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76A663 CES06 468 APPLICATION FOR ELECTRICAL VEERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING /n�
BUILDING AND SAFETY DIVISION ;-
ADDRESS . 22 /�N 4
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST pJ
NO EACH FEE
$ $ OWNER N
RECEPT _ MAIL
LIGHT TOTAL FIRST 20 20 ADDRESS .1-2-26 e
SWITCH_ OVER 20 10 CITY P TEL NO
PLAN CHECK
LIGHTING TOTAL FIRST 20 20 APPLICANT QAI
FIXTURES OVER 20 10 'ADDRESS f'
RANGE—DRYER_WTR HTR — CITY 7& TEL NO
STA COOK_DISP _F A U — COI4TRAC TOR
G
SPACE HTR AIR COND
ADDRESS
CLOTHES WASH —DISHWASH CITY TEL NO
FAN—OTHER I 1 00 LICENSE IAO CLASS
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
0 - 1 1 00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 - 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE.LEGAL OWNER OF AND INTEND TO
10 - 50 5 00 RESIDE IN THE ABOVE D RIP ESI IAL PROPERTY CLO
SIGNATURE U
50 - 100 10 00 OF PERMITT p
100 - 500 15 00 U
DIST I T O G UP Z/0)N�7y PR SSED BY a
SIGN GAS [ADDITIONAL
GN AND ONE CIRCUIT 3 00 1. A ( Z
TUBE OR nx/ ry
MARQUEE CIRCUITS 1 00 NOTES (/ � r
^r�
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR S SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (507 PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2 00 UTILITY CO NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE4lovJOSEPH C OOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M 0 ASH'
7 3% AUG11 2 U 4.00-
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ,v f/