HomeMy Public PortalAbout10218 DAINES DR_Electrical__ 76A663-C~806 1)_/70 ApPOC-ATION FOR ELECTRICAL PERMIT I LJ
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS G-6
COLEMAN W. JENKINS SUPERINTENDENT OF BOILDING LOCALITY �/ I
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
OUTLETS NO EACH FEE
/ OWNER;
RECEPT.r MAIL
$ $ ADDRESS ��J�/ (•• '�/
LIGHT TO fAL FIRST 20 P5,
SQ OVER 20 CIT TEL. NO.
SWITCH v 10 PLAN CHECWZ, _
FIRST 20 25 APPLICANT
FIXTURES '•
LIGHTING TOTAL
OVER 20 10 ADDRESS
� ,
APPLIANCES CITY TEL NO.
PERMIT /
RANGE DRYERWTR. HTR' IJ• APPLICA
STA. COOK DISP •F A U _ ADDRESS /
SPACE HTR, AIR COND CITY TEL NO
CLOTHES WASH. DISHWASH LICENSEN•0 V CLASS w
FAN OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT'THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND-STATE LAWS REGULATING
IND HEATERS, ETC HP KW K,VA ELECTRICAL WIRING
I SIZE & TYPE OVER TO
_ I HEREBY CERTIFY THAT•I AM PROPERLY RE IS EKED AND/OR
100 LICENSED AS REQUIRED BY LOS ANGELES COUN Y ND STATE OF
�CAL'IFORNIA OR THAT I,AM HE LEGAL OWNER O D INTEND TO
1 -•lO 300 'RESIDE' ,I'N:' THE ABOV DESCRIBED , RES DE IAL PROPERTY O
10 - 50 500 SIGNATURE
OF PERMITTE
50 -'100 - 1000 DISTRI CT NO. CLASS,
Zy ESSED BY O
100 - S00 1500 �� 7L a
SIGN, GAS SIGN AND ONE CIRCUIT 500 NOTES: ' - N
TUBE, OR ?
MARQUEE •ADDITIONAL CIRCUITS 100 f
SERVICENOTOVER600VOLTSOR200AMP - 300 '
APPROVALS DATE •INSPECTOR'S SIGNATURE
SERVICE OVER 600 VOLTS OR 200 AMP 1000- � _ ,
TEMP POWER•POLE '
TEMP SERVI CE,POLE, &APPURTENANCES 500 - -
UNDERSLAB WORK
TEMP LIGHT OR RECEPT, SYSTEM ' 3DB ,
ROUGH CONDIUT
WIRING •SGL -
FIXTURES
POWER AUTHORIZED '
PERMIT FEE (SUB TOTAL)
UTILITY,CO-NOTI•FIED""-
PLAN CHECK FEE
FINAL t,
v'
PERMIT ISSUING FEE 300
_ JOSEPH C. ROOHAN
TOTAL FEE SUPERVISING ELECTRICAL ENGIN P.
PLAN'CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK ' M 0 CASH
4,24 -2 0 6,:7 5�. .Q
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
f