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76AO63 CESO6 If 51APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINSES FL,
BUMDING AND SAFETY DMSION iPo
rrOHIli A LAMBIE. Connt�Ea aer
CASSRT!D GEIPFIN S P t of t>�dl�
FOR APPLICANT TO FILL IN CROs T
PERNIIT FEES
ITEM NUMBER EACH FEE OWNER DO
OUTLET S E a ADDRESS
LIGHTSMAIL
RECEPT SW 10
LIGHTING FIXTURES �_ 10 CITY TEL NO
ELEC RANGES CLO DRYERS ELECTRICIAN e
WATER HEATERS 50 ADDRESS
ELEC SPACE HTRS DISHWASHERS
GARBAGE DISPOSERS AUTO CITY / TEL N010- 6 2—
WASHERS STA COOKING UNITS 25 STATE
LICENSE NO d (o r0
MOTORS OVER INC Hp
O — 1/z 25
DIS RSjAIO GROUP ZQNE READY FOR INSPECTION
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1/2 — 2 50 w I
2 — 5 100 INSPECTION RECORD
5 — 15 150
15 — 50 250
50— 200 500
SIGNS NO TRANS
NO LAMPS
SERVICE O 600V 100
SERVICE OVER 600V Soo
MISC
WIRING PERMIT 100 Q
FIXTURE PERMIT too Q
SUPPLEMENTARY PERMIT 50
TOTAL FEE $ Q APPROVALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY ANGELE COUNTY AND STATE OF
CALIFORNIA OR THAT 1 T G OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIA PR PER
' SIGNATURE UTILITY CO NOTIFIED
OF PERMITTE
FINAL
/lALMATION SUPERVISIN4S ELE�T I
C MO CASH
1 IAr.06 9 5 --) - t" 25 2 A 2.70
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