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3AG63-CESOS 10-61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEBPUILDIING AND SA ENT OF COUNTY ETY DIV SION ENGINEER AD RESSD 1 '
v�Rosr'
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUP'T'OF BUILDING LOCALITY ( ( `t I
NEAREST �T
FOR APPLICANT TO FILL IN CROSS ST. / ffIV
1 T E M NO. EACH FEE /J -
oUTLETs: FIRST 20) $ $. OWNER ` (f
LIGHTS PAC. Bw. '2O 0 MAIL `
OUTLETS: (ADD'L UNITS) 10 ADDRESS
LIGHTS RECEPT. SW.
LIGHTING FIXTURES: (FIRST 20) 20 CITY TEL.NO. .
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN ZLF S
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS S-0,5p
GARB.DISP. STA.COOK CITY (• ` : TEL.NO.
DISHWASH. AUTO:-WASH. STATE -
SPACE HTRS. STA.APP.(V=X.P.MAX.) .50 LICENSE NO.
MOTORS: OVER. NOT OVER H.
P. DISTR T O. GROUP rN�E PRO S$ED BY
O f 1.00 Q (�
1 8 1.130 INSPECTION RECORD
o.
8 a 2.00 O
a 1 s 2.50 U
09
i5 50 8.00 0
50 100 5.00
O.
SIGNS: NO.TRANS. -
NO.LAMPS
SERVICE 0-600V-Nor OVER 200A 1.00
SERVICE 0.600V-OvER 200 A. 2.00
•.s
SERVICE OVER 600V 5.00
MISC.
r
PERMIT ISSUING FEE 2.00 Db
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ 2
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONi APPROVALS DATE INSPECTOR'S SIGNATURE ,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE;TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING r "/
ELECTRICAL WIRING. WIRING O i� .P
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/Olt
CE
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1'AM THE I.EGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA OPE POWER
SIGNATURE. UTILITY CO.NOTIFIED I Iw
OF PERMITTEE hh
FINAL
0 LIDATION ARTHUR C. VEIT�
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
a
3 6 8 2% AUG 3j0 2 0 4,20-