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76AS63 CES06 10 62 APPLICATION FOR LECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROs ST
RECEPT TOTAL NO EACH FEE I
LIGHT OUTLETS FIRST 20 $20 $ OWNER
MAIL
SWITCHADD L ADDRESSS91
OVER 20 10
LIGHTING TOTAL FIRST 20 20 CITY &C j TEL N
FIXTURES ADD L
OVER 20 +O ELECTRICIAN
RANGES CLO DRYERS WTR HTRS foo ADDRESS
GARB DISP STA COOK
CITY TEL NO
DISHWASH AUTO WASH STATE
SPACE HTRS STA APP (1/2 H P MAX ) 50 LICENSE NO
MOTORS OVER NOT OVER H P DISj�OT NO GROUP Z-O PROCESSED BY
O 1 1 00 //�
;,
+ 3 150 - INSPECTION RECORD
8 15 250
15 50 300
50 100 500
SIGNS NO TRANS
NO LAMPS LY
SERVICE o 600V NOT OVER 200A 100
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V Soo
MISC
PERMIT ISSUING FEE 200 -71 11
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $ I r
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECT8 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 R ISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES C TY AND STATE OF FIXTURES
CALIFORNIA OR TH I AM THE LEGAL ER OF THE ABOVE
DESCRIBED RESIDEN L PRIDPERTY , POWER
SIGNATURE UTILITY CO NOTIFIED
OF PERMI
FINAL
VALIDATLCASH__l
SU HUR C VETT
CK MO SUPERVISING ELECTRICAL ENGINEER
9
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