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APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 0 C d P7LL
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY 7&/)l Ldt"7r G!T'
FOR APPLICANT TO PILL IN NEAREST
CR035 ST.
NO. EACH F[[
s $ OWNER O L
RECEIPT._ KAIL
LIGHT TOTAL
FIRST 20 ,20 ADDRESS O jLL
CITY TEL.NO.
SWITCH OVER 20 .10 PLAN CHECK
LIGHTING 1 TOTAL FIRST 20 ,20 APPLICANT
FIXTURES Jy OVER 20 .10 ADDRESS
RANGE_DRYER_WTR. HTR. CITY TEEL11.NO.
STA. COOK_DISP._F.A.U. CONTRACTOR �GJ D/�[1 �L h'C x"121
SPACE HTR AIR CORD. ADDRESS G �'� �{ It--lo L
CLOTHES WASH. DISHWA3H. /�
CITY (J 1 N TEL.NO.
FAN OTHER 1.00 LICENSE NO. ao 'a CLASS. C)
MOTORS,TRANSFORMERS RATING I HERESY ACKNOWLEDO[ THAT I HAVE READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. AND STAT[ THAT THE ABOVE IG CORRECT AND AGREE TO COMELY
SIZE � TYPE OVER TO WITN ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING
ELECTRICAL WIRING.
0 - 1 1.00 1 HERESY CERTIFY THAT I AM FROP[RLY RK618TKRKD /10/011
,1n LICENSED AS R[QUIR[D BY LOS ANGELES COUNTY AND STAT[OF
yr 1 - 10 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWN R OF, D IN NO TO
REST DK IN. THE ABOVE CRISED RESIDE L O
10 — 50 5.00 u
SIGNATURE
50 - 100 10.00 OF PERMITTEE O
100 - SCX) 15M ol��CT N yg.37-
ZW PRoc [D er
SIGN,GAS SIGN AND ONE CIRCUIT 3.00
TUBE, OR p Z
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: 1 C• e.„ rt(e! �83
SERV ICE NOT OVER 600 VOLTS OR 200 AI P 2.00 p o
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APP LfMAkI ICES 3.00 APPROVALS DATE PCOPICTOOre S MINATURIE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING `
PERMIT FEE (SUB TOTAL) FIXTURES
POWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
PERMIT ISSUING FEE 2.00
UTILITY CO.NOTIFIED -G
SUPPLEMENTARY PERMIT ISSUING FEE 1,0`0 FINAL i
TOTAL FEE opv JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT,VALIDATIONcK M.O. AlH
8 A25 2 D .033
r �V
■[[ SACK OF APPLICATION FOR COMFL[Tf FE[ SCH[AUL f.
79"03-Cgfn06.7-139 APPLICATION FOR ELECTRIC PERMIT ].
BUILDING AND SAFETY DIVISION
Cq"Deparhmew cd �
rAJoRaeaJCVHN A.LAIABIE. CouNTY �ic*ikwj ecAstlATT D.G'RIFF'IN.•UT OF RUILDINa OCALITY
EGIT
F_OF�APPL�C,�M TO FILL IN CNROSIa Br.
PUUMBER per= GINNER
61 LIGHT 0LrrLITS PAIL
ADDRESS
RECEPTACLE6
WALL SWITCHES llfEE C O
TOTAL OUTLETS 0 DRELECTRICIKI-Er—C. AN r
ESRANGES 2Dl
ADDR
ELEC. HEATERS ZDCITY Td NO.
Z'S� STAT][
P REE DLICBN•SS NO.
OTORS IDISTRICT NO. GR ON ■sADY roc I1sprcTlo■
NUY a[n HORS EPOW SR FEE
HrW MVD. HP OVIn INC. TACH
INSP=ON BI=RD
Is .DO
R D 1.00
D ID 1.D0
15 DO 2.DO
DO R0' - D.00
NO.SIGNS NO.TRANS.
NO SIGNS NO. LAM D
FOR EACH PERMIT:
WIRING PERMIT •1.00
FUCTURE PERMIT 4 I.00 C/
SUPPLEMENTARY .50 AMOVAIS
TOTAJ, F 411DATE INDPECTOR E 314MATURE
IEREBY A KXO LEDGE THAT 1 HAVE READ THIS APP[ CATION CONDUIT
AND STATE THAT TAE ABOVE IS CORRECT AND AGREE TO COMPLY 7
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING. FDnURSS
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANG LSD AND STATE OR POWER
CALIFORNIA OR THAT 1 Y THE GAL OF THE ABOVE
DESCRIBED RESIDER P LMLfT'Y CO.NOTIFIED
SIGNATURE
OF PERM ITTIK
FINAL
ATHUR C
IN[� /CHJ YO CASH COUNTY BN4BArON .ARTHUR
ILLKCTFUCI&L QrtOiN�t
I�`'�o
7 9 4 9 PAY 9 2 7.7 0 �