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76A663 CE606 12 65 APPLICATION FOR ELECTRICAL PLRM
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS p
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUPERINTENDENT OF BUILDINGLOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST /
RECEPT 1 TOTAL NO EACH I FEE
OUTLETSFIRST 20 �, $20 $ OWNER
LIGHT J} MAIL
SWITCH ADD L 10 ADDRESS
OVER 20
TOTAL FIRST 20I 20 CITY TEL NO
LIGHTING FIXTURES
FIXTURES ADD L I OVER 20 10 CONTRACTOR p Yy/gC `fj �C
�
RANGES DRYERS✓WTR HTRS ` 1 00 400 ADDRESS /T J
GARB DISP STA COOK A /'
CITY �O{ I_ EL NO c fo
DISHWASH AUTO WASH STATE IF-2-/p J 1'l:
SPACE HTRS STA APDL 50 LICENSE NO I'
MOTORS OVER NOT OVER H P DISTRICT NO I G P ONE �PROCWSSED BY
O 1 100 Q �
1 3 150 INSPECTION RECORD a
O
s 8 200 1 L ��� U
w
8 15 250 O
15 50 300 1V
a
50 100 500 N
Z
SIGNS NO TRANS
NO LAMPS
SERVICE O 600V NOT OVER 200A 100
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V 500
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100 APPROVALS DATE INSPECTOR B BIGNATURE
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROU]GHDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIR
1 HEREBY CERTIFY THAT I A ER R ISTERED AND/OR FIXT
LICENSED AS REQUIRED BY L ANG TY AND STATE OF
CALIFORNIA OR THAT I AM T E EGA F AND INTEND TO POW
RESIDE IN THE ABOVE DES 1 D AL PROPERTY
SIGNATURE UTILNOTIFIED / ` /OF PERMITTEE FINAV'`VA-I3
VALIIc Tg JOSEPH S ROELEC
CK M CASH SUPERVISING ELECTRICAL ENGINEER
i
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