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11 APPLICATION FOR ELECTRICA PERMIT
COUNTY, OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 7ADDRESS
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BUILDING AND SAFETY DIVISION e S
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING
FOR APPLICANT TOFILL IN IIIIIIIII
FOR
CROS ST t/
NO EACH FEE
$ $ OWNER J^_ c-
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RECEIPT -4 MAIL
LIGHT TOTAL FIRST 20 20 ADDRESS_
f - CITY 'e/ry7 Il G TEL NO 4)a-
SWITCH OVER 20 10 PLAN CHECK
LIGHTING TOTAL FIRST 20 20 APPLICANT
FIXTURES }_ OVER 20 10 ADDRESS
RANGE DRYER WTR HTR CITY TEL NO
STA COOK_DISP F A U CONTRACTOR y,
SPACE HTR AIR COND ADDRESS
CLOTHES WASH DISHWASH CITY TEL NO
FAN_OTHER 1 00 /` LICENSE NO CLASS
MOTORS TRANSFORMERS RATING / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
IND HEATERS ETC HP KW KVA AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
0 - 1 1 OO 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
ICENSED AS REQUIRED BY L05 ANGELES COUNTY AND STATEOF }
1 - 10 3 00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO a
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY c
10 - 50 500 ', � U
SIGNATURE �� �i� Ix50 - 100 10D0 OF PERMITTEE Q
lOO - SOO 1500 DISTR T N V GGR' ZO P SED BV CL
SIGN GAS SIGN AND ONE CIRCUIT 3 00 Jc+-` N
TUBE OR z
MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTORS SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
PLAN CHECK FEE (507 PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2 00 00 UTILITY CO NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE its JOSEPH C ROOHAN
Y1/ SUPERVISING ELECTRI ENGINEER
PLAN C N CK CK VALIDATION CK M D ASH PERMIT VALIDATIOM 0 CASH
IU 6 6 ? 0r 4.40- 4
SEE BACK OF APPI ICATION FnR COMPLFTF FEF «HFOULF I ak