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3A689•CE808 10-61 APPLICATION FOR ECTRICA► K PERMIT - Q
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING}
BUILDING AND SAFETY DIVISION i ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
^ate'. .' NEAREST
OR APPLICANT TO FILL IN CROSS ST.
I T E M NO. I EACH 1 FEE 1
OUTLETS: (F RBT 20) 20 $ OWNER
LIGHTS RECEPT. SW. MAIL
OUTL : ADD'L UNITS) 10 ADDRESS
LIGHTS RECEPr. SW.
LIGHTING FIXTURES: (FIRST 20) 20
CITY -TEL.KIM
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN
RANGES CLO.DRYERS WTI.HTRS. 1.00 ADDRESS
93
GARB.DISP. STA.COOK CIT TEL.NO.
DISHWASH. AUTO.-WASH. STATE n .
SPACE HTRS. STA.APP.(V,H.P.MAX.) ,50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DIST I�CLT(� GROUP ZO E. P. FFFSSED BY
0 9 1.000/ O
1 a 1.50 INSPECTION RECORD
a a 2.00 'L
8 15 2.50
15 so 3.00 O
so 100 5.00 owG
W
SIGNS: NO.TRANS. �•
NO.LAMPS h
Z
SERVICE O.600V-Nor OVER 200A 1.00
SERVICE 0-600V-OVER 200 A.' 2.00
SERVICE OVER 600V 5.00
MISC.
1 alz
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
1 HEREBY.ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATI N APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE I8 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ppff
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT.I AM PROPERLY REGISTERED AND/Olt
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF a FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRO Y. ': POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE �I
FINAL42
LIDATION A Hu c. VEIT
NO CASH SUPERVISING ELECTRICAL ENGINEER
,,� _ GO 4 4 5Ql ANI 9 2 Dr. 11.7 0-