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76A663 CE-806(11 /78) APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND-SAFETY
FOR APPLICANT TO FILL IN JOB /J
New Residential Bldgs.&Pools -EACH NO. FEE - ADDRESS
I &2.Family,Sq. Ft. $ .025 — $ LOCALITY
Multi-f.am.Hy Sq. Ft. .02. - NEAREST
Residential Swimming Pools 25,00 CROSS ST.
OWNER OR n �/
FIRM NAME &
Outlets: Rec Light.' Sw. MAIL
U ADDRESS
.+.� First 20 .50 '
Total No.•" ' Additional .30 CITY Tel.IN -lodo
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 .50 ADDRESS
Additional 30
Total No, CITY Tel.No.
Fixed Appliances Not Over-1 HP PERMIT.
APPLICNT J�
Range_Heater_D.W:— ADDRESS
Oven' Dryer—W.M. E
Top _FAU —W.H. _ CITY Tel. No. —4�-
Hood_Fan I Other_ ,
LICENSE OR
Disp._Room Air Cond. 2.50 REG.NUMBER Class,
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA-
I Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
COMPLY WITH ALL'COUNTY -ORDINANCES AND STATE LAWS;
Size&Type HP, KW, KVA,or KVAR 2 50 REGULATING ELECTRICAL WIRING.
Up to 1 Incl I HEREBY-CERTIFY THAT I AM PROPERLY REGISTERED AND/OR , 'u
Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS:ANGELES COUNTY AND STATE OF
Over 10 to 50 Incl. •72.50 CALIFORNIA OR THAT I AM THE,LEGAL,OWNER OF THE,ABOVE ,
Over 50 to 100 Inc-
25.00 DESCRIBED RESIDENTIAL PROPERTY
Over 100 SIGNATURE .
'
40.00 PERMITEE "�
` �
Services - DISTRICT NO. P ESS BY
0-200 Amp.Under 600 V 12.50
201-1000 Amp. Under 600'V' 25.00
Over 1000 Amp.or Over 600 V 50.00 Z
O
Temp. Power Pole&Appurtenances 10.00
Sign with One Branch Circuit 10.00
Additional Sign Branch Circuits 2.00
INSPECTION.
Misc.Conduits&Conductors• INFORMATION'
10.0o ON'REVERSE ' i
Other(,See Complete Fee Schedule) u
SIDE a 631.6
4.o o'o o o 2
PERMIT FEE (Sub-Total) 2 o o ( (!.C
PLAN CHECKING FEE (One-Fourth Permit Fee) O .0 o c /I-ri (t..0
PERMIT ISSUING FEE $7.00' �/ 0 R 2 3 e 7 9
J
TOTAL FEE >
INSPECTION FINALED
a W
date: m/�J /}f'� J�Jj�^ By ` (E)s