HomeMy Public PortalAbout5616 ROSEMEAD BLVD_Electrical__ UC C w 441 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC
WM J FOX, CHIEF ENGINEER
"I NATURE OF INSTALLATION DISTRICT NO I GROUPI ZONE PERMIT NO
WIRING FIXTURES B[RVICE
RSCEVm BY FOR DAT[ ISSUEDRANO[ HEATER POWW rI . .. FIRST
INSPECTION
SIG COLLANIII14
PLICANT FELL IN HEAVILY OUTLINED PORTION ONLY
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NAM[ ADDRESS
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CITY TEL N / ✓� CROSS ST
CURT COUN C 3*W
DESCRIPTION OF WORK MAIL
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NUMBER OF OUTLETS ON CIRCUITS O /p�
LOCATIOM BY ROOMS CITY Td NOX
LIGHT OUTLETS BW PLUGS 1 AM THE LEGAL [SSOR F TH6 ABOVE LOS
CIRCUIT
*Aj C D E F G H ANGE[SCOUNTYCETTIFIN
LIVING ROOMI AM THE LEGAL OWNER OF THE PROPERTY DESCRIBE]
DINING ROOM ABOVE
BRFST RMBATHowNRu
° CORRECTIONS
ERT.HALL
HALL NO
FRONT PORCH
OUTSIDE
KITCHOI —
SERV PCN
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SDRM NO. a
Z
CLOSET -- -- O
BDRM NO O
CLOSET
TOTAL S
NO OF OUTLETS APPROVALS
NO OF FIXTURES , ' DATE INSPECTOR'S HAM[
NO OF MOTORS H P ♦� CONDUIT
NO OF SIGNS TRANS S WIRING
NO OF RANGES OR HEATERS S FIXTUREI
MISCELLANEOUS ♦ POWES i
PBRYIT PEE S / UTILITY CO NOTIFIER
TOTAL FEE a NAL
TSMBa CIU10610 St APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER =LOCALiTy
BUILDING AND SAFETY DIVISION
JOHN A LAMBIE COUNTY ENGINEERL
WILLIAM A JENSEN Sup T or RVILDINO
NEAREST
FOR AI!PLICANT Y FI IN I caoee Hr
1 T Q M NO IzAcN F¢[
OUTLETS, (FIRsT 20) •20 t O OWNER
um1Ta e\Y MAIL
OUTLETS (AD L UNITS) ADOREHS
LIGHTS IEcvr BW 10
LIGHTING FIXTURES, (FINET 20) 20 CITY TEL NO
LIGHTING FIXTURES, (ADDITIONAL) 10 ELECTRICIA
RANDo CLo DRT[N[ WTR Hrw 1 00 ADDRESS 4ci> —]
OARO Dial, [TA COOK
CITYI� TEL NO
DiWWAM AUTO WASH STATE }�
SPACE HTRQ STA APP (M,H P MAX) 60 LICENSE NO
MOTORS Own NOT OVER HP DIST/RICT( 1p GROUP ZONE P E98ED BY
O 7 100 'J, p
i a 1 eo INSPECTION RECORD
a e 200 D-
O
S 18 250 l.1
D:
18 60 a 00 0
SO 100 600
SIGNS No TRANS d
NO LAMPE Z
SERVICE O 60OV-NOT OVER 200A 100
SERVICE 0600V OWn 200 A 200
SERVICE OVER 600V 500
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEB 100
TOTAL FEE III
1 H[IHQY ACKNOWLEDGE THAT 1 HAV[ READ THIQ APPLICATION APPROVALS DATE INSPECTOR aBIGNATURE
AND STATE TAT THE ABOVE IS CORRECT AND AOIBUt TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
1 HSR®Y CERTIFY THAT 1 AM PROPERLY REOISIEREO ANO/ON
LICENSED All REQUIRED BY WE ANGELES COUNTY NO RA OF FIXTURES
CALIFORNIA OR THAT 1 THE OWNS F THE VE
CCECNINED RESIDENT, P NTYBE POWER
SIGNATURE UTILITY CO NOTIPIE0 �y L
OF PFRMITTfi PINAL
VAL (CASH
A HUS C
IX MO VETT
MO l/CASH SUPERVISING ELECTRICAL ENGIN\`iiR
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