ABOVE
DESCRIBED RESIDENTIA O Y POWER
SIGNATURE i UTILITY CO NOTIFIED irf'
OF PERMITTEE
VA (DATION ARTHUR C VEIT
CK MO CASH '
SUPERVISING ELECTRICAL ENGINEER
LAU) 8 0 3 41�v APR 3 2 D 4 50-