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76A663 CE806 ,,,7D APPLICATION FOR ELECTRI AL PERMIt
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OUTLETS NO EACH FEE
OWNER
RECEPT $ $ MAIL
LIGHT TOTAL - µ
FIRST 20 25 ADDRESS jr'O 7 /l
SWITCH OVER 20 ip
CITY TEL NO
— PLAN CHECK
LIGHTING TOTAL I
FIRST 20 25 APPLICANT
OVER 20 ADDRESS
FIXTURES 10
CITY TEL NO
APPLIANCES
PERMIT
RANGE DRYER_WTR HTR_ APPLICANT +7 y/ i
STA COOK DISP I F A U ADDRESS ..�OJ r / r
SPACE HTR AIR COND CITY TEL NO
CLOTHES WASH DISHWASH LICENSE NO j�/Z CLASS
FAN OTHER 100 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATING I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC HP KW KVA y ELECTRICAL WIRING
SIZE & TYPE OVER, TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 — 1 100 LICENSED AS RED U[RED BY LOS ANGELES COUNTY AND STATE OF a
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO �—
1 — 10 300 RESIDE IN THE ABOVE DESCRIB D RESIDENTIAL ROPE TY CL
10 - 50 500 SIGNATURE ` V
OF PERMITTEE r
$O — 100 1000 DISTRICTNOASS ZON PR Y 0
100 — 500" 1500 l v w
CL
SIGN GAS SIGN AND ONE CIRCUIT 500 I NOTES N
�Z
TUBE OR
MARQUEE ADDITIONAL CIRCUITS 100
SERVICE NOT OVER 600 VOLTS OR200AMP 300
APPROVALS DATE INSPECTOR S SIGNATURE
S ERVI CE OVER 600 VOLTS OR 200 AM P 1000
TEMP'POWER POLE
TEMP SERVICE POLE &APPURTENANCES 500
TEMP LIGHT OR RECEPT SYSTEM 300 UNDERSLAB WORK '
ROUGH CONDIUT
WIRING
FIXTURESk
PERMIT FEE (SUB TOTAL) j- OroPOWER AUTHORIZED
UTILITY CO NOTIFIED io
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 300 � JO EPH C ROOHAN
TOTAL FEE,' U v StO
ELECTRICAL ENGINEEP
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VAcK M 0 CASH
4
6693s x`28 8.00-
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
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76A603 CEeOG 119APPLICATION F'O, l ELECTRIC Y ERi Y YIT
COUNTY OF LOS ANGELES s
DEPARTMENT OF COUNTY ENGINEER BUILDING �7
BUILDING AND SAFETY DIVISION ADDRESS ' l4_, F� e to
CASSAATTOHN AD GRIFFIIN Supt ofgBuildwg
LOCALITY 'TArnDle City
FOR APPLICANT TO FILL IN CROs
NEAREST
Lower Azusa Rd.
PERMIT FEES
ITEM NUMBER EACH FEE OWNER
OUTLE 1. pp s $ , MAIL
LIGHTS RECEPT 11L SW U 10 ADDRESS
LIGHTING FIXTURES 10 70 CITY i TEL NO n `
ELEC RANGES CLO DRYERS ELECTRICIAN Conj ge & Son Electric
W A T E R HEATERS 50 ADDRESS C) I� Grandview Ave.
ELEC SPACE HTR S DISHWASHERS ((�� n
GARBAGE DISPOSERS) AUTO 75 4 CITTj .a T P TEL P44t 0-200
WASHERS STA COOKING UNITS 25 STATE //
LICENSE NO h
MOTORS OVER INC H P ATEMmommEp
O — '/z 25 DISTRIC NO GR UP ZONEREADY FOR INSPECTION
1/2 — 2 so
INSPECTION RECORD
2 — 5 100 _
r
5 — 15 150
15 — 50 2 50
50— 200 Boo
SIGNS NO TRANS L. ~
NO LAMPS
SERVICE O 600V 100 1100
r
SERVICE OVER 600V Boo
MISC
a
C
WIRING PERMIT 1 00 1 QQ
FIXTURE PERMIT too 1 00 ^
SUPPLEMENTARY PERMIT L
f
TOTAL FEE 7 35 APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE RPPLICATION DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT ATO COMPLY F
T~WITH ALL COUNTY ORDINANCES AND STAEGULATINGELECTRICAL WIRING I HEREBY CERTIFY THAT I AM PROPERLD AND/ORLICENSED AS REQUIRED LOS ANGELES CSTATE OF S
CALIFORNIA OR THAT A T L L OHE ABOVE DESCRIBED RESIDENTI PR ESIGNATURE CO NOTIFIED
OF PERMITTE
YJVMATION ARTH U R C V EIT
MO CASH SUPERVISING ELECTRICAL ENGINEER
CK
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