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76A663 CE806 8-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES I
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS oZ� JF_S E
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST oW L AIJ10 ,/el--
RECEPT TOTAL NO EACH FEE
OUTLETS FIRST 20 $20 $ OWNER
LIGHT MAIL
SWITCHADD L 10 ADDRESS
OVER 20
TOTAL CITY���i/ �/f TEL NO T 7
LIGHTING I
FIRST 20 20
FIXTURES OVDRZO 10 ELECTRICIAN
RANGES CLO DRYERS WTR HTRS too ADDRESS
GARB DISP STA COOK
CITY TEL NO
DISHWASH AUTO WASH STATE
SPACE HTRS STA APP (y¢H P MAX) so LICENSE NO
Y
MOTORS OVER NOT OVER H P DISTRICT NO GRIIUP' Z P OC SED Y
too
1 3 1150 INSPECTION RECORD
3 8 200
8 15 250
15 50 300 0
a
50 100 Soo 0
SIGNS NO TRANS
NO LAMPS O
H
SERVICE O 600V NOT OVER 200A 1 00 U
Lu
a
SERVICE O BOON OVER 200 A 200 y
SERVICE OVER 600V 500 ?
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 1100
TOTAL FEE 8�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR B SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR t �.
LICENSED A8 REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PERTY POWER ` T• r. �
SIGNATURE UTILITY
EE CO NOTIFIED r T�
OF PERMITT
FINAL
VALIDATION(---. AR HiJR C VETT
CK MOCASH SUPERVISING ELECTRICAL ENGINEER
L,�Co 4 3 4 OG JAN 13 2 D 5 0 0— ��