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7GA668-CES061-67 APPLICATION FOR ECTRICAL 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 l
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE
1 OUTLETS FIRST 20 R.20 $ OWNER
LIGHT J MAIL
SWITCH ADD'L .10 ADDRESS L
OVER 20
TOTAL FIRST 20 .QO CITY EL.NO.
LIGHTING 1______4 FIXTURESFIXTURES ADD'L 1O CONTRALTO e C
OVER 20
RANGES DRYERS WTR.HTRB. 1.00 ADDRESS Ajdl,03 Amm Di/
GARB.DISP. STA.COOK
CITY TEL.NO —3-o'.03 a3
D18HWASH. AUTO.-WASH. STATE �i1
SPACE HTRB. BTA. APPL. .50
LICENSE NO. a 1.
MOTORS: OVER NOT OVER H.P. DISTRICT NO I GROUP Zojmx P E BY
O 1 I 1.00
1 s 1.50 INSPECTION RECORD
a B 2.00
sI s 2.50
Is so 5.00 d
50 100 5.00 V
SIGNS: NO.TRANS. 09
NO.LAMPS 0
SERVICE 0-SOOV-Nor OVER 200A 1.00 W
SERVICE 0-SOOV-OVER 200 A. 2.00 H
SERVICE OVER 600V 5.00 Z
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR FIXTURES
LICEN8ED A8 REQUIRED Y LOS ANGELES COUNTY AND STATE OF
CALIFORNIA ORT T 1 THE LEGAL OW R OF. D INTEND TO POWER
RESIDE IN.THE AS VE CRI
SI ALP PERTY.
SIGNATU.RE UTILITY CO.NOTIFIED 6F
OF PERMIT'
FINAL
"AJIDATION JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
CK' MO CASH
LALo 0 0 1 5 NO AW 9 2 D 3.0,0- co