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V76AGbo6 'l APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING s�
BUILDING AND SAFETY DIVISION ADDRESS e{
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
I T E M NO. EACH FEE
OUTLETS: (FIRST 20) $20 $ OWNER
LIGHTS RECEPT. SW. MAIL
OUTLETS: (ADD'L UNITS) to ADDRESS
LIGHTS RECEPT. SW. ��,
LIGHTING FIXTURES: (FIRST 20) 20 CITY !l`Twpo
EL.NO.
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN z
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
` SO. v� GC
GARB.DISP. STA.COOK / //__
CITY 57 /�.Q-ly-5 TEL.NO. � f�
DISHWASH. AUTO.-WASH. STATE I O ._. /6 pa3o
SPACE HTRS. STA.APP.0A H.P.MAX.) ,50 LICENSE NO. C
MOTORS: OVER NOT OVER H.P. DISTRICT G Z P O D
O 1 1.00 ��
I 3 1.50 INSPECTION RECORD
, / CL
3 S 2.00 //' t [� �.._ --✓; - D_
O
8 15 2.50
15 50 3.00 / / ` G
50 100 5.00
W
a.
SIGNS: NO.TRANS. z
NO.LAMPS (� G�W`�` __
SERVICE 0-600V-NOT OVER 200A
SERVICE 0-600V-OVER 200 A. 2.00 ��GC/
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ 3
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 6
ELECTRICAL WIRING. WIRING 'O �` S-•�'�'
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER _
SIGNATURE �. UTILITY CO.
OF PERMITTEE
FINAL
LIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
4 6 4 1a SEP 21 2 D 3.0 0- V'