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APPLICATION FORM EL'ECTRICAL PERMIT LI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER TADDRES.S
G
BUILDING AND SAFETY DIVISION
TY
T
FOR APPLICANT TO FILL IN ST.
OUTLETS NO. EACHFEE
. OWNER
RECEPT._ $ $ MAIL
LIGHT TOTAL
FIRST 20 25 ADDRESS
CITY ( gs
SWITCH OVER 20 10 TEL. NO
PLAN CHECK
LIGHTINGTOTAL FIRST 20 .25 APPLICANT
OVER 20 ADDRESS
FIXTURES .10
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICA let
STA. COOK DISP. F.A.U. ADDRESS, f A
SPACE HTR. AIR COND. C1TY L. NO
CLOTHES WASH. DISHWASH. LICENSE NO. CLASS.
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM FIE LEGAL OW ER OF, AND INTEND TO
1 - 10 3.00 RESIDE IN, THE OVE `CRIBED ESIDENTIAL OPERTY. V
SIGNATURE ,_J`p/- ad
10 - 50 5.00 OF PERMITTE O
so,- 100 10.00 ' rj
DISTRICTNO. CLASS ZO E PR ESSED BY IL
100 - 500 15.00 � edro irr —o Z
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES:
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
LEREOT OVER 600VOLTS.OR200AMP 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
VER600VOLTSOR200AMP 10.00
TEMP.POWER POLE
VICE,POLE,&APPURTENANCES / 5.00
UNDERSLAB WORK
HT OR RECEPT. SYSTEM 9.00
ROUGH CONDI UT
WIRING
FIXTURES
POWER AUTHORIZED
EE (SUB TOTAL)
UTILITY CO. NOTIFIEDCK FEESUING FEE 3.00- }e> pFINAL
FEE 'stJ-/ n
PLAN CHECK VALIDATION "CK. M.0. CASH PERMIT VALIDATION CK. M.O. CASH
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 1N
7GA5V-CES06,I?/70 'APPLICATIO FOR ELRICAL PERMIT
E TLJ
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESSj�/
COLEMAN W. JENKINS. SUPERINTENDENT OF BUILDING LOCALITY Lam- 7
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACH FEE
OWNER
RECEPT._ $ MAIL
LIGHT TOTAL
FIRST 20 25 ADDRESS
OVER 20
SWITCH_ 10 CITY TEL. NO.PLAN CHECK
LIGHTINGTOTAL FIRST 20 .25 APPLICANT
OVER 20 ADDRESS
FIXTURES .10
APPLIANCES CITY TEL. NO.
PERMIT ee''
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP. F.A.U. ADDRESS
SPACE HTR, AIR COND. CITY EL. NO. v
CLOTHES WASH.' DISHWASH. LICENSE NO. S^ CLASS. `1
FAN OTHER 1.00 1HEREBY 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO }
1 - 10 3.00 �. RESIDE IN, THE ABOVE D CRI�ED RESIDENTIAL PROPERTY. Q
SIGNATURE U
10 - 50 5.00 OF PERMITTEE ' r
50 - 100 10.00 O
DISTRICT NO. CLASS PROCESS D BY 1-
100 - 500 15.00 V i- a
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: Z
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICENOTOVER 600 VOLTS OR 200AMP 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVI CE OVER 600 VOLTS OR 200 AMP 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE,&APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH.CONDI UT
WIRING
FI XTU RES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 9.00
1 1514 C- ROOHAN
TOTAL FEE SUPERVISING ELECTRICAL ENGINEER.
PLAN CHECK VALIDATION CK. M.O. , CASH PERMIT V'LL
IDATI N cK. M.0. CASH
t^, 2 2 ?3 JUL 3 2 D 6.0 0A
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
•7
76AQ63-CE806ti;W 70 APPLICATION FOR ELECTRICAL PERMIT
COUb(TY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUI Elss0 g q j,
�11 L•js.�,Ld-. t=s%
BUILDING AND SAFETY DIVISION AD
' COLEMAN W. JENKINS SUPERINTENDENT OF BUILDING LOCALITY
NEAREST t
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACH FEE
OWNER
RECEPT. $ $ MAIL 6
LIGHT TOTAL FIRST 20 t) 25 `!� ADDRESS
SWITCH OVER 20 :i 10 } CITY TEL. N0.
�J PLAN CHECK
LIGHTING TOTAL I FIRST 20 25 �y�y APPLICANT
OVER 20 ADDRESS
FIXTURES � .f0 a
APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP.•5 F.A.U. ADDRESS
SPACE HTR. AIR COND. +5 CITY .� sL TEL. NO. 41VIr/tfj
CLOTHES WASH. 2. DISHWASH. :2� LICENSE N0.„7 5 S CLASS.0 -/6
FANOTHER {p� 1.00 dJ !," d��y 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
�G •T 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 1 AM PROPERLY REGISTERED AND/OR
0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO }
1 - 10 3.00 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 0
10 - 50 5.00 SIGNATUOF PERMITTEE 1 ��� ) V
50 - 100 10.00 0
DISTRICT NO. CLASS Z PROLE SED
100 - 500 15.00 0 aul
SIGN, GASSIGN AND ONE CIRCUIT 5.00 NOTES: 7 Z
TUBE, OR —
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICENOTOVER 600 VOLTS OR 200 AMP f 3.00 Q
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVI CE OVER 600 VOLTS OR 200 AM P 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE,&APPURTENANCES 5.00
TEMP LIGHT OR RECEPT. SYSTEM 3.00 UNDERSLAB WORK
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL
PERMIT ISSUING FEE 1 3.00 3 �(� JOS HROO AN
TOTAL FEE SUPERVISI ELECTRICAL ENGINEER.
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDn/ CK. M.0. CASH
�jjuo () 6 4 7 JAN 19 2 D 6 3.3 0 V
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE