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7SA663-CESOB IO-BI APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUaDIN
ADDRESS "
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BUILDING AND SAFETY DIVISION LL� u-•/
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST 7 -
FOR APPLICANT TO FILL IN CROS
5 ST.
1 T E M NO. I EACH FEE
OUTL.ETs: (FIRSEce2PT.W .
T 0) .. g 20 S f ���, OWNER '
UGHTs RMAIL ,�((
OUTLETS: (ADWL UNITS) 10
7 ADDRESS
LIGHTS RECEPT. SW.
—yam l'
LIGHTING FIXTURES: (FIRST 20),3 . ,20 F(7 CITY / TEL.NO.
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS J—
I
GARB.DI6P. STA.COOK CITY J Z/' ViE_ . NO I J /
OISHWASH. AUTO.-WASH. _ STATE
SPACE HTRS./ STA.APP.(y H.P.MA%.) J .50
/ •511 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DIST ICT�Y(JO. GR UP ZONE P - SSED BY
O 1 1.00 Q U�
1 3 1.50 INSPECTION RECORD
r
8 15 2.50
.t-GIY v't 0
15 50 3.00 Q
Ci
so 100 s.00 'v, w
a
SIGNS: NO.TRANS. h
NO.LAMPS _Z
SERVICE O-600V-NOT OVER 200A / 1.00 I136)
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 5
I LI
HEREBY ACKNOWLEDGE THAT 1 HAVE REAO THIS APPCATION APPROVALS I DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT J
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED aT�G2
OF PERM ITTEE `^,I C� v
FINAL A
VALIDAT -, ARTHUR C. VEIT
CK MCI CASH SUPERVISING ELECTRICAL ENGINEER
LACoI869% JUL19 2 -0 8.10-
>fiAfifi] CE 98fiR.IR/JJ APPLICATION r-®R ELECT AL PERMIT
' COUNTY OF LOS ANGELES // (r
DEPARTMENT OF COUNTY ENGINE ER q0 RESS D(� Q
BUILDING AND SAFETY DIVISION
FORAPPLICANTTO FILLIN LOCALITY lemloLt CTL
New Residential Bldgs.&Pools EACH NO, FEE NEAREST
I &2-Family,Sq. Fr. $ .025 — S CROSS SL L
Multi family Sq. FC OWNER
.02 — FIRM NAORME
Residential Swimming Pools 25.00 _MAIL
/ ADDRESS
Outlets: Rec�light sw. / CITY — Tel.No. _ Ri'7 First 20 .50 PLAN CHECK
Total No._L 7 Additional .30 APPLICANT
ADDRESS
Lighting Fixtures First 20 .50 CITY i Tel. No.
Additional .30 PERM
Total No. APPIT
LICANT O
Fixed Appliances Not Over I HP ADDRESS _ If
'i IAI
Range—Heiner—D.W._ CITY Tel. No.
Oven_Dryer_W.M.— LICENSE OR
Top —FAU —W.H.— REG.NUMBER Class.
Hood_Fan _Other_ HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp. _ Room Air Cond. 2'50 THAI THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN.
ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING.
Power Apparatus&Large Appliances
Size&Type HP, KW, KVA,or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM
Up round. 2.50 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 0
Over I to 101ncl. 5.00 ca
Over 10 to 50 Ind. 12.50 PERMITTEE
Af o
Over 50 to 100 Inc 25.00 SIGNATURE t
Over 100 40.00 DISTRICT NO. ROCES ED BY
Services �O of
0- 200 Amp,Under 600 V 12.50 I ECTOR'S
201000 Amp.Under 600 V 25.00 APPROVALS DATE b GN
1ATURE
Over 1000 Amp.or Over 600 V 50.00 TEMP.POWER POLE
UNDERSLAB WORK
Temp. Power Pole&Appurtenances 10.00
Sign with One Branch Circuit 10.00 ROUGH CONDUIT
Additional Sign Branch Circuits 2.00 WIRING
Misc.Conduits&Conductors �� 10.00 FIXTURES
Other[See Complete Fee Schedules
POWER AUTHORIZED
UTILITY CO.NOTIFIED _
FINAL 1 C7—jz J9 G
PERMIT FEE (Sub Total 1 NOTES
PLAN CHECKING FEE (One-Fourth Permit Feel
PERMIT ISSUING FEE $7.00
TOTAL FEE
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK M.O. CASH
436�WJi1L 5 2 D- 1 aSid
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
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