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APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER LOCALITY
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. yL'
OUTLETS NO. EACX FEf
OWNER
RECEP:nS� S $ MAIL
LIGHT�.L- TOTAL FIRST 20 y _20 - Q AOOR E55 �j ( P
OVER 20 CITY io..0 V Y TEL. 0.
SWITCH .10 PLAN CHECK
GHTING TOTAL
-40
FI
L %TURES FIRST 20 20 APPLICANT
I
OVER 20 .10 ADDRESS
APPLIANCES CITY TEL. NO.
PERMIT
RANGE_DRYERWTR, HTR._ APPLICANT
STA. COOK_OISP,_F.A.U._ ADDRESS '(f"
SPACE HTR, AIR COND. CITY TEL, NO.,-? _ (�
CLOTHES WASH._DISHWASH. `K LICENSE NO. 7CLAE S.
FAN A OTHER �, 1.00 /�') 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 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 b TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1L00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
1 - 10 3.00 RESIDE IN, THE ABOVE SCR IP.ED RESIDE AL PROPERTY. a
SIGNATURE O
10 - 50 5.00 OF PERMITTEE v
50 — 100 10.00 oof
015 TRICT NE. .2L A55 GROU EON P 5 T O
100 — 500 15.00 � r
V
W
SIGN, GAS SIGN AND ONE CIRCUIT 3.00 NOTES: N
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 100
SERVI CENOT OVER 600 VOLTS OR 200 AMP 200
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICEOVER600 VOLTS OR 200AMP 500
TEMP.POWER POLE
TEMP SERVICE, POLE, &APPURTENANCES 3.00
UNDERSLAB WORK
TEMP LIGHT OR ftECEP i. SYSTEM 3.00
ROUGH CON OIUT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
POWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
UTILITY CO. NOTIFIED
PERMIT ISSUING FEE 2.00 Qej !
FINAL
SUPPLEMENTARY PERMIT ISSUING FEE 100
J SEP4 C. ROOHAN
TOTAL FEE SUPERVISING ELECTRICAL ENGINEER.
PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION -DK.' M.D. CASH
s 1 4 ON MAR 15 a o 720-
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE -
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