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784888-CE808 4-65 APPLICATION FOR ELECTRICAL PgRMIT
wCOUNTY OF LOS ANGELES
c DEPARTMENT OF COUNTY ENGINEER FF=A
O
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGY
FOR APPLICANT TO FILL IN .
NO.-EACHFEE
RECEPT.V
Q S S OWNER
MAIL
LIGHT TOOTA++��L FIRST 20 .20 C7 ADDRESS
SWITCH -,:LZ OVER 20 .10 CITY Ta NO.
PLA CHE
LIGHTING l�-y-r-:0—yER
TOTAL FIRST 20 .20 AFIXTURES 20 .10 ADDRESS
RANGE_DRYER—WTR.HTR._ CITY TEL. NO.
STA.COOK_DISP._F.A.U._ CONTRACTOR
SPACE HTR. AIR COND. ADDRES
CLOTHES WASH._DISHWASH._ CITY TEL. NO:
FAN—OTHER 1.00 LICENSE IJ . CLASS. C .�D
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
'ELECTRICAL WIRING.
0 - 1 1.00
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
I - 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
10 - 50 5.00 RESIDE IN, THE V.E DESCRIBED (DENT L PROP R Y.
50 - 100 10.00 SIGNATURE t
OF PERMITTEE V
100 – Soo 15.00 DISTRI T G$QUP NE P CESSE BY
CD
SIGN,GAS Gc.�-
TUBE, OR SIN AND ONE CIRCUIT 3.00 -- C~7
MARQUEE LLI
ADDITIONAL CIRCUITS 1.00 NOTES ti
Z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 d
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE. &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
�
PERMIT FEE (SUB TOTAL) WIRING ,_ �
PLAN CHECK FEE (50% PERMIT FEE) FIXTURES
POWER AUTHORIZED
PERMIT ISSUING FEE 2.00d UTILITY c)
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 I A of ke
FINAL -1
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECT ICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION GK. M.O. CASH
LAf%MIA
97 .92 6 o 9.8 CLI
IEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE /
76A663 DBS 5A 3-30 -• - APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND'SAFETY '7
COUNTY OF LOS ANGELES. ELECTRIC IC ° 1
WILLIAM J. FOXp CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO.' GROUP 'ZONE PERMIT N4O.
-r ���/
ELECTRICIAN RECEIVED BY READY FOR DATE I813UED
ADDRESS At /drat? FIRST INSPECTION
CITY TEL.NO.
/� -i 7677
COUN LICENSE NO-5d EXPIRES BUILDING
ADDRESS
PERMIT FEES
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
!! RECEPTACLES CRO88ST.CIO
/.� WALL SWITCHES13WNER JA _
(�(f� TOTAL OUTLETS Be $ MAIL G
ELEC. RANGES 85 t ADDRESS
��- ELEC. HEATERS 25 CITY TEL. NO.
I� FIXTURES P 5 1 HEREBY ACKNOWLEDGE THAT I. HAVE READ THIN
!� MISC. APPLICATION AND. STATE
THAT THE A013VE IS CORRECT
!' O UMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
�� MOTORS NUMBER OF RECEPTACLE CIRCUITSi AND STATE LAWS REGULATING ELECTRICAL'WIRING.
I CERTIFY THAT A POSSESO
S THE ABOVE VALID L138
NUMBER HORSEPOWER ANBELEB COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
FEE'.
NEW MVD. HP °avER INC- EACH OF THE RESIDENTIAL PROPERTY DESCRIBEDNABOVE.
I/ t1 LESS .B .25 SIGNATURE OF'
'/28 .50 PERMITTER
2 5 1.00 INSPECTION RECORD
5 15 1.50
15 No 2.50
50 200 5.00
200 500 1o.o0 J
BOB 1000 15.00 Z
OVER 1000' 20.00 Ij
M.G. BET/FREO. CHAMBER-HP
WELDERBI AC-KVA 93
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. ,MOTORS (75% OF DRIB-)
MOVED MOTORS (75% or DRIB.)
MISC.
SIGNS
N0. NO.TRANS.
. APPROVALS
NO. NO.-LAMPS
FOR EACH PERMIT: DA/TE INSPEOTORIS NAME
WIRING 6100 CONDUIT F
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
__'
TOTAL FEE +�/ UTILITY cO.NOTIFIED / 4 ✓
4 I'
/ .FINAL