HomeMy Public PortalAbout5028AGNES AVE_Electrical (3) Y r
76A663 CEr806(11 /78) - Y c ✓�
APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AN S FETY d
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs &Pools ^ EACH NO- FEE r� ADDRESS -
1 &2 Family Sq Ft $ 025 — $ LOCALITY,-- ^
_�Multi family-Sq- Ft -� 02 — NEAREST 1
Residential Swimmin Pools 25 00 CROSS ST y✓ w _
g OWNER OR-- -- - it--
FIRM NAME I
Outlets Rec ' Light Sw MAIL
First 20 50 ADDRESS ^
....,Total No Additional 30 CITY , �L _ Tel No
PLAN nECK p�
_ , M APPLICANT
Lighting Fixtures' First 20 50 ADDRESS v
^ Additional 30, _ _ T _ - -- ---
Total Na CITY } r No
FixedrAppliances Not Over 1-HP PERMIT
+ APPLICANT ,
Ronge� Heater_D W
OvenDryer_W M— ADDRESS-
'Top FAU — W H CITY
Hood_Fan - Other_ ' }~
LICENSE OR
Disp —Room Air Cond _ 2 50_ REG NUMBER . _ __.Clas�
y i ` I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPETCA 4�
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
COMPLY WITH ALL-COUNTY-ORDINANCES AND STATE L-AWSt
Size&Type HP KW KVA or KVAR 2 50 , v _ REGULATING ELECTRICAL WIRING 0
Up to 1 Incl , ,f
I HEREBY CERTIFY THAT MM PROPERLY REGISTERED AND/OR --IU
Over�l to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNT 'AND STATE OF jS
Over 10 to 50 Incl 12 50 _ CALIFORNIA OR THAT AM THE LEGAL OWNE OF THE ABOVE Q
25 00 DESCRIBED RESIDENT L ROPERTY _
Over 50 to 100 Inc /
Over 100 -40 00 - _ PERMITEE
SIGNATURE N
Services - w _ `- _-Z
12 50 DISTRICT NO- `" ROCESS D BY
0 200 Amp Under 600V Yv O� D
`201 1000 Amp Under 600 V s 25 00
Over 1000 Amp or Over 600 V 5000
L Y� p O 4h
Temp Power Pole&Appurtenances 10 00 ],/ p� /7S2 * +
Sign with One Branch Circuit ^ 1000 Iv 2 i
Additional Sign Branch Lcurts 2 00 INSPECTION > t
INFORMATION u � ]�4,6 A i
Misc Conduits&Conductors 1000 - ON REVERSE "� i
Other(See Complete Fee Schedule) Y SIDE u '
F — t ' Z # O o 0 0 0 2
wa.a. 2`0 1 200
PERMIT FEE (Sub Total) T _ 0 0 os� 200,5
PLAN CHECKING FEE (One Fourth Permit Fee) T ` O r Q03,-79
z 1
Q 1
PERMIT ISSUING FEE + $7 00
h 1 �
TOTAL FEE °/ >
INSPECTION F NAcc
---77ILED
date /U�� ' By �j1JlJ�i�✓� 4 6 ry r fYos