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76A6§3'C:806 11/70 APPLICATION FOR ELECTRICA�ERMIT
U
' COUNTY OF LOS ANGELES
' r DtPARTMENT OF COUNTY ENGINEER BUILDING O Q
' BUILDING AND SAFETY DIVISION ADDRESS
COLEMAN W. JENKINS SUPERINTENDENT OF BUILDING LOCALIT
NEAREST
FOR APPLICANT TO FILL'IN CROSS ST
OUTLETS NO EACHI FEE
OWNER
$ $
RECEPTVado MAIL
LIGHT TONAL
FIRST 20 25 QO ADDRESS
OVER 20 ( CITY TEL. NO
SWITCH J 10 PLA CHECK
LIGHTING FIRST 20 O 25 Od APPLICANT
TOTAL ADDRESS
FIXTURES OVER 20 10
PPLIANCES CITY N0.
PERMIT 1 I
RANGE DRYERWTR. HTR APPLICANT
STA. COOK DISP.�F A U. ADDRESS 0
SPACE HTR I AIR COND "sl - CITY - TEL. NO.
CLOTHES WASH DISHWASH LICENSE NO. CLASS. -A D
FAN�OTHER I/�i 100oO 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
.•'JJ 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
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, ND INTEND TO
1 - 10 300 RESIDE IN, THEYABOV,,-) DESCRIBED RE IDE AL PROPERTY, CL
10 - 50 500 SIGNATURE U
OF PERMITTEE
DC
50 - 100 1000 go I STRICT NO SS ZO PRO ED O
100 - 500 1500 � Lu
SIGN, GAS SIGN AND ONE CIRCUIT 500 NOTES: h
Z
TUBE, OR -
MARQUEE ADDITIONAL CIRCUITS 100
SERVI CENOT OVER 600 VOLTS OR 200 AMP 300
APPROVALS DATE INSPECTOR'S SIGNATURE
S ERVI CE OVER 600 VOLTS OR 200 AM P 1000
TEMP.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES 500
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 300
ROUGH CONDIUT
WIRING
FIXTURES
ZED
PERMIT FEE (SUB TOTAL) POWER AUTHORI ,
UTILITY'CO. NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 300
JOSrEPHd. ROOHAN
TOTAL FEE '
CK
PLAN CHECK VALIDATION M 0 RSUPERVISING ELECR L ENGINEER.
i �CASH PERMIT VALIDATION C/f K d M 0. CASH
'
Liao 4 2 6 6- FEB 3 2 p 3
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE