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APPLICATION FOR ELECTR C PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
ITEM NUMBER I EACH EE OWNER r ` .I
MAIL
0 L a/�/` 8 ADDRESS
LI HTG RECEPXYI-) .1G
LIGHTING FIXTURES / 10 CITY TEL. -
ELEC RANGES CLO.DRYERS ELECTRICIAN C +c-(
WATER HEATERS .50 ADDRESS [TCL-✓CJ'� ` ,//
EIEC.SPACE HTRS. DISHWASHERS CITY TEL. NO. `.�Ll� W b
GAR AGE DISPOSE-" AUTO.- STATE ] �C/ �+
WASHERS BTA.COOKING UNITS .25 � LICENSE NO. J L 4/
MOTORS: OVER INC. H.P. _ DISTRRj�.;T NO. I UHUUP I ZONE P OC ED BY
0- Y° . .25 �-
Ih- 2 .50 INSPECTION RECORD
2— 5 1.00
Is— 1s 1.50
15— s0 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICED-60OV 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE REaAD/
ICATION APPROVAL$ DATE INSPECTOR'8810NATURE
ANDSTATE THAT THE ABOVE IB CORRECT ANCOMPLYWITH ALL COUNTY ORDINANCES AND STATULATING CONDUIT
ELECTRICAL WIRING. WIRINGEREBY CERT' THAT I AM PROPERLYAND/ORLIGEN8E0EO 1OBYL08 ANGELES TATE OF FIXTURESDESCRIBED REBID CALI IAq AL A OpTEHRYLESAL ABOYE POWER / I
SIGNATURE ' /,/ UTILITY CO.NOTIFIED
OF PERM ITTE - ✓`� -
FINAL V t
®° DATION ARTHUR C.VEIT,
CK Mo CASH SUPERVISING ELECTRICAL ENGINEER
f i; 1 J 2 U
cs» " Cc
76A663- 806" '° APPLICATION FOR EL EMIICAL HERMIT
COUNTY OF LOS ANGELES ((]]
DEPARTMENT OF COUNTY ENGINEER 7RE
BUILDING AND SAFETY DIVISIONY�flftoI> —c��ll` rFOR APPLICANT TO FILL IN kjOUTLETS N0. EACH FEE RECEPT._1 S 5 FIRST 20 ZB
LIGHT_ TOTAL
OVER 20 CITY 1'Z rn(L L� C C777-1 TEL. N0. L(O
SWITCH_ ID PLAN CHECK w�v���� ..�J.y�1�
LIGHTING FI RST 20 2B APPLICANT (OL-W Nub\
TOTAL
OVER 20 ADDRESS
FI%TURES 0
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT ����,�FF
RANGE_DRYER_WTR. HTR._ APPLICANTOU+-N�\
STA. COOKDISP._F.A.U._ ADDRESS
SPACE HTR. AIR CORD. CITY TEL. NO.
CLOTHES WASH. DISHWASH._ LICENSE OR
REG, NUMBER CLASS.
FAN_OTHER 1 OI HEREBY ACNNOW LEDGE 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. RVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR
0 - I I 0 LICENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF ]..
CALIFORNIA OR THAT I AM rHE LEGAL OWNER OF THE ABOVE
1 - 10 3 0 OESCPI DECFIDEA L ,�R QPERT T.�
U
ZI
PIGRATEE
10 - 50 SIGNATURE 1 � O
U
s0 - 100 10. DISTRICT NO. �/ PROC/p//SSEO BY / H
100 - 500 MID S/D X co-:T
'�
SIGN, GAS SIGN AND ONE CIRCUIT 0 APPROVALS /U/ DATE l• INSPECTOR'S L• 9GNANRE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 00 TEMP. POWER POLE
SERVI CENOT OVER 600 VOLTS OR 200 AMP .00 U UNDERSLAB WORK
SERVICEOVER 600 VOLTS OR 200AMP I ho ROUGH CONDUIT
TEMPSERVICE, POLE, &APPURTENANCES .00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM .00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED O 1�
FINAL -7
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE A9O
PERMIT ISSUING FEE &.TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONfes. M.G. CASH
9
i[`KIM1P Gb 2 U .t, 0 AC.;
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE `/ '
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