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APPLICATION FOR ELECTRI AL PERQ�'�
'COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
• i
RECEIPT. OWNER
_ MAIL
LIGHT �-- TOTAL FIRST 20 ,20 ADDRESS
SWITCH - 7 OVER 20 .10 CITY TEL.NO,
PAN CHECK
LIGHTING TOTAL FIRST 20 ,20 APLPLICA
FIXTURES } -2—I OVER 20 ,10 ADDRESS
RANGE_DRYER_WTR. HTR. CITY TEL.NOO.
STA. COOK DISP. _F.A.U. CONTRACTOR /f
SPACE HTR_ AIR COND. ADDRESS �/..• Q v{
CLOTHES WASH._DISHWASH. CITY e4 TEL.NO. �fS�
FAN OTHER 1.00 LICENSE NO. Z �� G CLASS..
MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. AND STAT[ THAT THE ABOVE IS CORRECT AND AGR[[ TO COMELY
SIZE Q TYPE OYER TO WITH ALL COUNTY 0DIMANCES AND STAT[ LAWS REGULATING
ELECTRICAL WIRING.
0 — 1 1.00 1 HERESY CERTIFY THAT I AM PROPERLY REGISTERED NO/011
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATED
1 — 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN, THE AEOV[ D[�e CRIS[D RESIDENTIAL PROPERTY. O
10 - 50 15.00 U/J/// v
SIGNATURE OC
50 - 100 10.00 OF PERMITTEE O
100 - 500 15.00 DISTRICT N0. aRouP xoNE PRO
SIGN,GAS SIGN AND ONE CIRCUIT 3.00 4�L. (//1 OU
TUBE, OR Z
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: 1D
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 -
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, h APPIRTENAJiCES 3,00 APPROVALS DAT[ *DBPVCTD#M SMSIATUFM
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1,p0 FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRI I ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. DASH
I �r . 4 5 1F- WR27 2 D 5.20" rl
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