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76AG63-CES061/70 APPLICATIONS FOR ELECTRI AL PERAW
COUNTY OF LOS ANGELES // G r
DEPARTMENT OF COUNTY ENGINEER rBUILDING
DEPARTMENT
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BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE. COUNTY ENGINEER CALITY �L
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGINEARE
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FOR APPLICANT TO FILL IN CROSS ST. /V
OUTLETS NO. EACH FEE
$ $ OWNER R LY r-
RECEPT._ pL
LIGHT TOTAL FIRST 20 .20 ADDRESS `' l�j2�
OVER 20 10 CITY /7 }oLG `TEL. NO. (��
SWITCH PLAN CHECK
LIGHTING TOTAL FIRST 20 .20 APPLICANT
FIXTURES
OVER 20 .10 ADDRESS
APPLIANCES CITY TEL. NO.
RANGEIT
DRYER_WTR. HTR. APPLICANT
L CCTZ/
STA. COOK DISP. F.A.0 ADDRESS G 61 LFad a
SPACE HTR. AIR COND. CITY �/ , TEL. N0.
CLOTHES WASH. DISHWASH. LICENSE NO.2_ CLASS. Ul 6
FAN OTHER 1.00 , 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
I - 10 3.00 RESIDE IN, THE ADO DESCRIB RESIDENTIAL PERTY.
SIGNATURE
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10 - 50 5.00 OF PERMITTEE O
V
50 - 100 10.00
DISTRICTNO. CLASS JGPUP4E + PR SED BY OG
100 - 500 15.00 .Q /J��' 1 O
SIGN, GAS SIGN AND ONE CIRCUIT 3.00 NOTES: UJ
d
TUBE, OR I N
MARQUEE ADDITIONAL CIRCUITS 1.00 Z
SERVICENOTOVER 600 VOLTS OR 200 AMP r .00 /�
APPROVALS DATE INSPECTOR'S SIGNATURE
S ERVI CE OVER 600 VOLTS 0 R 200 AM P 5.00
TEMP.POWER POLE
TEMP SERVICE,POLE,&APPURTENANCES 3.00
TEMP LIGHT OR RECEPT. SYSTEM 3.00 UNDERSLAB WORK
ROUGH CONDIUT
WIRING
PERMIT FEE (SUB TO FIXTURES
In
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
UTILITY CO. NOTIFIED
PERMIT ISSUING FEE 00 ,
SUPPLEMENTARY PERMIT ISSUING FEE 1A0 FINAL
JOSEPH C. ROOHAN
TOTAL FEE SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATION CK. M.O. CASH
A',, 1 7 7 973 JUN 20 2 0 7.00v
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE