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� APPLICATION FOR ELECTRIC L PERMIT
COUNTY OF LOS ANGELES
• DEPARTMENT OF COUNTY ENGINEER BUILDING aa++�� '"'/ �1
BUILDING AND SAFETY DIVISION ADDRESS A Q. A /�
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NO. EACH FEE
RECEIPT. Aamico'cw RYE'
$ $ OWNER oil
I
LIGHT TO FIRST FIRST 20 .20
ADDRESS`p b ®''jr it r t
SWITCH !/>� OVER 20 10 CITY44
TEL.N
re
PLAN HECK
LIGHTING TOT L FIRST 20 .20APPLICANT
FIXTURES } OVER 20 ,10 r ADDRESS
RANGE_DRYER WTR HTR. CITY TEL.NO.
STA. COOK_DISP._F.A.U.
CONTRACTOR
SPACE HTR. AIR COND. ADDRESS
CLOTHES ASH-DISHWASH. CITY TEL.NO.
FAN .OTHER 1.00 ®C LICENSE NO. CLASS.
MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
IND. HEATERS, ETC, HP. KW. KVA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
x ELECTRICAL WIRING.
0 - 11.00 v o 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
I - 10 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO S
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. C
10 - 50 5.00 L
SIGNATURE pl
50 - 100 IO DO OF PERMITTE C
H
100 - SOO 15,00 DISTRICT I'D'
G i0 2,
PRQ C�ISS B1Y LL
SIGN GAS SIGN AND ONE CIRCUIT 3.00 6 ' V�`/s. 2' 91
T91
UBE1, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE PECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
1 PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIEq
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE JOSEPH C. ROOHAN
14 • SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION 0
M.O. CASH
i Air 4 1 9 6 C MAR 3 2 D 16.20-
CL
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE "/