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76AB63 CESOB.10-5. APPLICATION FOR ELECTRIC PERMIT -
BUILDING AND SAFETY DIVISION ADDRESS
Department of County Engineer - BUILDING —o
County of Los Angeles
JOHN A. LAMBIE.COUNTY ENGINEER
C HN A. D. GRIFFIN.COUNTY
OP BUILDING LOCALITY ('
NEAREST
.FOR APPCANT TO FILL IN Ross sr
LI -�
PERMIT FEES OWNER TA! kl9p. tTa Al
n
LIGHTS ` RECEPTACLES L SWITCHES
NUMBER 1 T E M EACH FEE MAIL .
ADDRESS
_ TOTAL OUTLETS $ .10 $ D '
ELEC. RANSES. WATER HEATERS. CITY TEL. NO
CLOTH Es ORTERS(� '50 -�6 ELECTRICIANQ E.
ELEC. SFACE HEATERS, STAT Y. COOK. /y �1
INO UN IT 5, GARBAGE DISPOSERS, / V U ADDRESS
AUTO WASHERS, DISHWASHER .25 al`
LIGHTING FIXTURES _10 - CITY ry S F F -'
TEL. NO.
MOTORS STATE lJ
LICENSE NO. J Y�
HORSEPOWER
H.P. OVER INC. DISTRICT �)�f{J GROUP ZONE/ REAor Poa Ins PEcnon
'/a a LESS - .25 ��, �/ 1
Vz — 2 .50 INSPECTION RECORD
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
M15C.
SIGNS I NO-TRANS
NO.LAMPS
SERVICE 0-600V 1.0'0 Od
SERVICE OVER OOOV 5.00 "
WIRING PERMIT 1.00 V
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50 APPROVALS
TOTAL FEE '$ DATE _INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Ay q
ELECTRICAL WIRING. WIRING I✓ N lJwrAr"s.nA'
1 HEREBY CERTIFY THAT 1 AM PROPERLY.REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT
I AM THE LEGAL
OWNER -OF�THE ABOVE POWER
DESCRIBED RESIDENT]AL/P TiY-
SIGNATURE CS, P.V�L PR E UTILITY CO. NOTIFIED 6
OF PERMITTE A 1 FINAL
JOHN A. LAMBIE. VALIDATION ARTHUR C. VEIT.
COUNTY ENGINEER Mo -ON SUPERVISING ELECTRICAL ENGINEER
4 85 3 n DEC 5 2 1 5 .7 0 01