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76A663 CE806 8-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER 1
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY /
NEAREST
FOR APPLICANT TO FILL IN CROSS ST cc,Pr U 5
RECEPT TOTAL NO EACH FEE
OUTLETS FIRST 20 + $20 $ OWNER 70,y Z
LIGHT MAIL
/ ADD L f0 ADDRESS
SWITCH / OVER 2O
1 TOTAL CITY TEL NO
LIGHTING I FIRST 20I 20 L(7
FIXTURES 1 ' ADD L 10 ELECTRICIAN �/ Pr—
OV R 20
RANGES CLO DRYERS WTR HTRS 100 ADDRESS
GARB DISP STA COOK
CITY TEl NO
DISHWASH AUTO WASH STATE
SPACE HTRS STA APP (/t H P MAX ) 50 LICENSE NO
oTORS OVER NOT OVER H P DISTRICT NO G)UP +ZONE P C S D�BY
0 1 �100 'CJ
1 3 150 1 IINN�ygSPxI�EEC-TTIIION RECORD c �
S B 200 �1)vv+!/d' tY_V1 Jam. - �./-�/t�,Y�✓1kYfL
8 15 250 .,npwM�' ,Lo'� A/.kA� �•.-
i 15 50 300 tKJ �1� f�(� �[6+l__ a
_11.5
50 100 500
rr O
V
SIGNS NO TRANS
NO LAMPS 0
SERVICE O 600V NOT OVER 200A 100 rW
SERVICE O 600V OVER 200 A 200 O.
N
SERVICE OVER 600V 500
ti
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL CATION APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT i • ./
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING 9Aly
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR P° (III � .
LICENSED A9 REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURESs�/✓.Ilt�
CALIFORNIA OR THAT 1 M THE LEGAL F THE A VE
R
DESCRIBED RESIDENT I OPERTY POWER
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE Dp p6,r� / � JA
FINAL
VALID ARTHUR C VEIT v r
CK MCASH SUPERVISING ELECTRICAL ENGINEER
LhC� 5950-1� tcv17 2 360- v