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76A663-CE806 5-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEBUL DING AND SAFETY DIVISIONENT OF COUNTY Ammo E1SS 10142 La Rosa
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OP BUILDING LOCALITY fl.4
NEAREST
7SWITCH. 1
APPLICANT TO FILL IN Caoss ST. 11-11 ckmart
TAL NO. (EACH FEE
LETS FIRST 20 ry1 $ 2OS - - OWNER Daugherty/��1I` 20v MAIL
Z— oV ER 20 2910 2 90ADDRESSOTAL CITY TEL. NO.
F1gsT20 1L .20 2 4412 ADD-L 1D ELECTRICIAN (Lang
av R 20 ' 8940
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RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS yy E. 18 y
GARB.DISP. STA.COOK
CITYRO8@m TEL. NO. a-001
DISHWASH. AUTO.-WASH.
STATE ry,�
LICENSE NO. 1?0188
SPACE HTRS. STA.APP.1%H.P.MAX.)1 2 .50 1 VV
MOTORS! OVER NOT OVER M.P. I D STRICT NO. G UP Z NEI PR 5 BY
O 1 i.00
1 3 1.50 INSPECTION RECORD
3 8 2.00
Ab P
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8 15 2.50 V a
15 50 3.00 I ' O
50 100 5.00
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SIGNS:
NO.TRANS Af)
NO.LAMPS r /T✓('l UJ
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SERVICE O-SOON-NOT OVER 200A 1.00 1 Vo ( Z
SERVICE 0-60ON-OVER 200 A. 2.00
SERVICE OVER SOOV 5.00
MISC.
PERMIT ISSUING FEE 1.00
SUPPLEMENTA13Y PERMIT ISSUING FEE 1.00
TOTAL FEE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVAL$ DAT! I INSPECTOR'SSIGNA/TURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ////
ELECTRICAL,WIRING. WIRING A.? >it
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSEO AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURE$
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RES IDENTIA PROPERTY. POWER )) Ey g ,T
SIGNATURE UTILITY CO.NOTIFIED Y' �T-0Oa� d
OF
SIGNATURE
PERMIT -
FINAL / G L
�LI ARTHUR C. VETT
CK MOO CAS CASH SUPERVISING ELECTRICAL ENGINEER
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