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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING D
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.a TOTAL NO. EACH FEE
OUTLETS FIRST 20C�� $20 $ OWNER
LIGHT �0 D -MAIL
SWITCH.
/ OVER 20 .10 7 b ADDRESS
�1
LIGHTING TOAL� FIRST 20 .20 CITY TEL. NO.
0,� ,
FIXTURES ADD'L ELECTRICIAN
v OVER 20 •1O� Z. � A
Xftt
CLO.DRYERS WTR.HTRS. .1.00 1>0o"
ADDRESS -0,
GAaw.nlua_ STA.COOK / P
CITY EL Nlfh
DIS AUTO.-WASH. L'(}I LICENSE NO. O.
/
h
STATE h g (.r /J
SPACE HTRS. � STA.APP.(y H.P.MAX.) •50 _ "�V C1 -.
MOTORS: 'OVER NOT OVER - H.P. DISTRICT GR UP ZONE P QED
.O•' 1 1.00 S o
1 3 1.50 INSPECTION RECORD
B 15 ' 2.50 O
.P A7: s,
15 50 3.00 4
�LI,F� I,Ail ��( OAC. �' _ IJG.'•�A
50 100 5.00 //• 1' - - }.
NO.TRANS.
SIGNS: NO.LAMPS' Hy
b
SERVICE 0.600V-Nor OVER 200A 1.00
-
SERVICE O.60OV-OVER200.A. 2.00
SERVICE OVER600V5.00
0
MISC.
PERMIT ISSUING FEE 2.00 04
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1-HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI N APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE.TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. I
WIRING .7/•�
1 HEREBY CERTIFY THAT I AM PROPERLY,REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - FIXTURES
CALIFORNIA OR THAT IAM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. POWER.
SIGNATURE (90
UTILITY CO.NOTIFIED
OF PERMITTEE -
_ FINAL '
LIDATION ARTHUR C. VEIT '
&K) MO CASH
SUPERVISING ELECTRICAL ENGINEER
r _ 3 7 3 OCT 2 5 2 D 'i 4 Q d
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