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16AC63 Ccb0610-59 APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY
ER
BUILDING AND SAFETY DIVISION
BUILDING C
ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER v
WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY 1
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES ROSS ST.
ITEM NUMBER EACH FEE OWNER (
OUTLETS: $ $ MAIL
LIGHTS RECEPT. SW. .fO ADDRESS
LIGHTING FIXTURES 10 CITY TE O.
ELEC.RANGES CLO.DRYERS ELECTRICIAN -�
WATER HEATERS .50 ADDRESS! C/ 6
ELEC.SPACE HTRS. DISHWASHERS
CITY � f EL. NO.
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT Ci1��1 ZO I P D8
O— 1/2 .25
1/2- z .50 _ IIVSP CTION RECORD
2— 5 1.00
5— 15 1.50
15— 50 2.50
50-200 5.00
SIGNS: NO.TRANS. —
NO.LAMPS
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
M
C.
WIRINGPERMIT 1.00 G �s
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE $ l
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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGA OWNER OF THE ABOVE
DESCRIBED RESIDENT OPE POWER
SIGNATURE / � UTILITY CO.NOTIFIED
OF PERMIT
FINAL r
�F � I
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
NOV 2 1 2 D 2.0 0 w