HomeMy Public PortalAbout6126 ROWLAND AVE_Electrical__ r6A66 C- CE606B 12/75 APPLICATION FOR ELECTRICAL PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Poo�B
EACH NO. FEE ADDRESS
1 &2 Finaily Sq. Ft. - - % $ - $ LOCALITY
Multi-family Sq.Ft. — NEAREST
Residential Swimming Pools CROSS ST.OWNER OR..
FIRM NAM
Outlets: Light,Switch&Receptacle MAI L
d V
First 20 ADDRESS
AdditibnalCITY Tel. No. "6_-Z77
PLAN CHECK
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional
CITY Tel. No.
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT
Range_ Heater_ D.W.
ADDRESS
Oven _ Dryer _ W.M.
Top _ FA.0 _ W.H. CITY Tel. No.
Hood Fan REG N
Disp. A.C. NUIIABER Q Class
1 HEREBY ACKNOWLEOGE THAT 1 HAVE READ THIS APPLICATION 0
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY V
Power Apparatus& Large Appliances WITH ALL COUNTY' 'ORDINANCES AND STATE LAWS REGULATING W
Size&Type HP, KW,KVA,or KVAR ELECTRICAL WIRING. a.
y
Up to 1 Incl.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERS.AND/OR
Over I to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE eGAL OWNS OP E ABOVE
Over 10 to 50 Incl. 'DESCRIBED RESIDE OPEpT
Over 50 t0 100 InCI. PERMITEE
Over 100 SIGNATU
Services DISTRICT NO. PROCESSED BY
0-200 Amp. Under 600 V
201 -1000 Amp. Under 600 VAPPROVALS DATE INSPECTOR'S
SIGNATURE
Over 1.000 Amp.or Over 600 V
IF
P.POWER POLE
Temp.Power Pole Appurtenances ERSLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits GH CONDUIT
(Other) ING �Z7i
TURES
ER AUTHORIZED
PERMIT FEE (Sub-Total) LITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) AL
PERMIT ISSUING FEETOTALFEEES
-�" �vvuT,IIq , kU CASH PERMIT VALIDATION CK. M.O. CASH
POLICY HOLDER:_A� " 9 3 4 9APR 17 2 5 6.1 3AN
POLICY NUMBER-div,7d' J a as-7