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-'COUNTY OF LOS ANGELES ,
DEPARTMENT OF COUNTY ENGINEER I
BUILDING AND SAFETY DIVISION ADDRESS �L��f�� yL
JOHN A. LAMBIE, COUNTY ENGINEER _
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY ` ['
-.,P —.-r.:e W;i.- .o.:-..•..r., ,ttt .-at tiY NEAREST ��//JJ
FOR APPLICANT TO FILL IN CROSS ST L. A4Ai„
NO EACH FEE
$ s OWNER
RECEPT MAIL J _\
LIGHT TOTAL FIRST 20 20 ADDRESS l 4eW
SWITCH_ OVER 20 10 CITY -TEL. NO.
PLAN CHECK ^ ��
FXR
1 TOTAL FIRST 20 20 APPLICANTT OVER 20 10 ADDRESS
RYER—WTR HTR.— CITY ^ TEL NO_DISP F.A U CONTRAC FOR4AA4�AIR COND
ADDRESS
. CLOTHES WASH._DISHWASH._ CITY TEL. NO.
01 FAN—OTHER 1 00
"r LICENSE IJO 2a�r� CLASS.
' MOTORS,TRANSFORMERS RATING
& IND HEATERS, ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
O — 1 1 00
ELECTRICAL WIRING
R
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 — 10 3 00 LICENSED AS REOU IR D BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR T M THE LEGAL OWNER F, AND TEND TO
10 — 50 5 00 RESIDE IN, E ABO PESfRIPED RES N71 P OPERTY
v
50 - 100 10 00 SIGNATOR
OF PERM! T E
G' loo - soo 15 00 DIS�RIC�TOMO GRS2UP �pNE PROCESSED BY w
TUBE,A SIGN AND ONE CIRCUIT 3 00 / d /y-
MARQUEE ADDITIONAL CIRCUITS 1 00
� NOTES:
r SERVICE NOT OVER 600 VOLTS OR 2DO AMP 2 00
SERVICE OVER 600 VOLTS OR 200 AMP 5 00 Jam\
TEMP SERVICE, POLE, & APPURTENANCES 3 00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) jooEFINAL
PLAN CHECK FEE (50% PERMIT FEE) RIZED
PERMIT ISSUING FEE TIFIED -
SUPPLEMENTARY PERMIT ISSUING FEETOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION A�CKM o CASH
iEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE �/ '
.760663-CE806 468 pyyU AN FOR ELECTROCAL PERT
COUNTY OF LOS ANGELESu
' DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMEIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST /J -
FOR APPLICANT TO FILL IN CROSS ST
FEE
RECEPT3o NO $AC $ OWNER
MAIL
LIGHT TOTAL FIRST 20 20 4, t3cO ADDRESS
SWITCH2� OVER 20 10 'CITY '14/j TEL NO.
" LIGHTING 1 TOTAL FIRST 20 j 20 PLAN CHECIC
APPLICANT
FIXTURES I OVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR._ CITY TEL NO
STA COOK_DISP ��F A U �• /��
CO JTRAC FOR
SPACE HTR AIR CONO ADD RESS2
CLOTHES WASH /DISHWASH./ CITY NOGG 3/1'5
FAN OTHER 1 00 QS LICENSE IJO / 7 .7 /6 CLASS.0
F MOTORS,TRANSFORMERS RATING
IND HEATERS, ETC HP. KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND 5TATE LAWS REGULATING
ELECTRICAL WIRING
0 — 1 1 00
I HEREBYCERTIFY THAT I AM PROPERLY REGISTERED AND/OR
71 1 — 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
10 — 50 5 00 RESIDE IN, THE AB �IrED RESIDENTIAL PROPERTY O
SIGNATURE
SO - 100 1000 OF PERMITTEC)
100 - 500 15 00 " ~
DISSRICT GRC EJS ED BY- Lu
TUBE, OR SIGN AND ONE CIRCUIT 3 00 a�. �� C0.
MARQUEE —
ADDITIONAL CIRCUITS 1 00
f NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP f 2 00 00
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
a
TEMP SERVICE, POLE, &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR'S SIGNATURE
l
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
LISSUiNG
(SUB TOTAL) WIRING
FIXTURES
EE (507 PERMIT FEE) POWER AUTHORIZED
FEE 200 2 c� UTILITY CO NOTIFIEDRY PERMIT ISSUING FEE 1 00 FINAL JO EPH C. ROOHAN
•4 r+ c' SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o CASH
91 i 2 3'Eo� ASR 3 2,' D 1 9.0 0,
5£E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE