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76A883:;CEB0.6,,9-67 AppLICATI N ELECTRI, AL PERMIT
•:COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGLOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
NOgk EAC H FEE
RECEPT
$- $ OWNER
MAIL
LIGHT TOTAJL FIRST 20 !o .20 ADDRESS
SWITCH OVER 20 .10 3 CITY TEL. NO.
LIGHTING }TOTAL FIRST 20 .20 CONTRACTOR , /�`C
FIXTURES .) OVER 20 .10 ADDRESS'
RANGE_DRYER—WT HTR.— CITY /� .V ��/ . �IJ(7 V
STA.COOK_DISP.VF.A.U._ LICENSE NO. gRe
Z� O
SPACE HTR:. AIR COND. 1 'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
,�. � AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
CLOTHES H."✓JDISHWAS H. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
FAN OTHE°R 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
MOTORS,TRANS FORMERS RATING CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
IND. HEATERS, ETC. HP. KW. KVA. "RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
SIZE & TYPE OVER TO SIGNATURE
0 - 1 1.00 OF PERMITTEE
1 - 10 3.00DIST BIC 14 OUP ZONE ED BY U
10 50 15.00 Al
_(" O
50 - 100 10.00 NOTES: G
v LU
100 - 500 15.00SIGN
N
TUBE, A SIGN AND ONE CIRCUIT 3.00
MARQUEE ADDITIONAL CIRCUITS 1.00
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
ISSUING FEE 2.001 tj
WIRING Jq
FIXTURES
SUPPLEMENTARY ISSUING FEE 1.00 POWER AUTHORIZED
PERMIT FSE UTILITY CO.NOTIFIED ,
PLAN CHECK FEE (50% PERMIT FEE) FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELEC ICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
LG.3 3 3,912 FO-28 2 D - :. 18.8 Q,.�,
EEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE