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16A663 CES06 10 61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING / v�
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
1 T E M NO I EACH FEE
OUTLETS (FIRST20) /� $20 $ D OWNER
LIGHTS RECEPT !J SW MAIL
OUTLETS ADD L UNITS) 10 ADDRESS
LIGHTS RECEPT SW
LIGHTING FIXTURES (FIRST 20) `I 20 CITY TEL NO
LIGHTING FIXTURES (ADDITIONAL) 10 vvV ELECTRICINCBMSON ELECTRIC Co., Ind
RANGES CLO DRYERS WTR HTR3 100 ADDRESS 8923 E. Broadway
R 9P STA COOK San�bO CITY Gabiiel, Calir. AT TEL NO 7-0539
DISHWASH UTO STATE
SPACE HTRS STA APP (1/.H P MAX) 50 LICENSE NO
MOTORS OVER NOT OVER HP DISTRIIC NO GRQ.VP NE P ESSED BY
0 1 100
3 150 INSPECTION RECORD '
a
3 S 200 Q
V
8 15 250
oe
15 50 300 GO
50 100 500 W
d
NO TRANS N
SIGNS NO LAMPS Z
SERVICE O 600V NOT OVER 200A too
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V Soo
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $f
I 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 4N�
LY CERTIFY THAT AM PROPERLY REGISTERED AND/OR �f��J
AS REQUIRED OS ANGELES COUNTY ST TE OF FIXTURESIA OR HAT 1 A THE LEGAL F T ABOVE -RES E TIA OPERTifPOWER
RE UTILITY CO NOTIFIED �ITTE FINAL C 9 L r
0c,
LIDATION ARTHUR C VEIT f'
MO CASH SUPERVISING ELECTRICAL ENGINEER
L�l,o 5 2 4 6 1 OCT g 2 D 1 2.9 ON
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