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76A663-CE806 ,-6B, APPLICATION FOR ELECTRICA PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING !731 0
BUILDING AND SAFETY DIVISION ADDRESS U .
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY r
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NO, ACH FEE
.�� $ $ OWNER
RECEPTO
MAIL
LIGHT �2 TOTAL FIRST 20 jt7 20 V/ I ADDRESS
SWITCH 3 OVER 20 10 CITY TEL. NO.
7T� PLAN CHECK _
LIGHTING TOTAL FIRST 20 -3 20 �v 'APPLICANT
FIXTURES OVER 20 10 ADDRESS
RANGE—DRYER—WTR.HTR._ CITY TEL. NO.
STA.COOK_DISP. F.A.U._ CONTRACTOR-
SPACE HTR. AIR COND. ADDRESS7.��(� �^p• `� D/
CLOTHES WASH._DISHWASH._ CITY -41 �(�h TEL NO.T�jT�IG �P
FANOTHER 1.00 LICENSE IJO � o� 3 CLASS.
MOTORS,TRANSFORMERS RATING
IND HEATERS, ETC. HP. KW KVA. I 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.
O - 1 1 00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 - 10 3 00 "LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO a
10 - 50 5 00 RESIDE IN, THE ABOVE DESCRIPED RESIDENTIAL PROPERTY. 0
SIGNATURE V
50 - 100 1'0.001 OF PERMITTEE -
GC
100 — 500 15 00 DISl��J C�iT]
TUBE, OR G P Z P S D
S IGN,GAS SIGN AND ONE CIRCUIT 3 00 <J + W
_ tZ
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 3 00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT /
WIRING
PERMIT FEE (SUB TOTAL)
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 P� UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEEI 1 00 FINAL
TOTAL FEE 80 JOSEPH C. ROOHAN
SUPERVISING ELEC ICAL ENGINEER
PLAN CHECK VALIDATION CK. M 0 CASH PERMIT VALIDATION cK M 0 I CASH
LEio 6 i3 3 SIL
25 ? 0 7.�t�N «:
;EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
L
76A663-CE806 11,70 APPLICATION FOR ELECTRICAL E_ RMIT -
i COUNTY OF LOS ANGELES
vi
DEPARTMENT
NG AND SAFETY DIVISION ER ADDRESS. g44S E . -,�� y Ir S
LOCALITY /
' COLEMAN W. JENKINS, SUPERINTENDENT CF BUILDING
NEAREST
F-OR,APPLICANT'TO FILL�IN CROSS ST. . L_Q"' L-
OU LETS . N0. EACHI FEE -
OWNER
RECEPT. $ $ MAIL
'FIRST 2025ADDRESSADDRESS
LIGHT TOTAL 25
- CITY TEL. N0.
SWITCH_ OVER 20 ,10 ,
PLAN CHECK
LIGHTING
'FIRST'20 25 APPLICANT
TOTAL '
, OVER 20 ADDRESS
FIXTURES - 10 "
APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYERWTR. HTR. APPLICANT "
STA. COOK DISP. •F.A.U. ADDRESS
SPACE HTR.. AIR COND. CITY TEL. N0.- `
CLOTHES WASH. 01SHWASH. LICENSE NO. CLASS. _--
FAN OTHER' 100 y I HEREBY ACKNOWLEDGE THAT I HAVE READ•_THIS APPLICATION
AND STATE THAT THE,ABOVE IS CORRECT AND-AGREE TO COMPLY '
MOTORS, TRANSFORMERS RATING I WITH ALL COUNTY ORDINANCES AND -STATE LAWS REGULATING
IND HEATERS, ETC HP.-KW. KVA. ELECTRICAL WIRING. "
SIZE & TYPE OVER' TO -
'I HEREBY CERTIFY THAT I AM.PROPERLY REGISTERED AND/OR
0 - 1 1pp LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM-THE LEGAL OWNER OF., AND INTEND TO, >_
1 - 10 300 RESIDE IN, THE ABOVE ' DESCRIBED' RESIDENTIAL 'PROPERTY. CL
SIGNATURE �� h \� ,� OU
10 - 50 500 OF PERMITTEE �►oo-.�ay" r 111CTC?"'���•••`ill......
50 -_100 1000 O.
DIS•TRIC,T�NO CLASS ZONE PROCESSED-13Y Y
1.00 - 500 13 00 �, 0 � LU
a_
SIGN', GASSIGN AND ONE CIRCUIT 5.00 NOTES: U)
Z
TUBE, OR _ - -
MARQUEE ADDITIONAL CIRCUITS 100
SERVICENOTOVER 600VOLTS OR200AMP 300
APPROVALS _ DATE INSPECTORS SIGNATURE
SERVICEOVER-600 VOLTS OR 200 AMP 10.00
TEMP,.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES' _ 500
UNDERSLAB WORK
TEMP LIGHT'OR RECEPT. SYSTEM, 300
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORI7ED
PERMIT FEE (SUB•TOTAL)• -
UTILITY CO. NOTIFIED
'PLAN CHECK FEE / q
FINAL
PERMIT ISSUING,FEE 300 3 ��
JOSEPH C. ROOHAN '
TOTAL FEE SUPERVISING ELECTRICAL ENGINEE
PLAN CHECK-VALIDATION CK. M 0. CASH PERMIT VALIDATION CK. M o cAs
2. 3.;7'5;'
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ,
76A663-CE+06 ,"0i74 APPLICATION .FO ELECTRICAL =PERMIT -
COUNTY OF LOS ANGELES,
• DEPARTMENT OF COUNTY ENGINEER JOB
BUILDING AND SAFETY DIVISION ADDREss e• h V/ _. '
LOCALITY .� .
NEAREST
FOR APPLICANT, TO FILL IN CROSS ST. C0 6."e
/-/
NO EACH FEE
OUTLETS' OWNER OR i /•
e�ln
RECEPT._ $ —FIRM NAME
MAIL
LIGHT TOTAL FIRST 20 4 ADDRESS EL.
!l CITY T.EL. 0. 87 0
SWITCH OVER 20 IO
PLAN CHECK -
(FIRST 20 APPL'ICANT
LIGHTING
, � TOTAL !/ - ,•, ,
20 ADDRESS
OVER 10
FIXTURES
RESIDENTIAL APPLIANCES . CITY TEL. No.
` PERMIT
RANGE' DRYER_WTR.-HTR. APPLICANT -
STA. COOK DISP. F.A.U: ADDRESS
SPACE HTR. AIR COND. CITY TEL. NO.,
LICENSE OR ••
CLOTHES WASH. DISHWASH.—, REG. NUMBER CLASS.
FAN OTHER' I 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 - }
I HEREBY CERTIFY THAT I AM PROPERLY.REGISTERED AND/OR
LICENSED AS RED IRED BY LOS ANGELES'COUNTY AND STATE OF
O - 1 16
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE a-
' T - 1'O '300 DESCRIBED RESIDENTIAL PROPERTY. / .. V
_ PERMITEE1=„��
10 — 50 500 SIGNATURE .�"'�''w D� CD
a~
” U
0 — 100 '1000
5i
_ - DISTRICT N0. P C SED y
1 00 = 500 1500 .—— Q Z
SIGN, GAS SIGN AND ONE CIRCUIT, 500 APPROVALS DATE INSP TOR'S SIGNATURE
I, TUBE, OR - -
MARQUEE ADDITIONAL CIRCUITS .100 TEMP. POWER'POLE
SERVI CE NOT OVER 600 VOLTS'OR 200 AMP 300 - UNDERSLAB WORK '
• SERVICE OVER 600 VOLTS OR 200 AMP= 1000 ROUGH.CONDUIT =-
TEMPSERVICE, POLE, &APPURTENANCES 500 WIRING • -
TEMP LIGHT OR,RECEPT. SYSTEM •300 FIXTURES. ..
• POWER AUTHORIZED
• , UTILITY•CO. NOTIFIED - -
FINAL
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK•FEE
PERMIT ISSUING FEE ' X00 � •'
/
TOTAL FEE ~~'
PLAN CHECK VALIDATION CK. M,O. CASH FERMI VA IDATION c .O CASH
4 6,1''4}CT , U �L� 7. 0,A5
SEE BACK OF,APPLICATION FOR COMPLETE SCHEDULE - '