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76A663-CER06 B-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS-ANGELES
DEPARTMENT OF COUNTY ENGINEER - BUILDING _//
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BUILDING AND SAFETY DIVISION ADDREss
JOHN A. LAMBIE. COUNTY ENGINEER /- AIN r--
NE
WILLIAM A. JENSEN, SUPT OF BUILDING + LOCALITY '_/ /.-
NEARESTJJL :17-
0
17
FOR APPLICANT TO FILL IN CROSS ST. / "
FFRE
Z/ llI TOTAL NO. EACH FEE p
� �1 OUTLETS (FIRST 20 S.zO S A/l OWNER VI c,-
OWNER
J( I` q V� 6 �I�
./O 1 OVERA-1 MAIL
'L e(/ .10ADDRESS /�� OING TOT L F1Rsi 20 0 .20CITY ? LI L. NO. ir-RES �d ADD'L 10 ELECTRICIAN
OV R 20
S CLO.DRYERS WTR.HTRS. 1.00 ADDRE66
P. 9TA.,COONCITY TEL.NO.
H. AUTO.-WASH. STATE
RS.' PSIA.APP.VAH.P.IAAX.) ,50LICENSE NO. I
: OVER NOT OVER H.P. DISTRICT G P ZONE P SED
1
0 1 1.00 _ 1 >
I 3 1.50 - INSPECTION RECORD
3 — 8 2.00
8 15 2.50
15 50 3.00 1-
50 100 5.00 I O
NO. LAMPS 1 2 /I��W v
SIGNS: NO. LAMPS �T f�!'./ �7� Gw/
SERVICE 0-600V-NOT OVER 200A 1.00LU
/c, jir/I�jQ f�'7'ir..:/ f.rf/�phLC•. vl
SERVICE O.600V-OVER 200 A. 2.00 -Ci5 .✓?a ��� ��r01 �y
SERVICE OVER 600V 5.00 1 , " / C .�.!" .rf T Z
MISC. G'
i s1�� s1?r71?tl�
r L v
PERMIT ISSUING FEE 2.00 •` '• �i �� �� �/� � �...u•/�
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 11
q ✓ `
TOTAL FEE ® L - 6'FFIXTURES ' �V1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIC TIONL6 / DATE INBPECTOR'9 SIGNATURE
AND STATE THAT THE ABOVE 19 CORRECT ANO AGREE TO COMPLYI /WITH ALL WIRIN ORDINANCES ANO STATE UW9 REGULATING5WITHELECLL WIRING.HEREBY.CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORLICENSED AS REGl11RED BY LOS ANGELES COUNTY A 9T TE OFDO�3LSOE9CRCALIFOIBEOARE8R1 TNj! I OPERTTHE LEGAL O O TH w9o;E � n ,{61GNATU RE / OTIFIED /O&7 MI o �/OF PERMITTE ,J
VALMO ARTHUR C. VEIT
SUPERVISING C. ELECTRICAL ENGINEER
CK MO CA6N
- L' o0 a 1 4G2 FEB 11 2 D 14.70-
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