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APPLICATION FOR ELECTRICAL PERM
COUNTY OF LOS ANGELES
DEPARTMF,NT OF COUNTY ENGINEER BUILDING /
BUILDING AND SAFETY DIVISION ADDRESS lv�d�
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST SJ�Gf/f
NO. EACH FEE Al
$ $ OWNER =� i - / lA77-
RECEIPT MAIL
LIGHT TOTAL
FIRST 20 20 ADDRESS
SWITCH OVER 20 10 CITY J (? TEL NO.Z 02-
PLAN CHECK
LIGHTING TOTAL FIRST 20 ,20APPLICANT
FIXTURES } OVER 20 .10 ADDRESS
RANGE_DRYER_WTR HTR. CITY TEL NO. _
STA COOK_DISP _F.A.U. CONTRACTOR
SPACE HTR. AIR COND. ADDRESS
CLOTHES WASH _DISHWASH CITY TEL.NO
FAN OTHER 1 00 LICENSE NO CLASS
MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
,IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING -
O - 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 5TATEOF
1 - 10 3 00 CALIIFORNIA OR THAT I A THE LEGAL OWNER OF, AND INTEND TO
RES DE IN, THE ABOVE ES CRIBED RESIDENTIAL PROPERTY. O
10 - 50 5 00 U
SIGNATURE l3C
50 - 100 10.00 OF PERMITTEE - - Q
F-
100 - 500 15.00 DISTRICT /N/O/� GROUP ZONE PRO _5 9B� U
Lu
SIGN,GAS SIGN AND ONE CIRCUIT 3.00 " el-
��
TUBE, OR Z
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 "
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP POWER POLE '
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 } UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL _
TOTAL FEEJOSEPH C. ROOHAN
f f SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
2--2 4 2% WT 15 2 D
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE