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76A663 CE806 4 65 APPLICATION FOR ELEC �ALRMJIT
a COUNTY OF LOS ANGELES
DEPA�2TMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER f
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEPTACL TOTAL NO EACH FEE
OUTLETS FIRST 20 q $20 $ ., OWNER
LIGHT �� LL e L MAIL
ADD L
SWITCH l� OVER 20 10 r (ADDRESS
TOTAL FIRST 2020 4 2-c CITY TEL NO
LIGHTING FIXTURES
FIXTURES ADD L
OVER 20 10 CONTRAC HARDSON ELECTRIC CO. Inc.
RANGES CLO DRYERS WTR HTRS 100 ADDRESS 8823 E. Broadway
GARB DISW" STA COOK CITY Gabriel,TEL NO
DISHWASH AUTO WASH STATE
SPACE HTRS STA APP (/p H P MAX ) 501 LICENSE NO /
MOTORS OVER NOT OVER H P / DISTRICT N G N PR Y
O 1 100
1 3 150 INSPECTION RECORD
9 6 200
8 15 250
15 50 300 O
50 100 500 L V
GC
SIGNS NO TRANS O
NO LAMPS b
SERVICE 0 600V NOT OVER 200A too 00 a
N
SERVICE 0 60OV OVER 200 A 200, Z
SERVICE OVER 600V 500
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 200 t?[)
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $ f �� APPROVALS DATE INSPECTOR S SIGNATURE
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK J,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT a
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO POWER
RESIDE IN THE ABOtll DESCRIBED REST ENTIAL PROPERT
SIGNATURE UTILITY CO NOTIFIED C` /
OF PERMITTEE FINAL J
1�
�IDATION JOSEPHR00 AN
MO CASH
SUPERVISING
ING ELECTRICAL ENGINEER
9 0 9 6- JAN25 2 D 13,80-