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76A663 CE806 4 65 APPLICATION FOR EI. CTRICA L PERMIT
COUNTY OF LOS ANGELES
DEPrARTMt:NT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS --
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPTACLE TOTAL NO EACH FEE r
LIGHT OUTLETS FIRST 20 $ 20 $ OWNER L L
MAIL
SWITCH � ADD L 'I 1O ADDRESS
OVER 20 /Gy` O I--,
TOTAL FIRST 20 20 CITY TEL NO
LIGHTING I
FIXTURES
FIXTURES ADD L 10 CONTRACTOR
OVER 20
RANGES CLO DRYERS WTR HTRS loo ADDRESS
GARB DISP STA COOK
' CITY Aj A, TEL NOS 3 b
DISHWASH / AUTO WASH STATE
SPACE HTRS STA APP (y¢H P MAX ) 50 I �.. Q LICENSE NO Q
MOTORS OVER NOT OVER HP DISIEZJCT NO GR,O�UP ZONE �PPQCESSED
�IgX
0 1 100 ----/
1 3 150 INSPECTION RECORD
_ _p. � g1
3 8 200 �� �� 'p e V��
8 15 250
15 50 300 //� ♦ d � A'.,��,f,,�
50 100 5 00 �C+l daa!'suegdlC 0d,
�Ia GuC
SIGNS NO TRANS O
NO LAMPS �"^ x
SERVICE 0 600V NOT OVER 200A 100 f a
t�
SERVICE O 600V OVER 200 A 2 00
SERVICE OVER 600V Soo
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 1 00
TOTAL FEE $ AP OVALS DATES �INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LI ATION UNDERALZ3 WORK -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT !
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING r� 1
ELECTRICAL WIRING WIRING Wjp I
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR t
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT THE LEGAL OWNER OF AND INTEND TO POWER
RESIDE IN THE OV DE CRIBED ENTIAL PROPERTY
SIGNATURE UTILITY CO NOTIFIED /n
OF PERMITTEE ,i --
FINAL
C �A,JJJII JOSEPH C ROOHAN
CK MOO CAS CASH SUPERVISING ELECTRICAL ENGINEER
" LACO7 1 2 9',,' NOV 5 2 D 1 8.3 0~ Q