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5-62 APPLICATION FOR EL�CTRI AL PERM(
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING �j 9 1
BUILDING AND SAFETY DIVISION ADDRESS �/
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE
OUTLETS FIRST 20 $20 $ OWNER
LIGHT MAIL
ADD'L
SWITCH. OVER 20 P`DDRESS
10
LIGHTING 1r TOTAL (FIRST 201 ,20 CITY TEL.NO.
FIXTURES I ADD'L OV R 20 1O ELECTRICIAN'
111
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DISP. STA.COOK
CITY TEL. NO.
DISHWASH. AUTO.-WASH. STATE '
SPACE HTRS. STA.APP.('/z H.P.MAX.) .50 �O LICENSE NO. d
L5 C-1
MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP ZONE PR SSED BY
O 1 1.00 %
1 3 1.50 INSPECTION RECORD
3 8 2.00
8 15 2.50 D-
O
15 50 3.00 V
50 100 5.00 w
O
SIGNS: NO.TRANS U
NO.LAMPS LU
D_
SERVICE 0-600V-NOT OVER 200A 1.00 Z
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
i PERMIT ISSUING FEE 2.00 �.
SUPPLEMENTAgY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS TE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
F ELECTRICAL WIRING. WIRING / I
I 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR I
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
OF
RESIDENTIAL PROPERTY POWER
SIGNATURE .� UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL
VALIDATION ARTHUR C. VEIT
(�CK ,! MO CASH SUPERVISING ELECTRICAL ENGINEER