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76AE68-CEE084-60 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDIN
BUILDING AND SAFETY DIVISION ADDREs
JOHN A.LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING \
LOCALITY
4a �
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
PERMIT FEES t
OWNER
1 TEM NUMBER EACH FEE MAIL
OUTLETS: $ $ ADDRESS 49
LIGHTS RECEPT. SW. .10 C -
LIGHTING FIXTURES' 10 CITY TEL.NO
ELEC.RANGES CLO. DRYERS ELECTRICIAN
WATER HEATERS ,50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS CITY EL.NO.
GARBAGE DISPOSERS AUTO.. STATE
< (�
WASHERS STA.COOKING UNITS 1 .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISC RICT NO. G 2. P Z NE ESSED BY
O — '/2 .25 .
+/2 — 2 ,sp INSPECTION RECORD
2 5 1.00
5 — is 1.50 O
15 50 2.50 w
O
5o 200 5.00 U
NO TRANS, W
0.
SIGNS: NO.LAMPS N
Z
SERVICE 0-600V 1.00
SERVICE OVER 600V 5.00
MISC.
` WIRING PERMIT 1.00
FIXTURE PERMIT i pp
SUPPLEMENTARY PERMIT .50
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I +t \r-
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ` LI 1A
f a P
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
o LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURESCALIFORNIA OR 9
DE CRII BED RESIDENTT L PROPERTYI AM THE , POWER OWNER OF THE ABOVE POWER
SIGNATURE UTILITY CO. NOTIFIED
OF PERMITTE
VALIDATIO ARTHUR C.VEIT.
CK Mo CASH SUPERVISING ELECTRICAL ENGINEER
162.3:34 DEC_18 2 0 1:2.5 M
i
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I6A663-CEl06 10-60 A I! L11471J'"ll 19 9-DN � FOR ��L1a`8s0 9C(/ L - ER V T
COUNTY OF LOS ANGELES o,n _
DEPARMENT OF COUNTY ENGINEER rDR
BUILDING AND-.SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF-BUILDING G/+�t. >t~•%.`� ��Ty�
t -
FOR APPLICANT TO FILL IN CROSS ST.,
PERMIT FEES OWNER
I T E M NUMBER EACH 1. FEE MAIL' S
OUTLETS: $ $ ADDRESS
LIGHTS RECEPT SW.2 •10 �7�� CITY -TEL. NO.
u LIGHTING FIXTURES °/10 0
ELEC.-RANGES CLO. DRYERS / ELECTRICIAN �s/
WATER HEATERS / .50 ADDRESS
i. ELEC.SPACE HTR5j.?_DISHWASHERS,,f -
'- CITY
GARBAGE DISPOSERS AUTO.- STATE
a .LICENSE NO.. '
WASHERS STA.COOKING UNIT .':25 , O �`-� �' Y
MOTORS: OVER INC. H.P: DISTRICT NO.- GRO-UP ZONE PRQfESSED BY
0— I/z
1i2— 2so }(/`�INNSSP/ECTION' RECORD
2- 5 1.005- 15 1.50
is— 50 2.50. 1� �< G�'p O�i/(.� P°✓�J r
s
50- -2000
5.00 C1
1 SIGNS: NO TRANS. 1JJ
NO.LAMPS - n_
to
^° SERVICE 0-600V 1-.00 CS
SERVICE OVER 600V. 5.00 _
misc.
WIRING PERMIT , 1:00 a
FIXTURE PERMIT - 1.00
r, SUPPLEMENTARY PERMIT
TOTAL FEE. $ _
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 'APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT y%
ELECTRICAL WIRING. WIRING
Ai
I HEREBY CERTIFY THAT 1 AM PROPERLY-REGISTERED AND/OR -LICENSED AS REQUIRED BY LOS ANGELES,COUNTY AND STATE OFFIXTURES �,� j•1;CALIFORNIA OR THAT I A H AL .OWNER OF THE ABOVEDESCRIBED RESIDENTIAL P ° POWERy��,�I ',a„
SIGNATURE ZIA
UTILITY CO.NOTIFIED MAI +
OF PERMIT
^LIDATION ARTHUR C.'VEIT
/ � / MO CASH SUPERVISING ELECTRICAL ENGINEER.
U .
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