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76A803-CEB06 10-61 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 s .
1 T E M NO. EACH FEE
OUTLETS: RE'(FIRST 20). $20 $ N OWNER '
LIGHTS CEPT. _ SW. MAIL
OUTLET : (ADD'L UNITS) .10 ADDRESS
LIGHTS RECEPT. 8W.
LIGHTING FIXTURES: (FIRST 20) 20 CITY TEL. NO
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRI IAN 2j
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRES J
GARB.DISP. STA.COOK
CITY E NO
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(+/z H.P.MAX.) . ,50 LICENSE
MOTORS: OVER NOT OVER ' H.P. DIST CT O. G O P NE P CESSED BY. .
O 1 1.00 R
i
1 3 1.50 INSPECTION REC' RD -
3 S 2.00 d 116 v O
8 15 2.50 - , J/
15 50__ __ 3.00 -� - ♦,��p/'
50 100- 5.00
JLLJ
NO.TRANS. \ ,/ U)
SIGNS: NO.LAMPS (� � ml/_,f.Jr6��,/ L/
SERVICE 0-60OV-NOT OVER 200A 1.00 Al �� /,��-�!/I / �j 01 /7
SERVICED-60OV-OVER 200 A. 2.00
.f
SERVICE OVER 600V 5.00
PERMIT ISSUING FEE 2.00 "
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 ��
TOTAL FEE $ b,/,,9_
LELECTRICAL
BY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
L COUNTY ORDINANCES AND STATE LAWS REGULATING
AL WIRING. WIRING
EBY CERTIFY THAT I A,%% PROPERLY REGISTERED AND/OR
D•AS REQUIRED'BY LOS ANGELES COUNTY AND STATE OF FIXTURES
NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEED REBIDENTIA ROPE 1 POWERURE . UTILITY CO.NOTIFIEDMITTE +`�'
FINAL
NALIDATIO ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
CK MO CASH
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