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6A663=080`6`1-68 APPLICATION FOR ELECTRICAL PERMIT �.
Di
COUNTY OF LOS ANGELES
DiAARTWENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 3
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO.FILL IN NEAREST.
ST.
NO. EACH FEE
$ $ OWNER
RECEPT._ MAIL
_IGHT TOTAL FIRST 20 .20 ADDRESS
;WITCH_ OVER 20 .10 CITY TEL. NO.
PLAN CHECK
_IGHTI'NGJTOTAL FIRST ZO .20 APPLICANT
=IXTURES OVER 20 AD ADDRESS
RANGE_DR YER—WTR.HTR.— CITY TEL. NO.
;TA.COOK—DIS P.—F.A.U._ CONTRACTORe&.-�L.�c
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z Cal
;PACE HTR. AIR COND. ADDRESS Is �Y
'LOTHES WASH._DISHWASH._ c�
CITY J . TEL. NO. /� "�
�
-ANOTHER 1.00 LICENSE NO. p�� CLASS.
AOT ORS,'TRANS FORM ERS RATING
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT 1 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"I AM PROPERLY REGISTERED'AND/OR
1 - 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
:CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
10 - 50 5.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIA PROPERTY. O
\ 50 - 100 10.00 SIGNATURE V
OF PERMITTEE 4r
100 - soo 1s.Do DISTM.0-T N GRO ZONE P ED G
'SIGN,GAS SIGN AND ONE CIRCUIT 3.00 W
TUBE, OR
4
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: Z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
HEMP SERVICE, POLE, IN APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
]ROUGH CONDUIT
HERMIT FEE (SUB' TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE')
POWERAUTHORIZED
DERMIT ISSUING FEE. 2.00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 4FINAL
TOTAL FEE Q� JOSEPH C. ROOHAN
SUPERVISING ELE AL ENGINEER
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION CK M.O. CASH
X,9 5 7 5� APR24 2 D 5,��N co
BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
76A668-CE80'dt:A-68 APPLICATION FOR ELE.CTRI L PER
COUNTY OF LOS ANGELES _
DEPARTMENT OF COUNTY ENGINEER BUILDING r
BUILDING AND SAFETY DIVISION A'DDR'ESS �0 �.3
JOHN A. LAMBI.E. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN. CROSS ST.
NO. EACH FEE AA
RECEP
$ - $ OWNER CO
MAIL
LIGHTS( , TO'TAL 'FIRST 20 iAO .20 Q .6'U ADDRESS
SWITCH/ a• OVER 20 10 CITY TEL. N.O.
Q n PALAN CHECK.
LIGHTING TOTAL FIRST 20 .20 O 1✓ PPLICANT
FIXTURES OVER 20. .10 ADDRESS
RANGE—DRYER—WT .HTR'. CITY TEL. N.O.
'STA.cooK_DisP. .a.u._ CONTRACTOR
.SPACE HTR.—Al C.OND. ADDRESS ,` L
CLOTHE�'W.ASH.i DISHWA'SH:_ ,^,\\ CITY� TEL. NO. 7 �+
FAN—OTHER 1.00 E) gg
- LICENSE IJ O. �V � CLASS.
MOTORS,TRANS FORMERS RATING 1
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO .AND STATE THAT TME ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
0 - 1 1.00
ELECTRICAL WIRING.
' i
• I HEREBY CERTIFY'THAT [-AM PROPERLY REGISTERED AND/OR
1 - .10: 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
'RESIDE IN, THE ABOVE DESCRIBED RESIDENTIA PROPERTY.
10 - 50 5.00 _ Q
SIGNATURE V
50 100 10.00 OF' PERMITTEE
CC
I Do - 500'' 15.000
DIS IC: G. P N P G
SIGN,GAS
TUBE, OR' SIGN AND ONE CIRCUIT 3.Qo 4�
. d
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: Z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.06:
i
'SERVICE OVER 600 VOLTS OR 200'AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES" 3.00. APPROVALS - DATE INSPECTOR'S SIGNATURE
TEMP. POWERPOLE
UNDERSLAB WORK 'y
ROUGH CONDUIT „{,1,V �,1: , _A
R
PERMIT 'FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% P•ERMl'T FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1..00 FINAL
TOTAL FEE I �' JOS PH C. RO AN
SUPERVISING ELECIAICAL ENGINEER'
PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION cK. M.O. CASH
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7.60
E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
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