HomeMy Public PortalAbout5210AGNES AVE_Electrical (2) 16A663 CES06 10 61 APPLICATION FORr ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING ^ ! QAC
BUILDING AND SAFETY DIVISION ADDRESS e1. l
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY latA
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
I T E M NO EACH FEE C
OUTLET (FIRST 20) $20 $ OWNER
LIGHTS RECEPT SW D MAIL
OUTLETS (ADD L UNITS) f0 ADDRESS
LIGHTS RECEPT SW
LIGHTING FIXTURES (FIRST 20) 20 ( O CITY TEL NO
LIGHTING FIXTURES (ADDITIONAL) 10 ELECTRICIAN
RANGES CLO DRYERS WTR HTRS 100 ADDRESS .20 8
GARB DISP STA COOK h
CITY TEL NO
DISHWASH AUTO WASH STATE `�
SPACE HTRS STA APP ('/.H P MAX) 50 LICENSE NO / V J /
MOTORS OVER NOT OVER HP DIST ICT O GROUP ZONE PR ESSED'BY/
O 1 100
1 3 15o INSPECTION RECORD r
a
3 s 200 O
V
8 15 250
15 5o 300 O
50 100 Soo
a
SIGNS NO TRANS Z
NO LAMPS y
SERVICE O 600V NOT OVER 200A 100
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V Soo
MISC
PERMIT 1 ISSUING FEE 200 0
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CATION APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT /h
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING !
ELECTRICAL WIRING _ WIRING m 7
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR !✓ '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGA OWNER OF THE ABOVE v
DESCRIBED RESIDENTIAL PRO RT POWER
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEEcp
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FINAL /] Q X ;�
VALIDATCARTHUR C VETT
CK MO CASH "
SUPERVISING ELECTRICAL ENGINEER
LAf:o2 8 3,2 o AM1 0 2 D 7.60- Q `
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