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BAS63-CESOS 10-60 APPLICATION FOR ELECTRICAL RMIT
COUNTY OF LOS ANGELES
DEPARMENT OF COUNTY ENGINEER B
UILDING s��
BUILDING AND SAFETY DIVISION ADDRESS ,40, N0&C�/�'AOG�C_
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,.SUPT OF BUILDING LITY / s
S ST.
FOR APPLICANT TO FILL IN
PERMIT FEES ER J2 A .
1 T E M NUMBER EACH FEE ESSOUTLETS: $LIGHTS RECEPT. SW. .10
TEL. NO.
LIGHTING FIXTURES
to
ELEC. RANGES/ CLO.DRYERS: ELECTRICIAN
WATER HEATERS 50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS
CITY . . TEL NO.�
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS 1 ,25 1 LICENSE NO. ® 41 Xt*,
MOTORS: OVER INC. H.R... DISTRI NO GRO P Z1 S O E I P OC EDS
0— 1/2 .2s
1/a— 2 so INSPECTION RECORD
2— 5 1.00 d
5— 15 1.50 V
1s— so 2.60 p�
go— 200 5.00
NO TRANS.
SIGNS:' NO.LAMPS co)
SERVICE 0-600V 1.00 u'L)
SERVICE OVER 600V 5.00
M ISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT ,S0
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AMTHE LEG L OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PRO ,o POWER
SIGNATURE � Ar.aC� UTILITY CO.NOTIFIED 16
OF PERMITTE FINAL ,__fl A
Q►LI ARTHUR C.VETT
cK Moo CASH SUPERVISING ELECTRICAL.ENGINEER
L.l lCo9'3 9 2 JUN 29 2 D 3.0 0 n