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16A663-CE806 5-62 APPLICATION FOR ELECTRICAL PERMIT ,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING / LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL
OUTLETS FIMAIL
RST 20 $20 $ OWNER
LIGHT ADD'L ij 10 R
ADDESS O
SWITCH. 16 U OVER 20 7
142- Z7-1 17
TOTAL CITY EL. NO.
LIGHTING FIRST 20 / 20
FIXTURES } ADD .10 1O ELEC
OV R TRICIA
0
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DIBP. / BTA.COOK CITYTEL.NO. ,
DISHWASH. /' AUTO.-WASH. STATE zi
SPACE HTRS. STA.APP.(1/s H.P.MAX. — .50 LICENSE NO.
141
MOTORS. OVER NOT OVER H.P. DISTRICT}NO. GROUP ZONE PROCESSED BY
O l
1 1.00 r cS .3 t'�7- 775,
3 1,50 INSPECTION RECORD
3 B 2.00
8 15 2.50 a
O
15 50 3.00 u
50 100 5.00 04
O
NO.TRANS ~
SIGNS: NO.LAMPS W
0-
SERVICE 0.60OV-Nor OVER 200A 1.00 N
Z
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
it
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $,� "�'
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INHPECTOR'8 SIGNATURE
AND 8TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -
ELECTRICAL WIRING. WIRING
IOW
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY ANGELES COU TY A STATE OF FIXTURES .�
CALIFORNIA OR THAT I A T LEGAL OW R O THE BOV
DESCRIBED RESIDENTIAL PR P POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE FINAL
(JCK
LIDATION ARTHU C. VEIT
MO CASH SUPERVISING ELECTRICAL ENGINEER