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76A663-CE80612-65 APPLICATION FOR ELECTR AR iERMI
COUNTY OF LOS ANGELES
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DEPARTMENT OF COUNTY ENGINEER BUILDING ,�
BUILDING AND SAFETY DIVISION ADDRESS -
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN co55 ST
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RECEPT. TOTAL No. EACH FEE
OUTLETS FI 5 20 $ OWNER
LIGHT MAIL '
SWITCHADD'L 10 ADDRESS
OVER 20_
TOTAL FIRST 201 .20 CITY TEL, NO.
LIGHTING FIXTURES q
FIXTU RE6 ADD'L
OVER 20 10 CONTRACTORAG
RANGES DRYERS WTR.HT.S. 1.00 ADDRESS
GARB.DISP. STA.COOK
CITY TEL.NO.
DISH WASH. AUTO.-WASH. STATE
SPACE HTRS. STA. APPL. .50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT Nn, .GROUP ZO P D
o 1 ` 1.00
1 3 1.50 INSPECTION RECORD 0
3 8 2.00 vloo04
V
6 1s 2.501 0
O
15 50 3.001 W
50 f00 5.00 I U)
Z
SIGNS: ND.TRANS.
NO. LAMPS _
SERVICE 0.60OV-NOT OVER2ODA 1.00
SERVICE O.6OOV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
T
Z—, 7- o0
PERMIT ISSUING FEE 2.00 Y 00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00APPROVALS DATE INSPECTOR'S SIGNATURIt
TOTAL.FEE 8 00.
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO POWER
RESIDE IN.THE ABOVE DESCRIBED E610EHT FL PROPERTY.
SIGNATURE I UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL
VALIDA 0 JOSEPH C. ROOHAN
NO
CK NO
H SUPERVISING ELECTRICAL ENGINEER
1
5.2 8 1 Z2 OCT 14 2 0 9.00- q
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