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SA653-CES06 5-62 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.SUPT OF BUILDING '. LOCALITY ,
�JMEJW_5 NEAREST
FOR APPLICANT TO FILL IN I CROSS ST.
R EC EPT. TOTAL NO. I EACH FEE
OUTLETS FIRST 20 S.2O $ _ OWNER
LIGHT MAIL
ADD'L 10 ADDRESS
SWITCH. OVER 20
CITY' L.NO.
LIGHTING TOAL 1 C FIRST 20 .20 �'►- r
1 r
FIXTURES ADD'L
0V9R 20 1 .10 ELECTRICI
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS /
GARB.DISP. / STA.COOK TY Tr
NO.
DISHWASH. / AUTO.-WASH./ STATE
SPACE HTRB. STA.APP.(Vs X.P.MAX.) _ .50 LICENSE NO.
MOTORS, OVER NOT OVER H.P. u DISTRICT NO. GROUP I ZONE ,PROCESSED BY
o f 1.00 O$ Z ?f SjFe
1 3 1.30 INSPECTION RECORD
8 8 12.00
8 Is 2.50 a
O
is ISO 3.00 V
50 100 .5.00
O
F
SIGNSs NO.TRANS.
NO.LAMPS a
SERVICE O-SOOV-Nor OVER 200A 1.00 Z
SERVICE 0-SOOV-OVER 200 A. 2.00
SERVICE OVER SOOV 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATI APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY :". CONDUIT A I�
WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING A/40 -�..
1 HEREBY CERTIFY THAT' I AM PROPERLY REGISTERED ANO/OR
LICENSED AB REQUIRED LOS ANGELES UNTY AN STATE OF -'; FIXTURES •� 6 s� ���r✓�:.'- :<<�
CALIFORNIA OR THAT 1 M THIP LEGAL WNE OF ABOVE.
DESCRIBED RE8IDENTIA Y. •� POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE FINAL
LIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
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