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78A889-CE8081_BB APPLICATION FOR ELECTRICAL IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FNEAR7EST
BUILDING AND SAFETY DIVISION �� �OGv S
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING
1J)_FOR APPLICANT TO FILL IN 164U'sw.
No $Ac $ FEE
OWNER t1k s ( ✓
RECEP��Tpp_ MAIL
LIGHT 10 TOTAL FIRST 20 -1-0 20 Q ADDRESS
SWITCH_ OVER 20 10 CITY TEL NO
PLAN CHECK
LIGHTING TOTALI FIRST 20 'zd 20 g APPLICANT
FIXTURES -w I OVER 20 10 ADDRESS
RANGE—DRYER—WTR HTR — CITY TEL NO
STA COOK_DISP _F A U — CONTRACTOR 6If" �jLL-C I
SPACE HTR AIR COND ADDRESS 'O(pfE
CLOTHES WASH —DISHWASH CITY FC O TEL NO O TT
FAN—OTHER 1 00 LICENSE NO Z 1 CLASS �� V
MOTORS TRANSFORMERS RATING
IND HEATERS, ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
0 — 1 00
ELECTRICAL WIRING
1
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
1 — 10 3 00 LICENSED AS REQUIRED BY LNGELE
COUNTY AND STATE OF
CALIFFORNIA OR THAT 1 AM T LEGAL OWNER OF, AND INTEND TO
10 — 50 5 00 RES DE IOS N, THE ABOVE ED RESIDENTIALO
SIGNATURE QY V
50 – 100 1000 OF PERMITTEE ' OC
1 100 — Soo I5 00 DISTRICT NO GR UP ZONE IP�/p��7 C, SSED B
TUBE OR Y G
SIGN GAS SIGN AND ONE CIRCUIT 3 00 .D
MARQUEE ADDITIONAL CIRCUITS 1 00N
NOTES Z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00
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
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE)
POWER AUTHORIZED
PERMIT ISSUING FEE 12 00 UTILITY CO NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE Q J0§IfP9 C ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION M o CASH
5 2 6 34 JM28 2 8 1 0.00" OT
IEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE