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76AS63-CE606 6-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS i'V 170
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
R.APPLICANT TO FILL IN CROss ST.
RECEPT. T'_
TOTAL NO. EACH PER
UTL TS FIRST 20 $2O 6 ,�1 OWNERLIGHT Ov MAIL
ADD'L .10 !7 ADDRESSSWITCH. OVER 2O (/
LIGHTING
TOTAL CITY TEL.NO.
FIRST 20 .20
FIXTURES }� ADD'L
OVER ZO .10 ELECTRICIAN
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DIBP. STA.COOK city TEL.NO. oF/
DISHWASH. AUTO.-WASH. STATE
PACE R BTA.APP.(V=N.P.MAX.) .50 LICENSE NO.
'NoTaRSt OVER NOT OVER H.P. DIST ICT NO. GROUP ONE P ESSED
O 1 .1.00
1 8 1.50 INSPECTION ECORD ,
8 B 2.00
8 15 2.50
15 50 8.00 V d v a
50 100 5.00 0
SIGNS, NO.TRANS.
NO.LAMPS t0'
SERVICE 0.800V-NOT OVER 200A 1.00 �^ W
SERVICE O-SOOV-OVER 200 A. 2.00 N
SERVICE OVER 600V 8.00 ?
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 6
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ T1418 APPLiqkTION APPROVALS DATE .-INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TOCOMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR !'/
LICENSED AS,REQUIRED BY LOS ANGELES COUNTY AND 8 FIXTURES ,igi 4• ,j
CALIFORNIA OR THAT I AM THE LEGAL WNER ABOVE
DESCRIBED RESIDENTI OPERTY OWER • 0 ` �.0 AA
SIGNATURE /� �( UTILITY CO.NOTIFIED
OF PERMI�
FINA
VALMO SUPERVISING
C: VETT
CK MO CABH SUPERVISING ELECTRICAL ENGINEER
L`I�o 3 7 1 7 DEC 2 0 2 D 1 7,2 Q N qr