HomeMy Public PortalAbout5738AGNES AVE_Electrical 76A663 CE 806R 10,77.. APPLICATION FOR ELECTRICAL PERMIT
T CA`UNeTY OF LOS ANGELES
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DIE F°ARTMENT OF COUNTY ENGINEERJOB
ADDRESS
BUILDING AND SAFETY DIVISION
FOR APPLICANT.TO FILL IN LOCALITY ;%,V0L
New Residential Bldgs.&Pools $ 25 EACH NO. CROSS ST.
NEAREST
1 &2-Family,Sq. Ft. $ FEE OWNER T.
Multi-family Sq. Ft. 02 — FIRM NAME
Residential Swimming Pools 25.00 MAIL ��
�/� ADDRESS c 5736 0- rv� OFF.
Outlets: Rec -7 LightL_Sw. / CITY—Mwof "l. Tel. No —C Z
First 20 ` PLAN CHECK j
Total No. V1 Additional .30 (� APPLICANT
ADDRESS
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Lighting Fixtures First 20 50 CITY C.i
Tel. No.IRIE22A
y Additional .30 PERMIT
Total No. t® APPLICANT
Fixed Appliances Not Over 1 HP ADDRESS
Range_Heater—D.W.— CITYTel.No.
Oven _Dryer—W.M. 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. 2'50 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 >
Up to 1 Incl. 2.50 THE LEGAL OW E OF HE OVE DESCRIBED RESIDENTIAL PROPERTY. a:
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Over 1 to 10 Incl. 5.00 PERMITTEE �
Over 10 to 50 Incl. 12.50
Over 50 to 100 Inc. 25.00
SICNATUR C)
Over 100 40.00 DISTRICT NO. OCES D BY a_
Services z
0-200 Amp. Under 600 V 12.50 APPROVALS DATE SPECTOR'5
201-1000 Amp.Under 600V 25.00 SIGNATURE
Over 1000 Amp.or Over 600 V 50.00 TEMP. POWER POLE
UNDERSLAB WORK
Temp. Power Pole&Appurtenances 10.00
Sign with One Branch Circuit 10.00 ROUGH CONDUIT
Additional Sign Branch Circuits 2.00 WIRING
Misc.Conduits&Conductors 10.00 FIXTURES
,Other(See Complete Fee Schedules POWER AUTHORIZED
UTILITY CO.NOTIFIED
FINAL
PERMIT FEE (Sub-Total) NOTES �„
PLAN CHECKING FEE (One-Fourth Permit Fee) ^
PERMIT ISSUING FEE $7.00
TOTAL FEE �•��
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
S ;g # t 2 U t2.6OL, &i�:3
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE � �
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