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76A663 CE 80616/78) APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs &Pools /� EACH NO FEE ADDRESS {�
1 &2 Family Sq Ft ; Oj $ 025 — $ � LOCALIT
Multi family Sq Ft 02 — NEAREST
Residential Swimming Pools 25 00 CROSS ST /1�+f
OER OR
RM NAME ///�JCs� P /�6/•�_
Outlets Rec Light Sw MAIL
First 20 50 ADDRESS d
Total No Additional 30 CIT ` Tel No Q �
PLAN CHECK ,
APPLICANT
Lighting Fixtures First 20 50 ADDRESS
Total No Additional 30 y I
CITY Tel No
Fixed Appliances Not Over 1 HP PERMIT / �-
Range_Heater_D W APPLICANT r7
Oven—Dryer_W M— ADDRESS
Top _FAU — W H CITY Tel No
Hood_Fan —Other LICENSE OR
Disp —Room Air Cond 2 50 REG NUMBER F Y07 Class
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP KW KVA or KVAR - COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
2 50 REGULATING ELECTRICAL WIRING
Up to 1 Incl 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Over 10 to 50 Incl 12 50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 50 to 100 Inc
25 00 DESCRIBED RESI IAL�POPERTY W
Over 100 40 00 PERMITEE
SIGNATOR
Services f DISTRICT,fb PROCE SED BY
0 200 Amp Under 600 V 1250
_L v
201 1000 Amp Under 600 V 25 00
Over 1000 Amp or Over 600 V 5000 Z
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Temp Power Pole&Appurtenances 1000 Q
Sign with One Branch Circuit 1000 C
Additional Sign Branch Circuits 200 .4>
l o 0o INFORMATION -0
M sc Conduits&Conductors ON REVERSE x
Other(See Complete Fee Schedule) SIDE Z A 0 6 Q 2 A
Q
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6 # 0 0 0 0 0 2
PERMIT FEE (Sub Total) 2 - 5750
PLAN CHECKING FEE (One Fourth Permit Fee) O o - 57506
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PERMIT ISSUING FEE $700 0927-78
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TOTAL FEE Z5 Q
INSPECTION FINALED W
date g� By Os
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