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76A663 CES06 4 65 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS �O S
JOHN A LAMBIE COUNTY ENGINEER J ,
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPTACLE1 TOTAL NO EACH FEE t
LIGHT l OUTLETS FIRST 20 $20 $ U OWNER
J( MAIL
SWITCH ADD L f0 ADDRESS
OVER 20
TOTAL
LFIRST 20 20 CITY TEL O
IGHTING FIXTURES
FIXTURES ADD L f0 CONTRACTOR c
OVER 20
RANGES CLO DRYERS WTR HTRS 100 ADDRESS O U
GARB DISP STA COOK
CITY NO
DISHWASH AUTO WASH STATE
SPACE HTRS BTA APP (1/z H P MAX ) 50 LICENSE NO D
MOTORS OVER NOT OVER H P DISTRI T GRP ZONE PRS
O ED BY
O 1 100
1 3 150 Q INSPECTION RECORD
3 8 200
t
8 15 250 ` LI °
a
15 50 300 O
U
50 100 500
9x
NO TRANS O
SIGNS NO LAMPS V
W
SERVICE O 600V NOT OVER 200A 100, a
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V Soo
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 200 Ol}
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE 910 APPROVALS DATE INSPECTOR 8 SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAS WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO POWER
RESIDE IN THE ABOVE ESCRI BE ES EN L PROPERTY
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE FINAL
�LIDATION JOSEPH ROO
CK MO CASH
SUPERVISING ELECLEC
TRICAL ENGINEER
5 {)'52 SEP 3 0 2 D 4 9 Q q
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