HomeMy Public PortalAbout9629 BLACKLEY ST_Electrical__ C c 4 f
76A683C- AE608131 12,75 APPLICATION FOR ELECTRICAL PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN JOB
~ EACH NO. FEE ADDRESS 62 B]ackle
rResidentialial Bldgsa&Pools
ly Sq. Ft. $ — $ LOCALITY Te le Cit
y Sq. Ft. CROSSST Te le Ci Blvd.
Swimming Pools OWNER OR
FIRM NAME ,t, Switch & Receptacle MAI L
ADDRESSrO
Additibnal CITYTemT. e Cit. Tel. No. 286^9686
PLAN CHECK
APPLICANT
Lighting Fixtures
First 20 ADDRESS
Additional CITY Tel. No
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT c
Range Heater_ D.W.
Oven Dryer W.M. -•
r ADDRESS RN1.3
Top _ FAU W.H. 1 50 CITY. Rosemead Tel. No. 280-1260
Hood Fan LICENSE OR or
REG. NUMBER Class.
Disp. A.C. Iv
• 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O
Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
Size&Type HP, KW, KVA,or KVAR E'LE CTRICAL WIRING. W
o_
Up to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR rn
Z
Over 1 to 10 Incl. O LICENSED AS REOUIR EO BY LOS ANGELES C UNTY AND STATE OF
CALIFORNIA OR THAT 1 AM T LEG ;N:E�ROFBOVE
Over 10 to 50 Incl. DESCRIBED RESIDENTIAL PRO P
TY.
Over 50 to 100 Incl. / PERMITEE �fJ+�
Over 100 SIGNATURE
DISTRICT NO. 4CE D BY
Services
0-200 Amp. Under 600 V
201 - 1000 Amp.-Under 600 VAPPROVALS D E INSPECTOR'S-
SIGNATURE
Over 1000 Amp.or Over 600 V
3 TEMP. POWER POLE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit
ROUGH CONDUIT
Additional Sign Branch Circuits
(Other) WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) UTILITY CO NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL5Z�2S/7 Z,-
PERMIT
rPERMIT ISSUING FEE 0
�+E NOTES
TOTAL FEE $15.00
PLAN CHECK VALIDATION CK. M.O, CASH PER T,VALIDATION (35/ MO CASH
1 1 3 JAN1 12 2 U