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76A663-CEB06 11-71 APPLICATION FOR ELECTRI . AL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
B �6,0UILDING AND SAFETY DIVISION ADDRESS
LOCALITY
NEAREST 000,
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACH I FEE
OWNER
RECEPT._ $ § MAIL
LIGHT TOTAL
FIRST 20 ADDRESS
CITY TEL. NO.
SWITCH OVER 20 10. PLAN CHECK/
LIGHTINGl FIR
FIXTURES ST 20 .Zg APPLICANT
)} TOTAL
OVER 20 .10 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT f
STA. COOK DISP.-J—F.A.U. ADDRESS, . �J
SPACE HTR. AIR COND. CITY �~ TEL. NO
CLOTHES WASH. DISHWASH. LICENSE N0. CLASS.
FAN OTHER1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE-THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND, HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF d
CALIFORNIA OR THAT I AM THE L GAL OWNER OF, AND INTEND TO
i - 10 3.00
RESIDE IN, THE AS VE DES IBED R;SIDE NT AL PROPERTY. V
SIGNATURE - ix
10 - 50 5.00 OF PERMITTE O
50 - 100 10.00
DISTRICT NO. ASS ZO E PR SE
100 - 500 15.00
&I Z
SIGN, GASSIGN AND ONE CIRCUIT S.00 NOTES:
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICE NOTOVER 600 VOLTS OR 200 AMP 3.00
SERVICEOVER 600 VOLTS OR200AMP 10.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP.POWER POLE
TEM P S ERVI CE,POL E,&APPU RTENAN CES 5.00
TEMP LIGHT OR RECEPT. SYSTEM 3.00 UNDERSLAB WORK
ROUGH CONDIUT
WIRING
FIXTURES
PERMIT FEE (SUB TOTAL) POWER AUTHORIZED
UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL
ELI
FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION' CK. M.0.
CASH
6 6.6: a , Jm26 2 D 82
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE