HomeMy Public PortalAbout5400 GOLDEN WEST AVE_Electrical__ 76A663CE-806(6/78) APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
FAppl
sidential Bldgs. &Pools
EACH NO FEE ADDRESS
-Family,Sq. Ft. .025 — $ LOCALITY
i-family Sq. Ft. 02 — NEAREST
25.00 CROSS ST.
eS
ential Swimming Pools OWNER OR
FIRM NAME
Rec Light Sw. MAIL
First 20 .50 ADDRESS
No. Additional .30 CITY Tel. No.
PLAN CHECK
APPLICANT
Fixtures First 20 .50 ADDRESS
Additional 30
No. CITY Tel. No.
ppliances Not Over 1 HP PERMIT
e_Heater_D.W.
APPLICANT
_Dryer_ W.M.— ADDRESS
Top _FAU — W.H._ CITY Tel. No.
Hood_Fan —Other LICENSE OR
Disp._Room Air Cond. 2.50 REG. NUMBER Class.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA.
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
LY WTH ALL COUNTY
Size&Type HP, KW, KVA,or KVAR R GULATI GI ELECTRICALL WIRING.ORDINANCES AND STATE LAWS 0
Up to 1 Incl. 2.50W
5.00 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
Over 50 to 100 Inc.
25.00 DESCRIBED RESIDENTIAL PROPERTY.
Over 100 40.00 PERMITEE
SIGNATURE Q
Services2
0- 200 Amp. Under 600 V
12.50 DISTRICT NO. PROCESSED BY W
201-1000 Amp. Under 600 V 25.00 ~
Over 1000 Amp.or Over 600 V 50.00 Z
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Temp. Power Pole&Appurtenances 10.00 11-
Sign
Sign with b&' ranch Circuit 10.00
Additional Sign Branch Circuits 2.00 INSPECTION >
INFORMATION
Misc.Conduits&Conductors
10.00
Other(See CaiRplete Fee Schedule) ON REVERSE u
SIDE Z
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d
a
PERMIT FEE (Sub-Totali
PIAN CHECKING FEE (One-Fourth Permit Feel O '
PERMIT ISSUING FEE $7.00 0
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Q
TOTAL FEE >
INSPECTION FINALED �A
By cl/r �r�CG� --
date: P s