HomeMy Public PortalAbout5210AGNES AVE_Electrical (15) 78A683 CE 806R 10/77 APPLICATION FOR ELECTRICAL PERMIT l.I
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB (f /,
BUILDING AND SAFETY DIVISION ADDRESS J !i
FOR APPLICANT TO FILL IN LOCALITY
New Residential Bldgs &Pools EACH NO FEE CNEAREST r 17
ROSS ST
1 &2 Family Sq Ft $ 025 —.7
NE
Multi fomily Sq Ft 02 — "RM NAMRE
Residential Swimming Pools 2500 MAIL
ADDRESS
Outlets RecLight Sw � r CITY Tel No
/ First 20 50 V 20,0 PLAN CHECK
Total No [ Additional 30 APPLICANT
ADDRESS
Lighting Fixtures First 20 50 S S6 CITY Tel No
Additional 30 PERMIT
Total No - APPLICANT
Fixed Appliance Not Over 1 HP ADDRESS—v
Range eater D W CITY t Tel No
Oven _Dryer_W M
Top —FAU —W H } R G NUMBER Class
Hoodan _Other- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp Room Air Cond 250 a D THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN
ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING
Power Apparatus&Large Appliances
Size&Type HP KW KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM ?�
Up to 1 Incl 2 5O THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY
Over 1 to 10 Incl 500 cD
PER
Over 10 to 50 Incl 1250 RMITTEE
01
Over 50 to 100 Inc 2500 SIGNATURE
Over 100 4000 DISTRICT NO 3ED BY o..
Services
Z9(P z
0 200 Amp Under 600V 1250 INSPECTOR 5
201 1000 Amp Under 600 V
2500 APPROVALS DATE SIGNATURE
Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE
UNDERSLAB WORK
Temp Power Pole&Appurtenorces
1000
Sign with One Branch Circuit 1000 - ROUGH CONDUIT
Additional Sign Branch Circuits
2 00 WIRING
Misc Conduits&Conductors 1000 FIXTURES
Other(See Complete Fee Schedule) POWER AUTHORIZED
UTILITYCO NOTIFIED _
FINAL 7 -7 s"
PERMIT FEE (Sub Total) NOTES
PLAN CHECKING FEE (One Fourth Permit Feel a
PERMIT ISSUING FEE $700 �01 ~
TOTAL FEE I
PLAN CHECK VALIDATION CK + MO CASH PERMIT VALIDATION CK M O CASH
2 ?y �>
Aix
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 2 7 9 MAY 4 2 0 2