HomeMy Public PortalAbout4815ALESSANDRO AVE_Electrical (4) -.�R ate-, �
76A663C CE8068 12/75 APPLICATION FOR ELECTRICAL PERMIT
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BUILDING A SAFETY DIVISIO
FOR APPLICANT TO FILL IN JOB /
EACH NO FEE ADDRES94 ♦/
rResidential
Bldgs & Pools ,
Sq Ft $ — $ LOCALITY
q Ft — NEAREST
CROSS ST
imming Pools OWNER OR
FIRM NAME V
Outlets Light Switch &Receptacle MAI L
First 20 Q ADDRESS
Additional CITY I No l
/ PLAN CHECK
APPLICANT
Lighting Fixtures
First 20 f e ADDRESS
Additional
CITY Tel No
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT
Range Heater_ D W ADDRESS V�
Oven Dryer W M
Top FAU W H CITY Tel No >-
Hood Fan LICENSE OR
Disp A C REG NUMBER ! ( � Class C-D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Q
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY r
Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V
W
Size&Type HP KW KVA or KVAR ELECTRICAL WIRING N
U to 1 Incl z
/y-�j �� P 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
'I LAD Over 1 to 10 Incl LICENSED AS REOUIR D BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR T I AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 50 Incl DESCRIBED RE51 AL PROPER
Over 50 to 100 Incl PERMITEE 1%
Over 100 SIGNATURE
Services DISTRICT �f OCES 4 BY
0 200 Amp Under 600 V V �^ r/
201 1000 Amp Under 600 VAPPROVALS DATE INSP TOR S
SIGNATURE
Over 1000 Amp or Over 600 V
TEMP POWER POLE
Temp Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits ROUGH CONDUIT (/
v
(Other) WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub Total) UTILITYCO NOTIFIED 42
yt
PLAN CHECKING FEE (One Fourth Permit Fee) FINAL
PERMIT ISSUING FEE
NOTES
TOTAL FEE
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION K M O CASH
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7 7 9til-JUN 2 .2 0 1 0.2 0 s!�b