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1,6A(563-CE8065-62 APPLICATION
FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ELI"OING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. IEACH FEE
III OU�T^ETS FIRST'20 �]n S 20 $ �� OWNER
LIGHT ( V.1/O ry MAIL �.
)I ADD'L - F
RESS
SWITCH. OVER 20 .10 0
LIGHTING TOTAL IF1RST 20I .20 A� TEL. N¢.
FIXTURES ADD'L 1O CTRICIAN
ov R 20
/RANGES CLO.DRYERS WTR.HTR9. 1.00 ORESS Y�
GARB.DISP. STA.COOK //
CITY EL. N6
OISHWASH. AUTO.-WASH. STATE
SPACE HTR9. STA.APP.Iy¢H.P.MAX.) .50 O LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP ZO N.E P/K, ESSED BY
o t 1.00 ,/ 1
1 a 1 1.5014 1 ..��INSj�PECTION RECORJJDQ
3 a 2.00 / n9✓T/7-Vl
8 15 2.50 q •I T `A�Tf/tL /i7�d-'/+- - d
15 50 3.00
s r O
V
so foo s.00 m
O
SIGNS: NO.TRANS H
NO.LAMPS W
D.
SERVICE 0.60OV-NOT OVER 200A 1.00 U)
SERVICE 0-600V OVER 200 A. 12.00` Z
SERVICE OVER 600V I 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'$SIGNATURE
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING �I
I HEREBY CERTIFY THAT 1 AM PROPERLY fl 19TERED AND/OR
LICENSED AS REpU1RED BY LO$ ANGELES C TY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEG O R OF THE ABOVE - 'T - ,/
DESCRIBED RESIDENTI PRO RTY. POWER A Y��jj ��//qe, Y
SIGNATURE �,� UTILITY CO.NOTIFIED ✓ Y'�lY�/q �XJ1/ " Y �.
OF PERMITTEE FINAL �f � 6
IDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER.
LJ Co 6 4 9 4NOV 5 2 D 15.70-
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