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APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING /J
BUILDING AND SAFETY DIVISION ADDRESS `J
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
/// NO EACH FEE
�O $ $
RECEIPT
V� S
LIGHT TOTAL FIRST 20, 20
SWITCH OVER 20 10 CITY TEL NO
PLAN CHECK
LIGHTING TOTAL FIRST�20 20 jtj APPLICANT
FIXTURE } OVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR CITY TEL NO
CONTRACTOR /
L �
STA COOK_DISP _F A U
SPACE HTR AIR COND ADDRESS
CLOTHES WASH _DISHWASH CITY C � TEL NO
FAN�OTT R 1 00 LICENSE NO CLASS G
MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
IND HEATERS, ETC. HP. KW KVA AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
O — 1 1 00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
'LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATEOF r
1 — 10 3 00 CALIFORNIA-0R GAL OWNER OF, AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY O
10 — 50 5 00 L)
SIGNATURE �/ 13d50 — 100 10.00 OF PERMITTEE O
100 — SOO 1500 DISTRIX NO GROUP ZO PR C
/�� W
SIGN,GAS SIGN AND ONE CIRCUIT 3 00 u�7
TUBE, OR Z
MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE, POLE, &APPURTENANCES 3 OO APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING / f DAiL
PERMIT FEE (SUB TOTAL) FIXTURES
POWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
PERMIT ISSUING FEE 2 00 UTILITY CO NOTIFIED 7—/o-7Q ov4
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASHI PERMIT VALIDATION =K M Q CASH
7 4 7cc:-3 Jif. 9 2 0 1 0.4 0�
SEE BACK OF APPLICATION FOR COMPLETF FEE SCHFnUIF