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7 AGt CE 06 10 0 APPLICATION FOR ELECTRIC PE MIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING � /
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMT FEES CROSS ST 1�
ITEM NUMBER EACH FEE OWNER
,4
MAIL
OUTLET RECEFi�� 9W $ 10 $ Q ADDRESS
LIGHTING FIXTURES 10 CITY TEL NO
ELEC RANGES CLO DRYERS ELECTRICIAN CY18TC�SyO�In Electric-,994
WATER HEATERS SO ADDRESS 8923 E. Broadway
ELEC SPACE HTRS DISHWASHERS CITY San Gabriel TEL NOAt*7-0539
GARBAGE DISPOSERS AUTO STATE
WASHERS STA COOKING UNITS 25 LICENSE NO
MOTORS OVER INC H P DISTRICT GR P ONE P ED Y
0— 1/2 25
V2- 2 50 INSPECTION RECORD
2— 5 100
a— 18 ISO
IS— 50 250
50-200 Soo
SIGNS NO TRANS
NO LAMPS
SERVICE O 600V 100 0 0
SERVICE OVER 600V Soo
MISC
WIRING PERMIT too OQ
FIXTURE PERMIT 100 OQ
SUPPLEMENTARY PERMIT SO
TOTAL FEE S
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR 8 SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING ��..
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING 5-.,1.2
1 Li/,-��d/n
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT L PROPERTY POWER
SIGNATURE UTILITYCO NOTIFIED
OF PERMITTE
FINA
CATION ARTHUR VEIT
K Mo CASH SUPERVISING ELECTRICAL ENGINEER
jjie7oa3 1-0 12 2 o X15
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78A683,CR,pOBR 30/77 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
• DEPARTMENT OF COUNTY ENGINEER ADDRESS 502 Farago
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN LOCALITY
New Residential Bldgs &Pools EACH NOFEE NEAREST
1 &2 Family Sq Ft $ 025 — $ CROSS ST
A4.A OWNER OR
Multi family Sq Ft 02 — FIRM NAME RUSSO
Residential Swimming Pools 2500 MAIL -5021
AIL502 Farago
ADDRESS
Outlets Rec 11 Light 3 Sw -5— CITY Temple C3-ty Tel No 286—,9861
First 20 50 PLAN CHECK
p
Total No� Additional 30 APPLICANT
ADDRESS
Lighting Fixtures First 20 50 3 150 CITY Tel No
Total No 3 Additional 30 PERIT
A PLICANTHOlzer Electric
Fixed Appliances Not Over 1 HP ADDRE558422 Securaf)Way
Range_Heater_D W CIT to Fe S rin S Tel No 696-4555
Oven_Dryer_W M_ t LICENSE OR
Top —FAU W* REG NUMBER 283057 Class C-10
Hood_Fan 1 Other- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp _ Room Air Cond
25o 3 7 50THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN
ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING
Power Apparatus&Large Appliances
Size&Type HP KW KVA or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM
Up 1 2 50 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY C
Over
1 too 1 10 Incl 5 00 v
Over 10 to 50 Incl 1250 PERMITTEE
SIGNATURE
25 00 1
O
Over 50 to 100 Inc i�
Over 100 4000 DISTRICT NO O P SSIP BY y
z
Services
0 200 Amp Under 600 V 12 5012 INSPECTOR S
201 1000 Amp Under 600 V 2500 APPROVALS DA SIGNATURE
Over 1000 Amp or Over 600 V 5000 d TEMP POWER POLE
Temp Power Pole&Appurtenorces
1000 UNDERSLAB WORK
Sign with One Branch Circuit 1000 ROUGH CONDUIT
Additional Sign Branch Circuits 200 WIRING
Misc Conduits&Conductors 10.00 11 FIXTURES
JY
Other(See Complete Fee Schedule) POWER AUTHORIZED
UTILITY CO NOTIFIED
FINAL /Q ,3h oplZ/Cvc�
PERMIT FEE (Sub Total) 31 00 NOTES
PLAN CHECKING FEE (One Fourth Permit Feel
PERMIT ISSUING FEE $700 7 00
TOTAL FEE 38.0 ° o
PLAN CHECK VALIDATION CK M O CASH AVT V�jIDATION CK M O CASH
1�
A�rc' w Lyn/ O O
V 0 ! ro� �O & 'O C:) N � -SG7dt(o
CH
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
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