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76A663-CEB0610-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMEIST OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER 0
,( /�
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ' � (0 ✓ (�� ' ;�'r
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE 1.
OUTLETS FIRST 20 F$_20
20 5 OWNER O/ lFiL �l/�U
u6xT /
3 MAIL /
swrtcn. aD. L ADDRESS,:
OVER 20 •10i'
LIGHTING
TOTAL Rsr 20 .20 CITV `+ i.K I, . TEL. NO._
FI .N
FIXTURES I� aoD'L 44
GVER 20 .10 ELECT � ,H q e 111
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS A A '!/ % �•� !
GARB.DRIP. STA.COOK (y
CITY A I TEL. NO. U c G(J
DISH WASH. AUTO.-WASH. STATE qq
SPACE HTRS. STA.APP.O/:X.P.MAX.1 ,50 LICENSE NO. H•
MOTORS: OVER NOT OVER H.P. DISTRICT NO. G UP ZONE PR D BY
O 1 1.00 f�� o c} I A — .
I 3 1.50 INSPEC7I1O/N RECORD , /
3 8 2.00
ac
IS 50 3.00 (/ / ' O
50 100 5.00 lLLrJl
a
SIGNS: NO.TRANS. I z
NO.LAMPS
SERVICE 0.600V-NOT OVER 200A 1.00
SERVICE 0-600V-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE
SUPPLEMENTARY PER MIT ISSUING.FEE 1.00 '
TOTAL FEE
1HEREBY�ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS (J I DATE INSPECTOR'S SIGNATOR _ -
AND STATE THAT THE.ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT 7 L-L
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -
ELECTRICAL WIRING. WIRING /
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR !
LICENSED p3 REQUIRED BY OS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THA A THE LEGAL OWNER OF THE OVE
DESCRIBED RESIDENTIA PR PERTY, POWER A
ERMITlEE�� `�1 - JJ UTILITY CO.NOTIFIED
SIGNATURE
OF P
FINAL Il
VALIDATION ARTHUR C. VEIT
CCKYMO CASH SUPERVISING ELECTRICAL ENGINEER .
CK MO CASH
LID .1 0 4cs SEP 12 z 0 3:8:0-
APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES - t
DEPARTMENT OF COUNTY ENGINEER FNEAREST
/O
BUILDING AND SAFETY DIVISION A 0.Y4.-I.cLa/
JOHN A. LAMBIE, COUNTY ENGINEER -
CA$SATT D. GRIFFIN,SUPT OF BUILDING
FOR APPLICANT TO FILL IN -PERMIT FEES
ITEM NUMSERI EACH FEE OWNER
OUTLET �♦ $ 10 $ X00, MAIL
LIGHTS RECEPT. Sw.
�j ADDRESS
LIGHTING FIXTURESS .f0 Q CITY TEL.NO. /pr��
ELEC.RANGES. CLO.DRYERS ELECTRICIAN .(lG
WATER HEATERS .50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS CITY TEL. NO. r oS34
puio.- STATE 9 8
WASHERS STA.COOKING UNITS / .25 01. LICENSE NO. I 4 0
MOTORS: OVER INC. H.P. zS �r DISTRICT NO. I Gre I ZQNE PR B
. JO. 1 /�
v— 2 .50 INSPECTION RECORD
2— 5 1.00 6 iw•-e �vv V/ tt
5— 15 1.50
15— 50 2.50 4 M, r`C� �3n.0
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00 / too-
SERVICE
andSERVICE OVER 600V 5.00'
MISC.
WIRINGPERMIT 1.00 ' QQ
FIXTURE PERMIT 1.00 0e)
SUPPLEMENTARY PERMIT .50
TOTAL FEE 5
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
WITH ALL COUNTY ORDINANCES AND STATE. LAWS REGULATING CONDUIT
ELECTRICAL WIRING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING I AL'C �J`�1y-� LiyA.qu{n.Lswyra,-II/
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
' .J`!J CI / ✓ / ^��
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESMENT]AA,PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED
R
OF PEMITTEE
FINAL " L
®/ DATION ARTHUR C.VEIT.
MO GSH SUPERVISING ELECTRICAL ENGINEER
CK
LG:5 4 3':9 2 JAN ?0 2 A. 1 1 .8-5