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DSS SA 25M SETS 2-47 A7�RDRRf'10�II ION FOR
' bfPAR Nr OF BUILDING
AND MF=� d91<��0..l �ELECTRIC
COUNFX OF LOS ANGELES
VVM. .1. FOX CHIEF ENGINEER
z - DISTRICT NO. GROUP I ZONE PERMIT NO.
Q NAME /. -.v. Cn • �y
aU^, ADDRESS g< /i 013
U �+ RECEIVED 13Y READY FOR BATE I�UED
1� CITY rf_ a TEL.NO. A FIRST INSPECTION
COUNTY / `7
CERT.NO. 1j EXPIRES, -3 Q
AWPLICANT FHJ IN HEAVILY UtTLEXED POMON ONLY
JOB
HDE5CREMON OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITYI t� cr, W1v C3 ! 4
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS SW. PLUGS F111T CROSS -P P
CIRCUIT / A B C D E F G H m NAME p ®/� t!'o N S 1
Q �.GI z MAIL r,..
f ADDRESS C+ C,Y. CfA--
.A0
n
. 0 6 AI/ IL O CITY TEL.NO.
.1J /A c3'of 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGFW..ES COUNTY CERTIFICATE OF eQUALIFICATION..
[- F� Y\• I I / w ELECTRICIAN.
/ I AVO'11'IE LMAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
.,11! }1�• OWNER.
4' tot J o(z 1- f Glc L''x<
R. 1?60 J 1_ eAOI e-)- I- L d G bcJ Com+ r �d6
Q
z
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0
To
NO. OF OUTLETS �j B �y APPROVALS
NO. OF FIXTURES S Flo DTE INS /"R'S NAME' f
NO. OF MOTORS H.P.FIS lv �'�- B CONDUIT
NO. OF SIGNS RANS. B WIRING
NO. OFitAIMPES-OR HEATERS SI FIXTURES ;
MISCE LANEOUS B POWER ,07 r /
PERMIT FEE $ 1 U T ILITYCO.NOTIF D . }` %f> ✓ ,
i f✓��'
TOTAL FEE _ 9 -. O --FIPIAL elfl�'� O
76AG53-CEBOG 11-71 APPLICATION MR ELECTRICAL PERMIT Ll
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 7w�
LOCALITY
NEAREST �,v
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACH FEE
p $ $ OWNER �.�•� i
RECEPT. \ MAIL
LIGHT TOTAL
FIRST 20 25 ADDRESS \yb►I(►>\alJ
OVER 20 CITY TEL. NO.AA
SWITCH 10. PLANCHECK
LIGHTING FST 20 .25 APPLICANT
TOTAL
FIXTURES
OVERIR20 .10 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP. F.A.U. ADDRESS•S 'Z 1� R
SPACE HTR. AIR COND.X CITY TEL. N0.
CLOTHES WASH. DISHWASH. LICENSE NO. • CLASS.
FAN OTHER1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 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 & TYPE OVER TO
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR
0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF d
_ CALIFORNIA ORTHAT I AM THE LEGAL OWNER OF, AND INTEND TO
1 - tO 3.00 // RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. V
V SIGNATURE Im
10 - SO 5.00 OF PERMITTE O
50 — 100 10.00 mf"
DIST�ICTNO. CLASS ZONE PROCE ED B tU
100 — 500 15.001-J,08 h
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: ol Z
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS IAO
SERVICE NOTOVER 600 VOLTS OR 200 AMP ` 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICEOVER600 VOLTS OR 200AMP 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE,&APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED 44
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 3.00 p
TOTAL FEE
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT V LIDYITION CK. M.O. CASH
1 4 4 173 IN 2. D 9.7.5^' cm
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE