HomeMy Public PortalAbout9232 BLACKLEY ST_Electrical__ • r
76AC63C- CE806612,7r APPLICATION FOR ELECTRI AL PERMIT
BUILDING�AS AFETY DIVISION
FOR APPLICANT TO FILL IN JOB y /
EACH NO. FEE ADDRESS 3,L
FRential Bldgs. &Pools _
aily Sq. Ft. $ — $ --LOCALITY
ily Sq. Ft. — NEAREST + I
CROSS ST. '��G T
al Swimming Pools OWNER.OR
FIRM NAME
ht, Switch & Receptacle MAIL
ADDRESS
al CITY Tel No.
p PLAN CHECK
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional CITY / Tel. No.
PERIT
Fixed Appliances Not Over 1 HP APPLICANT J C-/�41C- S
Range_ Heater_ D.W. ADDRESS
Oven Dryer W.M.
Top FAU W.H. CITY �!,+/U Tel. No. ���
Hood Fan RECG. NUMBER Class.6 -p
Disp. If A.C. CJI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O
Power Apparatus& Large Appliances WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING {--
ELECTRICAL WIRING. CJI
Size&Type HP, KW, KVA,or KVAR LU
Up to 1 Incl. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR C/7
Over 1 to 10 InCI. LICENSED AS REQUIRED 8Y LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 50 Incl. DESCRIBED REST NTIAL PROPERTY.
Over 50 to 100 Incl. PERMITEE
Over 100 SIGNATURE r
DISTRICT NQJ PRO�SED /
Services � f'
0-200 Amp. Under 600 V iOO V
201 -1000 Amp. Under 600 V APPROVALS DATE SPECTOR
Over 1000 Amp. or Over 600 V SIGNATURE E
TEMP. POWER POLE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit
ROUGH CONDUIT
Additional Sign Branch Circuits y
(Other) WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL �r`�ai C �y !�✓
PERMIT ISSUING FEE
NOTES
TOTALFEE -2t14-704' O
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
3 9 9 SGT 2 2 d ,•4 U a
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