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76A663CE-806(11 /78) APPLICATION FOR ELECTRICAL PERMIT`
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT.TO FILL IN JOB
New Residential.;Bldgs.&Pools EACH NO: FEE ADDRESS
1.&2-Family,Sq. Ft: $ .025 — $ LOCALITY l -
Multi-family Sq. Ft. .02 — NEAREST �r
Residential SwimmingPool2500 CROSS ST.
s . OWNER OR
FIRM NAME
Outlets: Rec Light MAIL �',r�
Firstst 2 20
50 ADDRESS `T�U
Total No. Additional .30 CITY • '%/ �!_ el_No. (?C..7C�
PLAN CHEC
APPLICANT �.
Lighting Fixtures First 20 .50 ADDRESS
Additional .30 - - ••
Total No. CITY1Z Tel. No.
Fixed Appliances Not-Over 1 HP PERMIT - r -
Range—Heater— D.W. _ APPLICANT �/$ /'� /C.� /
0
Oven_Dryer_W.M. ADDRESS - • d �V �,� �✓J" - '
Top _FAU — W.H. CITY
Hood_Fan _Other_ LICENSE OR
Disp.—Room Air Cond. _ 2'50 REG.NUMBER 7 Z2. 6 class./_#3`7-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA.
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND-STATE LAWS' Ai
Size&Type HP, KW, KVA,or KVAR 2.50 REGULATING ELECTRICAL WIRING.
Up to 1 Incl.' I HEREBY CERTIFY'THAT'I AM PROPERLY REGISTERED AND/OR ¢�
Over 1-to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF E'
Over 10 to 50 Incl. 12.50' CALIFORNIA OR THAT_.I AM THE LEGAL OWNER.OF THE-ABOVE
Over 50 to 100 Inc. SC
25.00 DERIBED RESIDENTIAL PRO. �
40.00 PERMITEE
Over 100 SIGNATURE r�
Services fDISTRICT NO. ROCE ED BY • `�
0-200 Amp.Under 600 V 12:50 ��
201-1000 Amp.'Under 600 V 25.00
Over 1000 Amp.or Over 600 V 50.00 r'�i' e �- Z
Temp. Power Pole&Appurtenances
10.00 � [.�:L�/•S �.� -
Sign with One Branch Circuit 10.00
Additional Sign Branch Circuits 2'00 •INSPECTION. >
INFORMATION v
Misc.Conduits&Conductors 10.00 ON REVERSE Y
Other(See Complete Fee Schedule) SIDE u Q 6 7 1,10 A
# 600'oo2.
201200
PERMIT FEE (Sub-Total)
PLAN CHECKING FEE (One-Fourth Permit Feel O o '0 0 1 2 0 0
PERMIT ISSUING FEE $7.00 7 G
0 9, 1 4 7-9
J
Q
TOTAL FEE / Z >
INSPECTIOk FINALED ;f W
date: t By
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