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•]GA6v'�'C ER O611/]0 .APPLICATION I•® I.LI_Ca RICAL ARMIT LJ
�. ,'COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS L{,
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
O
OUTLETS NO. EACH FEE
S S OWNER
RECEPT. MAIL ` I A
FIRST 20 25 ADORES
LIGHT TOTA a CITY �:. TEL. N0,
SWITCH OVER 20 ,10 3[�
PLAN CHECK
LIGHTING TOTAL FIRST 20 25 op APPLICANT
FI%
OVER 20 ADDRESS
TURES .f0
APPLIANCES CITY TEL. NO.
PERMIT
RANGE
_DRYER_WTR. HTR._ APPICANT
STA. COOK_D16P.j--F.A.U. ADDRESS
SPACE HTR./AIR COND. CITY A& TEL. N0, i lyy
CLOTHES WASH. OISHWASH—L- LICENS N0. `. .� CLASS.
FAN OTHER c1.00 G v'1 O I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
b �^ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTOR S, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRIUL WIRING.
S1ZE B TYPE OVER TO
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICE N$EO AS REOUIgEO 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 DESCRIBED RESIDENT L PROPERTY. d
SIGNATURE - � u
10 - $0 &00 OF PERMITTEE Q/
K
$0 - 100 1000 pISTgICT N_O. CLASS Z�QN/G `gq�O,F/E'9S EO BY O
100 - $00 1500 S(1� CC.- A//li.n..> p W
SIGN, GAS
TUBE, OR SIGN AND ONE CIRCUIT 5.00 NOTES:
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 3.00 0
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICEOVER600VOLTSOR200AMP 10.00
TEMP.POWER POLE
TEMP SERVICE, POLE, &APPURTENANCES 5.00
TEMP LIGHT OR RECEPT. SYSTEM 3.00 UN DERSLAB WORK
ROUGH CONDIUT
WIRING ,,. H /
1
FIXTURES
1{11
PERMIT FEE (SUB TOTAL) POWER AUTHORIZED
UTILITY CO. NOTIFIED
PLAN CHECK FEE g q
FINAL
PERMIT ISSUING FEE 3.0C 3 bC JOSEPH C. ROOHAN
TOTAL FEE A SUPERVISING ELECTRICAL ENGIN"E,—,,
PLAN CHECK VALIDATION CK. " "M.D. CASH PERMIT VALIDATION CK. M.O. CAs�1
�� .NOV 1 44 0 2^230 r
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE VLM 4\
085 5-A 2-46
DEPARTMENT OF BUILDING AND SAFEAPPLICATION FOR PERMIT
TY
COUNTY OF LOS ANGELES
ELECTRICW
M. J. FOX CHIEF ENGINEER
4 NAME r,� DISTRICT NO. GROUP ZONE JPERMIT NO.
U ADDRESS Z'y ` ^! ✓ �
p Z RECEIVE74? D BY READY FOR DATE IISSU�/ED�J
U CITY ✓ TEL.NO. /�C ]� /`�!!W" FIRST INSPECTION /-'T"/
A COUNTY
U CERT.NO. EXPIRES
APPLICANT FILL IN HEAVIL jobTLINEDw/PORT�IIp tN� ONLYJOB
p
DESCRIPTION OF WORK ADDRESS 6- 'STV/ .
NUMBER OF OUTLETS ON CIRCUITS LOCALITY rV
LOCATION BY ROOMS
NEAREST VC/
LIGHT OUTLETS 1111 SW.Jill UGS I FI%T CROSS ST.
CIRCUIT A B C D E I F G H I E I NAME (
Z MAIL
ADDRESS
O
CITY TEL.NO.
/• / 1 AM THE LEGAL POS5SESSOR OF THE ABOVE LOS
ANGELES COUNTY CE�FIC� QUALIFICATION..
7..
`�//J ELECTRICIAN.
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
CORRECTIONS
J
Q
Z
C7
Z
D
TOTAL f
NO. OF OUTLETS Z' $ O . APPROVAL'S
NO. OF FIXTURES _ S DATEJ IN�SI?E/CTOR'S NAME
NO. OF MOTORS H.P. 3 CONDUIT //�LJ{J 'fV"�,...•a-•�1-'-L{�r
NO. OF SIGNS TRANS. $ WIRING C/
NO. OF RANGES OR HEATERS $ FIXTURES
{ MISCELLANEOUS S POWER
!� PERMIT FEE $ UTILITYCO.NOTIFIED
4 TOTAL FEE 3'D FINAL ~�� "�:��`h' f"
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