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78A84�9 CEBOB 11/70 APPLICATION FOR ELECTRICAL PERMIT
' tt COUNTY OF LOS ANGELES ,,
DEPARTMENT OF COUNTY ENGINEER qoo ess �D/Sl�� /Vad�/'!6
BUILDING AND SAFETY DIVISION
COLEMAN W JENKINS UP INT DENT O BUILDING LOCALITY
C. T
FOR APPLICANT TO FILL IN CROSSS T �lt7 a
FRECEPT-3-71
TS o EACH FEE
$ S OWNER Ah 7'O h 13 aele
MAILyTOTALFIRST 20 ADDRESS Lf-rA �'h /;1;--:0
CITY a nq,&q TEL NO
OVER 20 PLAN CHECK
LIGHTING FIRST 20
TOTAL 25 �� APPLICANT
FIXTURES f� OVER 2010 ADDRESS
APPLIANCES CITY TEL NO
PERRANGE DRYER_WTR HTR APPLIICANT 134 �-+ ��p e' /4
STA COOK DISP F A U ADDRESS I it m'1) 04elN0 /
YPO,
SPACE HTR AIR COND CITY Am A#Ydit TEL NO 444 9f JZ
CLOTHES WASH DISHWASH LICENSE NO 2 7 Qo Q 9 CLASS C-10
FAN OTHER 100 ov I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 19 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 B TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED A8 REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM HE LEGAL OWNER OF AND INTEND TO }
1 - 10 900 RESIDE IN THE ABOVE DE9CRIBRESIDENTIAL PROPERTY d
SIGNATURE V
10 - 50 500 OF PERMITTEE '
OY
50 - 100 1000 rOl11C�N, CLASS ZONE P C BY O
100 - 500 1500 Fv, Q�
SIGN GAS SIGN AND ONE CIRCUIT 500 NOTES N
TUBE OR ?
MARQUEE ADDITIONAL CIRCUITS 100
SERVICE NOTOVER 600 VOLTS OR 200 AMP 300 3 Q�
SERVICEOVER 600 VOLTS OR 200AMP 1000 APPROVALS DATE INSPECTOR S SIGNATURE
TEMP POWER POLE
TEMPSERVICE POLE @APPURTENANCES 500
TEMP LIGHT OR RECEPT SYSTEM 300 UNDERSLAB WORK
ROUGH CONDI UT
WIRING 7 L
FIXTURft 3
PERMIT FEE (SUB TOTAL) POWER AUTHORI7ED
UTILITY CO NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 300
JOS C ROOHAN
TOTAL FEE SUPE V SING EL RI AL ENGINEER
PLAN CHECK VALIDATION CK M o CASH PERMIT VA L ION cK M 0 CASH
L� 4764N wJt 6 0 19 0 q
I _
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE