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76A663C- C:ES06812/75 APPLICATION FOR ELECTRICAL PERMIT
BUILDING A�TY DIVISION /V
FOR APPLICANT TO FILL IN ,JOB
New Residential Bldgs.&Pools EACH NO. FEE ADDRESS S ZCi &LIGle-tvi at4
1 &2 Finaily Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.FMOR
RM N ME !��"ll�! �. IY►L(�.l,yE'_e
Outlets: Light,Switch&Receptacle ADDRESS ��1 \C�IL� j�11�'Ki
First 20 1:3,
��n,I r LH
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Additibnal CITY,-r1:3,M IpL� C�,-7 Tel._No. LHI-00+4
PLAN CHECK
APPLICANT
Lighting Fixtures Yr
First 20 ADDRESS
Additional CITY /� Tel. No.
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT
Range_ Heater_ D.W. ADDRESS
Oven Dryer W.M.
Top FAU W.H. CITY Tel. No.
Hood Fan LICENSE OR a
REG. NUMBER Class.
Disp. A.C.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O
Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
Size&Type HP, KW,KVA,or KVAR ELECTRICAL WIRING. V
w
Up to 1 Incl. I HEREBY TIFY THAT 1 AM PROPERLY REGISTERED AND/OR Cn
Over 1 to 10 Incl. LICENSED 5 RE UIRED LOS ANGELES COUNTY AND STATE OF
z
CALIFOR IA OR THAT M T LE L OWNEROF HE ABOV
Over 10 to 50 Incl. DESCR IS D RES ENT L PROP TPA
'
Over 50 to 100 Incl. PERMI E U
Over 100 SIG NAT Ems'
Li
DISTRICT NO. 7SSED BY
Services
0-200 Amp. Under 600 V
201 -1000 Amp. Under 600 V APPROVALS DATE INSPECT RE
SIGNATURE
Over 1000 Amp.or Over 600 V
TEMP. POWER POLE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit ROUGH CONDUIT
Additional Sign Branch Circuits
(Other) WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED p J
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL
PERMIT ISSUING FEE
NOTES
TOTAL FEE J
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. =CASH
DBSSSA11-5E APPLICATION FOR ELECTRIC PERMIT 1
:DIVISION OF BUILDING AND SAFETY
Department of County Engineer BUILDING
County of LOS Angeles ADDRESS /
JOHN A. LAMBIE.COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
PERMIT FEES
NUMBER
OWNER
1 LIGHT OUTLETS MAIL
+ ! RECEPTACLES ADDRESS /z)
WALL SWITCHES FEE CITY eZ, // / / TEL. NO.L"
TOTAL OUTLETS @ 5¢ S ` a
r ELECTRICIAN
ELEC. RANGES 25
ADDRESS
ELEC. HEATERS 25
KW EACITY o�pk�F TEL. NO.
v..-
STATE
r% FIXTURES 5 %5 S4 LICENSE NO.
MOTORS DISTRICT NO. GROUP ZONE loOREADY FOR INSPECTION
NUMBER HORSEPOWER FEES
NEW I MVD. HP OVER INC. EACH
1/2&LESS $ 25 INSPECTION RECORD
1322 .50 1� ,j^/4, / /'1 i 6./X;- tJ fI'�
�
2 5 1.00
5 15 1.50
95 50 2.50
50 200 5.00
1
Misc.
NO.SIGNS NO.TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE $ 7 DATE INSPECTOR'S SIGNATURE
LLDESCRIBED
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ,
ICAL WIRING. +
REBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES * 6✓ �jJ��° �' i, �,_„_
ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
RNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
RESIDENTIA PROPE TY UTILITY CO.NOTIFIED
TUREERMITTEErFINAL
OHN A.LAMBIE,COUNTY ENGINEER AL`IDATI®N ARTHUR C.VEIT.CHIEF ELECT.INSPECTOR
f CK ;MO CASH
t o 6 6 1 4 Jl7iJ ? 2.4 5
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