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�"✓ APPLICATION FOR FREC ICAL PERMIT'
BASE61 1�-8f
v, COUNTY OF LOS ANGELES
DEPARTMENT'OF COUNTY ENGINEER Bu)LDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT of BUILDING LOCALITY
r% NEAREST
FOR APPLICANT TO.FILL.IN CRoss ST.
1 T E M NO. I EACH FEE
OUTLETS+ iRST 20) S'.20 ; OWNER p
LIGHTS RECEPT• Q SW. O MAIL +•
OUR (ADD'L UNIT )
RECEPT. 10 3 ADDRESS`
LIGHTS SW.
LIGHTING FIXTURES: (FIRST 20) szo D CITY TEL.NO.
s r
LIGHTING FIXT RES: (ADDITIONAL) .10 ELECTMCIA
RANGES LO.'DRYERS WTR.HTRS. 1.00 , ADORES
GARB. BTA.COOK g
CITY
DISHWASH. UTO.-WASH. STATE
//� r LICENSE NO. a
SPACE HTRB `1 STA.APP• ! H.P.MAX. .50
MOTORS3 - OVER ` NO H.P. DISTRICT NO. GROUP E P ES8ED BY
- -- /
1 s 1.50 INSPECTION RECORD
a s 2.00' C)
8 1 s 2.50 V
m
15 so .B.Oo Q
50 100 5.00
a
SIGNSe NO.TRANS. H.�.•
NO.LAMPS _- b
SERVICE 0-60OV-NOT OVER 200A 1.00
SERVICE O.600V-OVER 200 A. 9.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTAEY PERMIT ISSUING FEE 11. 0
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - APPROVALS 'DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO'COMPLY CONDUIT �• t
WITH ALL .COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED' AND/OR t
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES / �•'
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE l /i
DESCRIBED RESIDE- L OPERTY. POWER
, ./ s••�1�',� it
SIGNATURE UTILITY CO.NOTIFIED r• sr
OF PERMITT •
", .'..;,EINAL
LIDATION ART LIT! C. Vg "
CK MO CASH SUPE V181NG ELECTRICAL ENGINEER
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