HomeMy Public PortalAbout5211AGNES AVE_Electrical (2) 76A68�3 ;, ,77 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB I
BUILDING AND SAFETY DIVISION ADDRESS ;7
EAREST—
FOR APPLICANT TO FILL IN LOCALITY t
New Residential Bldgs &Pools EACH NO FEE CROSS ST
1 &2 Family Sq t $ 025 — $ C
OWNER OR
Multi family Sq Ft 02 — FIRM NAME
Residential Swimming Pools 2500 AMAIL
DDRESS
1
Outlets Rec - Llght_Sw CITY Tel
First 20 50
PLAN CHECK
Total No Additional 30 APPLICANT
ADDRESS
I
Lighting Fixtures First 20 50 CITY Tel No
Additional 30 PERMIT
Total No APPLICANT i
Fixed Appliances Not Over 1 HP ADDRESS
Range—Heater_ W CITY Tel No
Oven _Dryer h M_ LICENSE O
Top —FAU ��// W H I REG NUMBER Class
Hood—Fan —Other HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp — Room Air Cond 250 THATITHE 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 CERTIFYPAIAM PROPERLY REGISTERED AND/OR LICENSED AS
REOUIREO BY LOS A OUNTY AND STATE OF CALIF RNIA OR THAT I AM Up to 1 InC 250 THE LEGAL OW R F TOVE DESCRIBED RE
PERTY �O
Over 1 to 10 Incl 500 1
Over 10 to 50 Incl 12 50 PERMITTEE /o
Over 50 to 100 Inc 2500 SIGNATURE t3
Over 100 4000 DISTRICT NO ROCESS D BY nW.
I
Services I (f `
0 200 Amp Under 600 V 1250 APPROVALS DATE IrVtt-I UK
201 1000 Amp Under 600 V 2500
RE
Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE
Temp Power Pole&Appurtenarces
1000 UNDERSLAB WORK
Sign with One Branch Circuit 1000 ROUGH CONDUIT
2 00 WIRING
Additional Sign Branch Circuits
A , AV 17U
Misc Conduits&Conductors 1000 FIXTURES
Other(See Complete Fee Schedule) POWER AUTHORIZED r
UTILITY CO NOTIFIED
FINAL
PERMIT FEE (Sub Total) NOTES !7
i
PLAN CHECKING FEE (One Fourth Permit Feel I
PERMIT ISSUING FEE $700
I
TOTAL FEE
PLAN CHECK VALIDATION CK M 0 CASH ; PERMIT VALIDATION CK M 0 CASH
C_
27 5CPJUN 29 2 0 2 7G0tz,,>:,
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE i
rte— R