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76A663-CE806 4 65 APPLICATION FOR LECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 7sdjaX
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSSS T. ` CO
RECEPTACLE �T OTAL NO EACH FEE
./OUTLETS FIRST 20 $.20 $ OWNER
LIGHT MAIL
SWITCH OA
ADD'L 10 ADDRESS
OVER 20
TOTAL FIRST 20 .20 CITY TEL NO.
LIGHTING FIXTURES
FIXTURES ADD'L 10 CONTRACTOR UICC14AII G�
OVER 20
RANGES CLO DRYERS WTR.HTRS. 1.00 ADDRESS 3
GARB DISP. STA COOK
CITY e C Ci%llf TEL NO, '®O7
DISHWASH AUTO.-WASH STATE
SPACE HTRS STA.APP (ya H P.MAX ) .50 LICENSE NO.
MOTORS. OVER NOT OVER HP DISTRICT GRQUP ONEP C ED BY
0 1 1.00 S- e) �-
1 3 1.50 INSPECTION RECORD
9116-1 3 a 200
8 is 250
a
16 50 300 0
so too 500 '
V
ce
SIGNS- NO.TRANS O
NO.LAMPS ~
U
W
SERVICE 0-60OV-NOT OVER 200A 1.00
N
SERVICE 0.60OV-OVER 200 A. 1200 Z
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 1200
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ APPROVALS DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR T T I AM THE LEGAL OWNER OF ND INTEND TO POWER
RESIDE IN,THE AB ES IBED R ENTIAL OPERTY ¢�
SIGNATURE UTILITY CO.NOTIFIED �(f/
OF PERMITTE
FINAL
ALIDATION JOSEPH C. ROOHAN
(CK' MO CASH
SUPERVISING ELECTRICAL ENGINEER
LAL� ll 2 4 711 AAPR 2 7 2 D 1 120-