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ij,78AB63-CEQ06 1/70 4 APPLICATION FOR ELECTRICALQRMILT
L " COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS 9509 E. Lower Azusa Rd.
JOHN A. LAMBIE. COUNTY ENGINEER LOCALITY Temple City
UILDING
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING
FOR APPLICANT TO FILL IN CROSSS T. Te le City Blvd.
OUTLETS NO. EACH I FEE
OWNER Jerome-Vercruse
RECEPT.1 $ S ADDRESS 1521 Wo Hellman
LIGHT 1 TOTAL FIRST 20 3 .20 60
1 3 OVER 20 10 CITYAlhambra TEL. NO.284-7111 .
SWITCH_ PLAN CHECK
LIGHTING TOTAL FIRST 20 .20 60 APPLICANT
FIXTURES OVER 20 10 ADDRESS
APPLIANCES CITY TEL. NO.
PRIT
RANGE DRYER_WTR. HTR. APPLICANT Conlee & Son Electric
STA. COOK DISP. F.A.U. ADDRESS 1030 No Grandview Ave.
SPACE HTR. AIR COND. CITYS.San Gabriel TEL. No. 280-200
CLOTHES WASH. DISHWASH. LICENSE N0.242432 CLASSC 10
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTA ICAL WIRING.
SIZE & TYPE OVER TO
I .4EREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 1.00 LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AN INTEND TO
I - 10 3.00 RESIDE IN, TH VE DESCRIBED RE8I DENTI PROPERTY.
! D_
SIGNATURE Q
10 - 50 8.00 OF PERMITTE V
50 — 100 10.00 oC
DIST�RIC/T►N0. CLASS GROUP ZONE. PRO 9 BY 0
100 - SOO 16.00 t=1 (1� G
Lu
SIGN, GAS SIGN AND ONE CIRCUIT 3.00 NOTES; h
TUBE, OR I Z
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVI CE NOTOVER 600 VOLTS OR 200 AMP 1 2.00 2 00
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVI CE OVER 600 VOLTS OR 200 AM P 8.00
TEMP.POWER POLE
TEMP SERVICE,POLE,&APPURTENANCES 3.00
UNDERSLAS WORK 17
TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
UTILITY CO. NOTIFIED
PERMIT ISSUING FEE 2.00 2 00
FINAL
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
JO EPH C. ROOH N
TOTAL FEE 5 20 SUPERVISING ELECTRICAL ENGINEER.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION QM.O. CASH
.20-SO 7 2 `7 JUN
8 2 D 5.20-
SEE
EE BACK OF APPLICATION FOR COMPLETE SCHEDULE