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76A663 CE806 B-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING /r�1
BUILDING AND SAFETY DIVISION ADDRES6 V /moi .LL
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPT TOTAL NO EACH FEE /
OUTLETS FIRST 20 1,
20 $ OWNER
LIGHT MAIL
ADD L 10
LIGHTING ADDRESS
SWITCH
OVER 20
TOTAL F7Rsr 20 20 CITY EL NO
FIXTURES OVrR20 10 ELECTRICI N1 ` Lo
RANGES CLO DRYERS WTR HTRS foo ADDRESS +— I -I/
r
GARB DISP STA COOK
CITY (� (-�- TEL NO
DISHWASH AUTO WASH STATE
SPACE HTRS STA APP (y¢H P MAX) 50 LICENSE NO
MOTORS OVER NOT OVER HP DISTRICT NOG UP ZONE PR C ED�
O 1 1 00 'pI
1 3 / 1 50 1, S INSP CTION RECORD
3 S 200
8 15 250
15 50 3 00
d
50 100 500 O
U
SIGNS NO TRANS
NO LAMPS 0
SERVICE 0 600V NOT OVER 200A 1100 ( Q l W
SERVICE O 600V OVER 200 A 200 a
N
SERVICE OVER 600V 500
MISC
PERMIT ISSUING FEE i200
SUPPLEMENTARY PERMIT ISSUING FEE 1100
TOTAL FEE $ C
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS 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 /
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 1
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGA OWNER OF THE ABOVE
DESCRIBED RESIDENT L PROPERTY ` POWER
1
S9IGNATURE LQ UTILITY CO NOTIFIED
OF PERMITTEE FINAL S 1L
rY,QLIDATION AR HUR C VETT
(CK MO CASH SUPERVISING ELECTRICAL ENGINEER
k.&02063=0 J&31 2 D 4.50- q
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