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ISA883 CESOS 10 61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS D i
JOHN A LAMBIE COUNTY ENGINEER 1
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN [CROSS ST
1 T E M NO EACH FEE
OUTLETS (FIRST 20) 1 $20OWNER
LIGHTS (D RECEPT SW MAIL
OUTLETS ADD L UNITS) 10ADDRESS
LIGHTS RECEPT 8W
LIGHTING FIXTURES (FIRST 20) 20CITY TEL NO
LIGHTING FIXTURES (ADDITIONAL) IOUELECTRICIAN
RANGES CLO DRYERS NRR HTRS 100 ADDRESS
GARB DI STA COOK
CITY TEL NO
DISHWASH AUTO WASH STATE �7
SPACE HTRS S'[A APP (/ H P MA 50 LICENSE NO
MOTORS OVER NOT OVER H P DISTRICG Z N SE BY
O 1 100
C�
1 3 1 SO INNSyPECTION RECORD
91 e t
8 15 250 6 f All l U
-- .. m
15 50 300 Y W
50 100 500
d
SIGNS NO TRANS N
NO LAMPS Z
SERVICE O 600V NOT OVER 200A too
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V 500
MISC
PERMIT ISSUING FEE 1200
SUPPLEMENTARY PERMIT ISSUING FEE too
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AVAPLI A ON APPROVALS DATE INSPECTOR 8 SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES w
CALIFORNIA OR THAT I AM TH '
EGAL OWNER OF THE ABOVE v ,/
DESCRIBED RESIDENTIAL PROP E POWER
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE
FINAL.
�a(ALIDATION ARTHUR C VEIT '
MO CASH SUPERVISING ELECTRICAL ENGINEER
CK
3 3 4 1Ql AUG22 2 0 13.3 0- q
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