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,76A683-CE808 3-84 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FADDREN
/
BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING FOR APPLICANT TO FILL IN e
RECEPT TOTAL NO EACH FEE
OUTLETS FIRST 20 $20 $ 0 OWNER
LIGHT MAIL
ADD'L 10 ADDRESS
SWITCH. OVER 20
TOTAL " CITY TEL. NO.
LIGHTING FIRST 20 .20 V
FIXTURESADD'L 1D ELECTRICIAN
=4=-=I OVFR 20 ry
RANGES CLO DRYERS WTR.HTRS. 1.00 ADDRESS �J •j j� /g 4&,
GARB
GARB.DISP./ STA.COOK �i
CITY r/ TEL.NO.
DISHWABN
AUTO.-WASH. STATE
SPACE HTRS. BTA.APP.(yj M P.MAX. ,50
/ LICENSE NO.w'�
MOTORS, OVER NOT OVER HP. DIS y��. G�jgUPP1�11ELPR?C BY
O 1 1.00 (xf
1 3 150 INSPECTION RECORD a
9 S 2.00 0
8 15 2.50 OL
O
15 50 300 2
50 100 5.00 d
N
SIGNS. NO.TRANS Z
NO.LAMPS
SERVICE 0.60OV-NOT OVER 200A 1.00
SERVICE 0.600V-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTAFIY PERMIT ISSUING FEE 1.00
TOTAL FEE
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �+• �
ELECTRICAL WIRING. WIRING �IH I OSA/
1 HER®Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LCAFORNIA
8 REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
OR THAT I AM THEL L OWNER OF THE ABOVERESIDENTIAL-PR RTY. POWER
EUTILITY CO.NOTIFIEDTTEc
FINAL mom- 11V !S
0 IDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
ro ' L't�o 8 1 0 7 FEB 1 2 D 6.00- CQ 114