HomeMy Public PortalAbout5728AGNES AVE_Electrical 76A66�CC e116q 110,77 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
ADDRESS c
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN LOCALITY
New ResideAal`Bldgs &Pools EACH NO FEE NEAREST
1 &2 Family Sq ROSS ST
Ft $ 025 — $ OWNER T
Multi family Sq Ft 02 — OR
FIRM NAME
Residential Swimming Pools 25 00 MAIL
ADDRESS
Outlets Rec LightSw CITY Tel No
First 20 50 PLAN CHECK
Total No Additional 30 _ APPLICANT
y
ADDRESS
J
Lighting Fixtures First 20 56 /, 00 CITY Tel No
Additional 30 PERMIT
Total No APPLICANT
Fixed Appliances Not Over 1 HP i ADDRESS
Range—Heater_D W CITY Tel No
Oven _Dryer—W M_ vmitM
LICENSE OR
Top —FAU —W H REG NUMBER /'— Class
Hood_Fan _Other- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp — Room Air Cond 250 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 Y'
Up 10 1 Incl �//// 2 5O THE LEGAL OWNER OF THE ABOVE DESCRIBED RESID TIAL PROPERTY
Over 1 to 10 Inc(1'n/� 500 v
Over 10 to 50 Incl 12 50 PERMITTEE
Over 50 to 100 Inc 2500 SIGNATURE
Over 100 4000 DISTRICT NO PR SE Y d
�— 00 cn
Services Z
0 200 Amp Under 600V 12 50INSPECTOR S
201 1000 Amp Under 600 V
2500 APPROVALS DAT SIGNATURE
Over 1000 Amp or Over 600 V 5000 TEMP POWER POLE
UNDERSLAB WORK
Temp Power Pole&Appurtenarces 1000
_
Sign with One Branch Circuit10 00 ROUGH CONDUIT
rcuit 200
Additional Sign Branch Circuits WIRING
Misc Conduits&Conductors 1000 FIXTURES
Other ISee Complete Fee Schedules ]POWER AUTHORIZED
UTILITY CO NOTIFIED
FINAL �r y
PERMIT FEE (Sub Total) /` NOTES
PLAN CHECKING FEE (One Fourth Permit Feel qL ...
a
PERMIT ISSUING FEE $700
TOTAL FEE �
PLAN CHECK VALIDATION CK M O CASH PERMIT LIDATION CK M O CASH
r
95 JUN 13 2 3200 � Ei
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE