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11
76A663-CE806 1-68 APPLICATION. FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING /
BUIk5?NG'tkND SAFETY DIVISION ADDRESS D(p
JOHIG A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY r
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
11� $ $ OWNER
RECEPT.J� MAIL
LIGHT TOTAL FIRST 20 .20 2,67ADDRESS v
SWITCH_ OVER 20 .10 CITY TEL. NO.
PLAN CHECK
LIGHTING �TOTAL FIRST 20 .20 APPLICANT
FIXTURES OVER 20 .10 ADDRESS
RANGE—DRYER—WTR.HTR. CITY TEL. NO.
STA.COOK—DIS P. F.A.U.— fCONTRACTOR 5 �
SPACE HTR. AIR COND. ADDRESS ,�y(1-4
CLOTHES WASH._DISHWASH._ CITY_
d
FANOTHER 1.00 LICENSE NO. CLASS.
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
0 1 1.00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 - 10 3.00 LICENSED AS REOU IRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
10 - 50 5.00 RESIDE IN, THE ABOVE OESCRIP,ED RESIDENTIAL PROPERTY.
50 - 100 10.00 SIGNATURE �/ � O
OF PERMITTEE Ylaze Iw
100 - 500 15.00 O
DISTRICT NO. G OUP ONE 9CESSED BY
TUBE,GOR AS
SIGN AND ONE CIRCUIT 3.00 l� - r a
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 1 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
L
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
E (SUB TOTAL) FIXTURES
CK FEE (50% PERMIT FEE) POWER AUTHORIZED
SUING FEE 2.00 UTILITYCO.NOTIFIED
NTARY PERMIT ISSUING FEE 1.00 FINAL
E �Q JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONcK. M.O. CASH
6 8 8 9 2 OCT 16 D 420- 11
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer �� ��
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR,, P I T T F LIN D TRICT NO. GR13UP' ZONE PERMIT NO.
ELECTRICI 5� IA- 1
� a
ADDRESS q RECEIVED BY READY FOR DATE ISSUED
(/ y �-� . �14 FIRST INSPECTION /_�S
CITY L NO. � �I �•-�`!_>'
COUNTY LICENSE NO. EXPIRES BUILDING L
PERMIT FEES ADDRESS �/
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST. `
RECEPTACLES
WALL SWITCHES OWNER (/
TOTAL OUTLETS .;I 5C $ MAIL
ELEC. RANGES 25 ADDRESS 1 _
ELEC. HEATERS 25 - CITY TEL. NO.
FIXTURES 3
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER ANGELES COUNTY LICE E. OR I AM THE LEGAL OWNER
FEE
NEW MVO. HP OVER INC. EACH OF THE REBIDENTIA ROP RTY ESCRI ED ABE.
%2 & LESS $ .25 SIGNATURE OF
!/2 2 .50 PERMITTEE
2 5 1.00 INSPECTION RECORD
5 15 1.50
15 50 2.50
_ 50 200 5.00
200 500 10.00 J
500 1000 15.00 Z
OVER 1000 20.00ED
M.G. SET/FREQ. CHANGER-HP
WELDERS: AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (7S% OF ORIG.)
MOVED MOTORS (75% OF ORIS.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT A
FIXTURES $1.00 �y WIRING
SUPPLEMENTARY .50 FIXTURES pp n S ,
POWER
TOTAL FEE $ UTILITY CO. NOTIFIED 0,J �2�
FINAL �
7GA663 OSS#5A 2-S3