HomeMy Public PortalAbout10554 DAINES DR_Electrical__ DES
IDEPAR�.TENT OF BUILDING INTI SAFETY APPLICATION FOR P,���.,s-1,�
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COUNTY OF LOS ANGELES ELECTRIC
CTRIC
WM. J. FOX CHIEF ENGINEER
_� NAME DISTRICT NO. GROUP ZONE PERMIT NO.
U ADDRESS
CITY RECEIVE�IBY READY FOR DATE ISSUED
�. 'IEEE.NO. /A FIRST INSPECTION (�4
J COUNTY i/Jjbid _ � 1 r1
hl CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
(DESCRIPTION OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY `�
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. //��
CIRCUIT A B C D E F G H LL NAME V 70.
I Z MAIL
3 ADDRESS ,�
CITY ♦ / TFL.NO.
1 AM THE LEG POSSESSO OF THE ABOVE LOS
ANGFsLEB COUNTY CERTIFICATE OF QUALIFICATION.
ELECTRICIAN.
ABO B THE LEGAL OWNER OF THE FR PERTY DESCRIB
0
COIiMCTIONS
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TOTALr
NO. OF OUTLETS I $ b APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS" H P. $ CONDUIT
NO OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $ 5� UTILITY CO"NOTIFIED
TOTAL FEE • 9 FINAL,
75A563-CE605 ' APPLICATION FOR ELECTRICAL PERMIT
dOUNTNI'OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING f�
BUILDING AND SAFETY DIVISION ADDRESS f/
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL,IN CROSS ST `
OUTLETS NO EACH I FEE
$ $ OWNER
y� RECEPT MAIL '
LIGHT—Z TO fAL FIRST 20 25 ADDRESS
OVER 20 CITY TEL NO
SWITCH 10 PLAN CHECK
LIGHTING TOTAL t7
OVER 20 10 FIRST 20 25 IC'v APPLICANT
FIXTURES I
ADDRESS
Z
APPLIANCES CITY TEL NO
PERMIT
RANGE DRYER HTR APPLICANT
STA COOK DISP F A U
ADDRESS / Q/7
SPACE HTR AIR COND CITY �/-
.;j Li" TEL NO
CLOTHES WASH DISHWASH LICENSE NO Q CLASS
' 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 KVA ELECTRICAL WIRING
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSEDAS REQUIRED BY LOS ANGELES CONTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OW OF, AND INTEND TO }
1 - 10 300 RESIDE IN, THE AB IBED IDENTIALl PROPERTY a
0 - 50 500
1SIGNATURE / V
OF PERMITTEE
50 - 100 1000 DISTRICT NO CLASS ZONE PROCESSED BY V
100 - 500 1500 -- W
CL
SIGN, GAS SIGN AND ONE CIRCUIT 500 NOTES N
TUBE, OR Z
MARQUEE ADDITIONAL CIRCUITS 1 00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 300 00
APPROVALS DATE INSPECTOR'S SIGNATURE
S ERVI CE OVER 600 VOLTS 0 R 200 AM P 1000
TEMP POWER POLE
TEMPSERVICE,POLE, &APPURTENANCES 500
TEMP LIGHT OR RECEPT SYSTEM 300 UNDERSLAB WORK
ROUGH CONDIUT
WIRING
FIXTURES
ZED
PERMIT FEE (SUB TOTAL) POWER AUTHORIA�
UTILITY CO NOTIFIED �
PLAN CHECK FEE - 7�a/�� _�I�.�C. .�rT//
FINAL
PERMIT ISSUING FEE 300ff. JOSEPH . ROOHAN
TOTAL FEE 7 75 SUPERVISI ELECTRICAL ENGINEER,
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATr.7
M 0 CASH
i AL;o 4 6 2 8 FEB 2 8 2 D
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE