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7GA663-CESOG 10/7v" ,ARPLICATION FOR ELECTRICAL PERMIT L
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER �DDRE
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACH I FEE OWNER OR
FIRM NAM
RECEPT�� $ $ MAIL
FIRST 20 ADDRESS
LIGHT TOTAL Zg
AA CITY ,djr� TEL. N0.
SWITCH OVER 20 f0 LiePLAN CHECK
FI RST 20 / LICANT
LIGHTING TOTAL
Zg APP
OVER 20 ADDRESS
FIXTURES _ZL 10
RESIDENTIAL APPLIANCES CITY TEL. NO.
l
RANGE DRYER_WTR. HTR. APPLICANT t
STA. COOK DISP.-2-- F.A.U. ADDRESS Of
SPACE HTR. AIR COND.-/ CITY TEL. NO. ZS
CLOTHES WASH.�DISHWASH. ` /_ REG N MBER v CLASS, b
FAN OTHER 1� 1.00 1 HEREBY ACKNOWLEDGE THAT I 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. ELECTRICAL WIRING..
SIZE & TYPE OVER TO
I HERESY CERTIFY THAT I AM PROPERL R GISTERED AND/OR
O - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES C UN Y AND STATE OF
CALIFORNIA OR THAT AM THE LEGAL 0 NE OF THE ABOVE y,
1 - 10 3.00 DESCRIBED RESIDE L PROPERTY. G
10 - 50 gOp PERMITEE
S I GN ATU R �`'���""���������✓✓�
O
50 - 100 10.00 W
DISTRICT NO. PROCE SED BY
100 - 500 15.00 �� sj a
H
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INS TOR'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK
SERVICEOVER600.VOLTS OR200AMP 10.00 ROUGH CONDUIT
TEMPSERVICE,POLE,&APPURTENAN.CES 5.00 WIRING b f�Jf
TEMP LIGHT OR RECEPT. SYSTEM 8.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE T
PERMIT ISSUING FEE
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
508 JUN 14 2 D / 27.10A-%
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ., ,