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APPLICATION FOR ELECTRICAL PER: Ml "rZ'
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING q ,/D
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY'
FOR APPLICANT TO FILL IN NEAREST Y d
CROSS ST.
NO. EACH FEE$ $ OWNER �
RECEIPT._ MAIL
LIGHT dA TOTAL FIRST 20 •20A ADDRESS ,� d
SWITCH 7 7/ CIT TEL.N0. 11S
OVER 20 .10 PLAN CHECK
LIGHTING TOTAL FIRST 20 •P0 D APPLICANT
FIXTURES }�_ OVER 20 ,10 ADDRESS
RANGE DRYER_WTR. HTR. CITY TEL.NO.
STA. COOK_DISP._F.A.U. CONTRACTOR
SPACE HTR. AIR COND. ADDRESS r
CLOTHES WASH._DISHWASH. CITY TEL.NO 113-11,1
FAN_OTHER 1.00 LICENSE NO,. �7 7 S-1 CLAS
MOTORS,TRANSFORMERS RATING 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE 15 CORRECT ANO AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
0 — 1 1.00 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
I — 10 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. \�
10 - 50 5.00
SIGNATURE
50 - 100 10A0 OF PERMITTEE '
100 — 500 15.00 DISTRICT O. GROUPZONE PRO D
vZ
TSIGN GAS
UBS, OR SIGN AND ONE CIRCUIT 3.00 ,
MARQUEENOTES
ADDITIONAL CIRCUITS 1.00
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 100'le
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 D UTILITY CO.NOTIFIED
00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL Q
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELEC L ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH_ PERMIT VALIDATION CK. M.O. CASH
1 q �:5 o 3� r25 2 0 4-.80N
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
Rlwdra"F COW
76A663-CE806 8.62 APPLICATION FOR ELECTRICAL PERMIT
' COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING Olid Z'o BUILDING AND SAFETY-DIVISION ADDRESSJOHN A. LAMBIE, COUNTY ENGINEER
WILLIAMA.JENSEN,SUPT OF BUILDING LOCALITYNEARESTFOR APPLICANT TO FILL IN CROSS ST. ,eRECEPT. TOTAL NO. EACH FEOUTLETS FIRST 2O S.2O S OWNERLIGHT MAIL
AWL ADDREa8SWITCH. OVER 20 .10TOTAL CITY p A9. TEL.NO.LIGHTING FIRST 20 .20FIXTURES ADD'L ,1O ELECTRICIAN
OVKR 2O ']
RANGES CLO.DRYERS WTR.HTRS. 1.00 D
ADRESS bL •r /J/
— W
GARB.DISP. STA.COOK CITY a4lefdTEL.NO. oy X /
DISHWASH. AUTO.-WASH. STATE I
SPACE HTRB. STA.APP.(V=H.P.MAX.) .50 LICENSE NO. r 47-93
ME
MOTORS, OVER NOT OVER H.P. DISTRICT NO. GP ZONE PAPCESSED BY
O 1 1.00 111ht MA
1 s 1 11.50' INSPECTION RECORD
s a 2.00
8 15 2.50
is so 3.00 a
so foo 5.00 VO
SIGN%: NO.TRANS. p:
NO.LAMPS OO
SERVICE 0.600V-NOT OVER 200A 1.00 �y
SERVICE 0-600V-OVER 200 A. 2.00 to
SERVICE OVER 600V 5.00 ?
MISC. exg f Ou it tffe
PERMIT ISSUING FEE 2.00 eel
SUPPLEMENTAgY PERMIT ISSUING FEE 1.00
TOTAL FEE S �'
1 HEREBY•ACKNOWLEDGE THAT'1 HAVE READ THIS APPLICATION APPROVALS yyD��ATE�1 INBPECTOR'8��SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT yI�/ *j✓�.�L/';rz
4
WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING .
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR i
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROPERTY. P POWER •� .�!••
SIGNATURE �� UTILITY CO.NOTIFIED , I `ice a •_
OF PERMITTEE_.-' •a FINAL
VALIDATI ARTHUR C. VEIT J
CK MO QAS SUPERVISING ELECTRICAL ENGINEER
Livuo 6 3 9 3 DEC 2 2 D 5.5 0