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76 A 663�CZQ6 10/L]2 APPLICATION mo® .ER p4RICAS PERMIT MMIT
COUNTY OF LOS ANGELES /
DEPARTMENT OF COUNTY ENGINEER '01711 ESS
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. ('
OUTLETS NO. EACHFEE OWNER OR NAME QO PFJ.
RECEPT._ S $
MAIL p.
FIRST 20 25 ADDRESS p /)LC U�L11
LIGHT TOTAL
OVER 20 CITY P• TEL. N0.
SWITCH '10 PLAN CHECK
FIRST 20 23 APPLICANT
F
LIGHTING
%TURES NG TOTAL .10
OVER 20 ADDRESS
RESIDENTIAL APPLIANCES _ clry TEL. No.
PERMIT
RANGE/ORYER_WTR. HTR._ APPLICANT ;Jall
STA. COOK_DISP. F.A.U._ ADDRESS 2_3/ \ N
SPACE HTR. AIR CORD. CITY - a NG TEL. NO.
CLOTHES WAS H. OISHWASH._ LICENSM BE OR
REG. NUER /2s'06
, e �6 CLASS.
O
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 5 TYPE OVER TO
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OF
D - 1 L00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND E AB VE
DESCRIBED OR THAI AM THE LEGAL OWNER OF THE ABOVE
1 - 10 3.00
DESCRIBED RESIDENTIAL PROPERTY. //�/,///./ O
PERMITEE U
.:S
"I'll
10 - 50 5.00 SIGNATURE Z' 0
H
50 - 100 1000 DISTRICT N0. PR SS 0 BY yVj
100 - 500 1500 S• L.—up , Z
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'SSZGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 100 ""�� TEMP. POWER POLE
SERVICENOTOVER 600 VOLTS OR 200AMP 3.00 (J UNDERSLAB WORK
SERVICEOVER600VOLTSOR200AMP 10.00 ROUGH CONDUIT
TEMPSERVICE, POLE, &APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES ( „`
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES: _ �J
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M.D. CASH
1 a� C 5 9 S"3 APR 16 2 D 6.00 r,
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
DBS SA 25M SETS 1-48 A1yy$12CATION FOR
PERMIT
DEPARTMENT OF BUILDING AND SAFETY 2� S Gl t111V1V SCJR 6LYl1�Al1
COUNTY OF LOS ANGELES �i�Ei CTRIC �L
y � .-J. P C�1 GINEER
a NAME DISTRICT NO. GROUP Z�OJNE PERMIT NO.
ADDRESS �i �� ifl /PoJ I,w,tel _
RECEIVED BY READY FOR DATE ISSUED
tl, CITY FIRST INSPECTION
WCERT.NO. l SEXPIRES
COUNTY-- v 6q/,ry
APPLLICANT FQ L IN HEAVM ..OUTLINE6 PORTION ONLY
JOB
DESCRIP'T'ION OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY G h�
LOCATION BY ROOMS
NEAREST
LIGHT OUT 6W.I UGS lF,xT C ST.
CiRCU1T A B C D E, - F 6 ,A, W NAME
fn C :" AIL
T6 Z M
MAIL6 I
O
CITY w�M '7 TEL.NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
AMOKLM COUNTY CERTIFICATE OF�QUALIFICATION..
ELECTRICIAN.
1 AM THE LEGAL OWNER OOFF/�THE,PROPERTY DESCRIBED
ABOVE /n / il�� ./ !�, /
� OWNER.
CORRECTIONS
O �t
J
_ Q
Z
L7
0
O
t
Torm
NO. OF OUTLETS x B APPROVALS / l
NO. OF FIXTURES 6 GATE J. INSPECTOR'S NAME I
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. t WIRING
C
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOLIS B POWER
PERMIT FEE B -CS UTILITYCO.NOTIFIED
TOTAL,FEEK' C FINAL