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19A663 CEBQB a APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY ��� Le- [~
NEAREST
FOR APPLICANT TO FILL IN CROSS ST J
NO EACH FEE
RECEPT _
$ $ OWNER
MAIL
LIGHT TOTAL FIRST 20 / 20 j ADDRESS Q
SWITCH_ OVER 20 10 CIT TEL NO
PLAN 'CH +
LIGHTING �--LA
TOTAL FIRST 20 20 APPLICANirFIXTURES OVER 20 10 ADDRESS
RANGE_DRYER—WTR HTR CITY TEL NO t
STA COOK_DISP _F A U
COIJTRAC rOR � •
SPACE HTR AIR COND
DDRE O
CLOTHES WASH —DISHWASH CITY EL NO
FAN—OTHER 1 00 LICENSE NO CLASS J�
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
0 - 1 1 00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 - 10 1 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
10 - 50 5 00 RESIDE IN THE ABOVE DESCRIP RESIDENTIAL PROPERTY
SIGNATURECL
SO - 100 10 00 OF PERMITTEE • O
U
100 - 500 15 00
SIGN cns DIS ICT NO G P PN-F, OCE Fn� {j���j CD
CD
TUBE OR SIGN AND ONE CIRCUIT 3 00 •(f L U
MARQUEE W
ADDITIONAL CIRCUITS 1 00 NOTES
Z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR S SIGNATURE
TEMP POWER POLE
UNDERSLA13 WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
PLAN CHECK FEE (50% PERMIT FEE) FIXTURES
POWER AUTHORIZED
PERMIT ISSUING FEE 200 b UTILITY CO NOTIFIED
zZ
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE O JOSEPH C ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK M o CAStaH+ r, g
VPERMIT VALIDATIONcK
//'� y�M o CASH
^ LLS 1t 1 g 0: D Jai "i'0 �?
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE