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vA'G)hr' COU NTY IOr IF LLSOS ANGELES
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DEPARTMENT OF COUNTY ENGINEER N.&ESs �i G
BUILDING AND SAFETY DIVISION CC I rt
LOCALITY �Q�
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
OUTLETS No. EACH FEE OWNER OR ) ^
" NAME
RECEPT.� $ $
ADO LESS / -P
LIGHT TOTAL FIRST 20 -20
CITY TEL. N0.
SWITC _ OVER 20 .10 PLAN CHECK
LIGHTING FIRST 20 L APPLICANT
TOTAL 4
OVER 20 ADDRESS
FIXTURES .10
RESIDENTIAL APPLIANCES CITY TEL. No.
PERMIT A
RANGE_ORYERWTR. HTR._ APPLICANT "-'
STA. COOKDISP. F.A.U._ AOORESS,�5/ q
SPACE HTR. AIR COND. CITY TEL. N0.
CLOTHES WASH. DISHWASH. L M� LE"ENSEOR CLASS.rf,
l REG. NUMBER [ Cb
FAN�OTHER /�,f HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
/ _—^ ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC, HP. KW. KVA. ELECTRICAL WIRING.
51ZE B TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF
THE ABOVE y
1 - 10 300 DE5CRIP.ED RESIDENTIAL PROPERTY. O
PERMITEE
10 - 50 500 SIGNATURE
veO
50 - 100 1000 U
DISTRICT NO. OC 5 ED BY Iy
100 - 500 10.00 ,,-- 0 Z
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DkW INSPECTOR'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICENOT OVER 600 VOLTS OR 200AMP UNDERSLAS WORK
SERVICE OVER 600 VOLTS OR200AMP 10.00 ROUGH CONDUIT
TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING —'
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED �f
FINAL 9- -7 7
PERMIT FEE (SUB TOTAL) , NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00 �L7
TOTAL FEE ,L16
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK: M.o. cASH.
9 6 5�aAN io 2 0 1 9.40
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
sAss3.=Ea06 =s . APPLICATION FOR ELECTRIC PERMIT
BUILDING AND SAFETY DIVISION
Department of County Engineer BUILDING ,S
County o1 Los Angeles ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT O. GRIFFIN, SUPT of BUILDING LOCALITY "-
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES .
J
[UM OWNER L��-�-Yc-c•. c�
LIGHT OUTLETS MAIL
ADDRESS
RECEPTACLES
WALL SWITCHES FEE CITY TEL. NO.
TOTAL OUTLETS @ 5R $ ELECTRICIAN
ELEC. RANGES 25 ADDRESS ,�
ELEC. HEATERS 25 ��" CITY {_{.�_ _t%./Lr :� v TEL. NO./)j ej kh>lj°/
KW EA STATE
LICENSE NO. Y-1
FIXTURES 5 Z'
MOTORS Q DISTRI O. GROUP ONE READY FOR INSPECTION
NUmeER HORSEPOWER FEE I �� �J
NEW MVD. HP OVER INC. EACH
®LESS $ .25 INSPECTION RECORD
h 2 .50
2 5 1.00
50
5 IS 1.150
15 50 2.50
200 5.00
MISC.
NO. SIGNS NO. TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
L
G PERMIT $1.00
RE PERMIT $1.00EMENTARY .50 APPROVALS
TOTAL FEE $ � O DATE INSPECTOR'S SIGNATURE
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUITAND LY
ALL COUNTYTHAT HE ABOVE IS ORDINANCESC AND STATE LAWS ETO REGUATING WIRING 1l>151 —wjr'jd'4'-
ICAL WIRING. FIXTURESI
REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER ��I 1 A
CALIFORNIBEDARESIDENAI AL A OPTHTY LEGAL OWNER OF THE ABOVEUTILITY CO.NOTIFIED•T' i'i 1 7 -tlU L/T�C 1TUREERMITTEE FINAL Y 'Z.�C`'1 A..r
JOHN A. LAMBI . A ARTHUR C. VEIT.
COUNTY ENGINE cK G SUPERVISING ELECTRICAL ENGINEER
DT67 1 3 4 APR 15 2 3.3 0