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76A663-CE606 4-68 APPLICATION FOR ELECTRICAL I PE IT
IS, COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER n
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY L' Pt_� Cc �{
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NO. AC FEE
F'R
$ $ OWNER MAILTOTAL FIRST 20 L- 20 ADDRESS` OVER 20 10 CITY TEL. NO.
PLAN CHECK
TOTAL FIRST 20 20 APPLICANT
OVER 20 10 ADDRESS '
RANGE_DRYER—WTR.HTR.— CITY TEL. NO.
STA.CQOK_DISP.XF.A.U.— CONTRACTOR
1-4
SPACE HTR. AIR COND. ADDRESS
CLOTHES WASH._DISHWASH._ CITY EL. NO. C -?i US
IFAN—OTHER 1 00 OC3 LICENSE NO. S CLASS. G
MOTORS,TRANSFORMERS RATING
IND..HEATERS, ETC HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT,I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
0 - 1 i 00 ELECTRICAL WIRING.
•- I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR '
1 - 10 3 00 LICENSEDAS RED IRED BY LOS ANGELES COUNTY AND STATE OF '
CALIFORNIA OR THAT I AM ,THE LEGAL•OWNER OF, AND INTEND TO
10 - 50 5 00 RESIDE IN, THE AB VE ES IFEO RESIDENTIAL PROPERTY.
SO - 100 "l 0.00 SIGNATURE CL
OF PERMITTEE
U
100 - 500 15.00
SIGN,GAS DIST f IC��. 'GAP NE P O E cD
O
TUBE, OR SIGN AND ONE CIRCUIT 3 00 V
MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES: N
{ L 1. Al.
SERVICE NOT OVER 600 VOLTS OR 200 AMP ( 2 00 Z
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, & APPURTENANCES - 3.00 APPROVALS 'DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
]UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE' (SUB TOTAL)
FIXTURES• �
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2 00 V' UTILITYCO.NOTIFIED� G
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEED JOSEPH C. ROOHAN '
SUPERVISING ELEC AL ENGINEER
PLAN CHECK'VALIDATION CK M 0 CASH PERMIT VALIDATION CK M O CASH
-e,26 2 o. 5.4 Q=
- - r_.
1
iEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE