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76 Afi63-C E84610/]4 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
' DEPARTMENT OF COUNTY ENGINEER FooREss Q
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
OUT ETS x0. 54tH S FEE FOWNER OR
RM NAME
REC EP T, MAIL
LIGHT TOTAL
FIRST 20 .YB ADDRESS -
OVER 20 CITY TEL. NO.
SWITCH iD PLAN CHECK
LIGHTING FIRST 20 2B APPLICANT
OVER 20 ADDRESS
FI TOTAL
%TURES 10
RESIDENTIAL APPLIANCES CITY TEL. No.
PERMIT
RANGE_ORVER_WTR. HTR._ APPLICANT
STA. COOK_DISP. F.A.U._ ADDRESS
SPACE HTR. AIR CONO._/_ CITY TEL. NO.
CLOTHES WASH. DISHWASH._ LICENSE OR
REG. NUMBER CLASS.
FAN-OTHER 100 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO 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 B TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Ofl
O - 11.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE,OF
CALIFORNIA OR THAI AM THE LEGAL OW NEO OF TME ABOVE O
1 - 10 3.00 DESCRIC.EO RESIDENTIAL PROPERTY. V
RERMI TEE
-10 — 50 5.00 SIGNATURE OILLF
U
50 — 100 1000 DISTRICT NO. PRO CE TC BYy
100 - 500. IS OD /U-s
SIGN, GAS I--
NO ONE CIRCUIT 5.00 APPROVALS DA rE INSPECTOR'S SIGNATURE
TUBE, OR
MARQUEE ApDI TIONAL CIRCUITS 100 TEMP. POWER POLE
SERVICENOTOVER 600 VOLTS OR 200AMP 3,00 UNDERSLAB WORK
SERVI CEOVER 600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT
TEMP SER VICE,POLE, &APPURTENANCES 500
WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES _ ��
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL7 � ���
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASK PERMIT VALIDATION CK. M.O. CASH
1 3 6-ACG L1 ' 2 "D 6.7 Jc joa
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE '