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76A663-CE806 1 1-71 APPLICATION ,FOR ELECTRICAL P RMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDINGS�-�z Vreen �t•
BUILDING AND SAFETY DIVISION
TY Temple Cit
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FOR APPLICANT TO FILL IN ST.OUTLETS NO. EACH FEE t,�� fright
RECEPT._ $ $ MAIL 10Z1O Green St.
FIRST 20 25. ADDRESS
LIGHT TOTAL le it
CITY em P Y TEL. N0.
SWITCH OVER 20 10
PLAN CHECK
LIGHTING FIRST 2025 APPLICANT
TOTAL
FIXTURES
OVER 20 .10 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT Aa mor Electric Comp,
RANGE DRYER WTR. HTR. APPLICANT Y P
STA. COOK DISP. F.A.U. ADDRESS 315 So. San Gabriel BB/l�vd
SPACE HTR. AIR COND. CITY San Gabriel TEL. N0.287 0477
CLOTHES WASH. DISHWASH. LICENSE N0. 251206 COL CLASS.
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
IM CERTIFY THAT I AM PROPERLY REGI ERED AN O
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STAT
CALIFORNIA OR THAT THE LEGAL OWNER O AND INTEN
I - 10 300 RESIDE IN, THE BO DESCRIBED RE D IAL PROPE O
SIGNATURE CC
10 - 50 5.00 OF PERMITTEE O
50 - 100 10.00 1-
DISTRI N0. CL. S PRO SSED Y V
W
CL
100 - 500 15.00 a U N
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: ?
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVI CEOVER 600 VOLTS OR 200 AMP 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
5 6 6.0 E .�O
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT'
Department of County Engineer ELECTRIC 1
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN o� ��L 1=
RECEIVED BY READY FOR DAT ISS"D
ADDRESS FIRST INSPECTION I
CITY TEL NO. �>� .I; 1/184
COUNTY LICENSE NO. EXPIRES BUILDING �'
PERMIT FEES ADORE u
13B QC./ �L Cs' L //
A
17
NUMBER EACH FEE_ _LOCALITY F
LIGHT OUTLETS NEAREST
CROSS ST. AA 469 M11AI
RECEPTACLES
WALL SWITCHES
TOTAL OUTLETS 5C S DDRESS /LO C.r• /S_ `/f� ;°~
ELEC. RANGES 25 // �I
ELEC. HEATERS 25 CITY /h .TEL. NO. Q Q' �/
FIXTURES 5 �J
�—f���---fff----------- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORREC".
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND BTATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER INC.
EACH OF THE RESIDENTIAL PROPERTY DE CRI,AED ABOVE.
%2 6 LESS S .25 SIGNATURE
_ I/2 a .50 PERMITTE
2 5 1.00 INSPECTION RECORD
_ 5 15 1.50
_ 15 50 2.50 __ -' '� ',`� �/G c�<✓ ' A' G T`"
so 200 5.00 4
200 500 10.00 C r �`•...�"
500 1 000 15.00 Q
Z
OVER 1000 20.0_0_
M.G. SET/FREQ. CHANGER-HP
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIS.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1,00 CONDUIT
FIXTURES $1.00 G�(,/ _ WIRING `-iJ
SUPPLEMENTARY ,50 FIXTURES
D POWER
TOTAL FEE 52 UTILITY CO.NOTIFIED
FINAL f�'/ _ -•T r'
76A663 DBS#5A 2-53