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784683-CE80611-71 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING.AND SAFETY DIVISION ADDRESS '� �= �,p/Z
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. G{/V\.•i4 L t
OUTLETS N0. EACH FEE
OWNER � l�
RECEPT._ $ $ 7 A
LLIGHT TOTAL DDRESS
FIRST 20 25 7
CITY �ra.t DLe V t-+ TEL. NO.
SWITCH OVER 20 •10
PLAN CHECK
LIGHTING TOTAL FIRST 20 •25 APPLICANT
FIXTURES 2 OVER 20 .10
r� ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE 2 DRYER_WTR. HTR. APPLICANT � 14e-j-_0in&v5
STA. COOK DISP. F.A.U. ADDRESS, / :e*s $
SPACE HTR. AIR COND. CIT4p_led 11G>e `14 TEL. N0.
CLOTHES WASH. DISHWASH. LICENSE NO. ;t(fA fktl CLASSye/
FAN I OTHER 1.00 P 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORM ER9 RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
O - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STAT F
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND 'NTE
TO
1 - 10 3.00 RESIDE IN, THE ABOVE DESCR D ESIDENTIAL PRZOPTY. V
SIGNATURE
10 - 50 5.00OF PERMITTE O
50 - 100 1040 i-
DISTRICTNO. CLASS ZONE RO ;ED BY LU
100 - 500 15.00 ,
ti Z
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES:
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00
- APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICEOVER 600 VOLTS OR 200 AMP 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE,&APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00 00 FINAL
TOTAL FEE 11
PLAN CHECK VALIDATION CK. MA0. CASH PERMIT V L•ATION CK. M.O. CASH
Ao Q 6 6 1 IJ JAN 1 2 D 725, cv
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
COUNTY OF LOS ANGELES APPLICATION FOR PEBMT
OF DIMO OF COUNTY ELECTRIC 1
" WILLIAM 1. FOS,COUNTY ENGINM
FOR APPLICANT TO FILL IN DISTRICT NO. GROUPOE PERMIT NO.
ELECTRICIAN i i , ' -. Z
ADDRESS %1 / A RECEIVED HY READY FOR DATE ISSUED
V 4, y ��,i,��," FIRST INSPECTION
CITY TEL. NO.
COUNTY LICENSE NO. EXPIRES BUILDING
PE SM FESS ADDRE88
NUMBER EACH FEE
LOCALITY /
LIGHT OUTLETS NEAREST
RECEPTACLES CROB17
9 ST.
WALL SWITCHES / OWNE `
TOTAL OUTLETS T-I/ Sc $ 3MAIL /� //J � /➢ i�
ell
ELEC. RANGES 25 ADDRESS �`rr �X�irJCJ
ELEC. HEATERS /` 2S a C TEL. .0
b
FIXTURES 11 J
MISC. I HEREBI ACKNOWLED E THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. ppHP OVER I INc. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
va 9 LESS $ .2r,
- SIGNATURE clid, 4 -
Va 2 .50 PERMITT
2 5 1.00 II�TSPECTION RECORD
5 15 1.50
IS 50 2.110 D ,"
50 200 5.00 k
200 Soo 10.00 J
11oo 1000 15.00 Z
1�fis�
OVER 1000 20.00 �
M.G. SKT/FRKQ. CHANGER-NP
WELDERDs AC-KVA 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OR ORIS.) LG
MOVED MOTORS (75% OF ORIS.) VA
MISC.
SIGNS
NO. No.TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 &-p CONDUIT
FIXTURES $1.00 c WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $q UTILITY CO. NOTIFIED �/9�
FINAL
7ew 963 DBB# BA. 4-BS 1.6q
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