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76A663-CE806 1.0/72_ APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FAODRESSIIS���� (,()•
BUILDING AND SAFETY DIVISION
T
FOR APPLICANT TO FILL IN ST.
gyTLETS N0. EACH FEE R
UL FIRM NA
RECEPT. � $ $ MAIL
FIRST 2025 ADDRESS
LIGHT TAL V t/
CITYre,_66.
TEL. NO J`
SWITCH OVER 20 .10 ®p PLAN CHECK
LIGHTING FIRST 20 ,2S APPLICANT
T TAL
FIXTURES OVER 20to 10 � ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. N0.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP.-t,-F.A.U. ADDRESS
SPACE HTR. AIR COND. CITY TEL. N0.
CLOTHES WASH.-7gREG._DISHWASH.. __ l� LICENSE ORNUMBER CLASS. a
FAN OTHER 1.001 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND S.TATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
M I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
O - 1 1.00 V LICENSED AS REQUIRED BY LOS ANGELES C TY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL 0 NE OF THE ABOVE y
1 - 1O 9.00 DESCRIBED RESIDE TAL PROPERTY. �w ,,�I f C
PERMITEE �!� 2 31 _
10 - 50 5.00 SIGNATURE + 1
50 - 100 10.00 v
DISTRICT N0. g PRO SSED
gy
100 - Boo 15.00 `vr�^ �
N
SIGN, GAS SIGN AND ONE CIRCUIT 5.00APPROVALS DATE ]NSP R'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICENOTOVER 600 VOLTS OR 200 AMP 1 3.00 U UNDERSLAB WORK
SERVICEOVER 600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT 1,
TEMP SERVICE,POLE,&APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED Z/1 f
FINAL
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00 d
TOTAL FEE (�
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION cK. I M.0. CASH
5 0 3X%-JUN 14 2 D '5 7.0 0 A96
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE /