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76A669-CEW6 8.62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT O FILL IN CROSS sT CL vF— 7 .c.
RECEPT 6 1 TOTAL I NO CACN FEE
LIGHOUTLETS FIRST 20 S 20 B OWNER
SWITCH
MAIL
SWITCH `� OVER
2 �A ODREBB
OVER 2O 1D �URD
TOTAL CITY TEL NO 1LIGHTING 1F1RSr20 20 (/FIXTURES I ADD'L 10 ELECTRICIAN
RANO[[ CLO DRYERS / VTR HTHE 1OO ADDRESSGARD DI[P STA COOK
CITY TEL NO
DISNWASN AUTO WASH STATEAPACE HTRn STA AAI .JoLICENSE NOMOTORS OVER NOT OVER HP DISTRICTN G Z N
O 1 100
1 s 150 A INSPECTION RECORD
s e zoo
a 15 250 G '
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15 50 Soo
50 100 500 / / 0
SIGNS, NO TRANS I
NO LAMPS / O
r
SERVICED BOOV NOT OVER 200A 100
d
SERVICE O 800V OVER 200 A 200 y
SERVICE OVER 600V 500 ?
MISC -
PERMIT ISSUING FEE 200 ll� 00
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE • (57Q
I NE REOT ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION PR VAL DATE INSPECTOR[S GNATUR[
AND STATE THAT THE ABOVE
IS
CORRECT ANO ACRE[ TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
T.
1 HERESY
CERTIFY THAT I S ANGELES
C REGISTERED
LICENSED AS REQUIRED BY LOS ANGSLEp COUNTY AND STAT[ OF FIXTURES t `i
CALIFORNIA OR THAT 1 AM THE LEGAL OWNS OF THE ABOVE
D[SCRISED RESIDENTIAL PROPERTY POWER
SIGNATURE UTILITY CO NOTIFIED / Yl /
OF PERMITTEfi �/
FINAL JP —�
VALIDAT� ARTHUR C VER
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"'0 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES ! r Al
DEPARTMENT OF COUNTY ENGINEER BUILDING Y G LSIPAC / N A
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE, COUNTY ENOINZKR
WILLIAM A JENSEN SUP TOP BUILDING LOCALITY IE C 1 7 1 .
FOR APPLICANT TO FILL IN NR REST
PERMIT FEES OWNER p1 /) a EA
OUTLETS ITEM NUMBER EACH t me D AMAIL
DDRESS "/ PIC
LIGHTS REC[PT BW 10 ,T-
LIGHTING FIXTURES 10 �D ITY �'l C- rlf .
ELEC RANGES CLO DRYERS ELECTRICIAN
WATER HEATERS LO ADDRESS
ELPC SPACE HTRS DISHWASHERS CITY eZ TEL NO
GARBAGE DISPOSERS AUTO STATE
WASHERG STA COOKING UNITS pD LICENSE NO
Morons OVER INC H P DISTR�T GROUP Z P ESSED Y
0 — V. 2s s
V2 — 2 so I SPECTI RECORD
2 O Tood
1 50 O
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15 — DO 2 50 O
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SIGNS NO TRANS /// / Z
NO LAMPS j
SERVICE 0900V 100
SERVICE OVER 600V boo !/✓A .T ./r/I��.A/FC ✓D'�/
MISC
WIRING PERMIT loo
FIXTURE PERMIT 1 00
SUPPLEMENTARY PERMIT 50
TOTAL FEE t pa 9z
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE' INSPECTOR SBIIONATURE
AND STATE THAT THU ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT / //1 ////�
WITH ALL COUNTY ORDINANCES AND STATE LAWS RIGULATINO `
ELECTRICAL WIRING WIRING / AA
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR �'
LICENSED AS REGUIRKD BY LOS ANGELES COUNTY AND STATE OR FIXTURES I /
CALIFORNIA OR THAT 1 AM THU LEGAI,OWNER OF THE ABOVE
DESCRIBED RESIDENTI PROPER POWER
SIGNATURE UTI LITY CO NOTIFIED C . ./. ��LJ.C'.✓���
OF PERMITTE FINAL,
J/ `// . �'�U✓�/v„i
VALIDATI7 SVOEAFOVIS N VEIT
crc NO CAHN S PERV181NG ELECTRICAL ENGINEER
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TEMPLE CITY
APPLICATION FOR ELECTRICAL PERMIT 'I
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERI FAZOUD
ILDINaBUILDING AND SAFETY DIVISION DR E S9
JOHN A LAMBIE. COUNTY ENGINEERwIWILLIAMA JENSEN SUP T OF BUILDING CALITY '1
FOR APPLICANT TO FILL IN NEAREST
C12oss
PERMIT FEES G
OWNER
ITE ND [R ¢ACE PHE MAIL
OUTLETS 0 ADDRESS r
L'OHTS RE W .2 10
LIGHTING FIXTURES z 101___Fc) CI
ELEC "NOW CLO DRYERS ELECTRICIAN
WATER HEATERS a0 ADDRESS '9`41-ft eENITIAND
CLEC SPACE HTRS DISHWASHERS CITY EL NO_AT 1511)
GARBAGE DISPOSERS AUTO STATE
WASHERS STA COOKING UNITS 25 LICENSE NO
MOTORS OVER INC H P DISTR T VO GR UP Z NE ESSED
0 — va 2a
V. — 2 Ito ,INSPECTION CORD
2 — a 100 Z 7,-1,7,-711, —
/ / wf2 R
a — 115 150 I / /d 1 ✓y O
Is — ao 250 � .f /LP 40
50 — 200 Soo
SIGNS NO TRANS - a
NO LAMM N
Z
SERVICE O 600V 100
SERVICE OVER OOOV a OO
MISC
WIRING PERMIT 1 OO
FIXTURE PERMIT 1 OO
SUPPLEMENTARY PERMIT 00
TOTAL FEE f (�
I HEREBY ACKNOVlLEDGB THAT I HAVE READ THIS APPLICATION DATE INSPECTOR B SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGELECTRICAL WIRING i�� �nHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF IGLIFORNIA OR THAT i AM THE LEGAL OWN OF THE ABOVE
DESCRIBED REe'DERTI PROPERT SIGNATURE
OF PERMITTER
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VALIDAT� ARTHURC VETT
CX NO GBH SUPERVISING ELECTRICAL ENGINEER
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