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76AO63-CESOO 1 GB APPLICATIONIRYWELECT ICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY-ENGINEER BUILDING /
BUILDING AND SAFETY DIVISICtV ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUPeRINTtNDKNT OP BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS STIR
A
I 'EPT_ S OWNER / L # / L
MAIL
LIGHT_ TOTALbFIRST
20 ADORES$ T L
I QQ
SWITCH— f0 CITY EL NO
PLAN CHECK
LIGHTING !TOTAL 20 APPLICANT
FI%TURES J 10
ADDRESS
RANG DRYER_WTR HTR CITY TEL NO
STA COOK_DISP F A U CONTRACTOR
SPACE HTR -AIR GOND _ ADDRESS
CLOTHES WASH _OISHWASH CITY TEL NO
FAN-OTHER 1 00 LICENSE NO CLASS
MOTORS TRANSFORMERS RATING
IMG HEATERS ETC HP KW KVA 1 HEREBY ACKNOWLEDGE THAT 1 NAVE READ THIS APPLICATION
SIZE Q TYPE OVER TO ANp STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS RE000TING
ELECTRICAL WIRING
0 - I 1 00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 - 10 3 00 LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
10 50 B 00 1
RESIDE IN THE A 0 DESCRICED RESIDE N AL PROP PITY O
I SIGNATURE V
SO - 100 1000 OF PERMITTEE K
100 - 500 IS 00 0
SIGN GAS DIST CT NO G P NE PRO ESSED B G
TUBE A SIGN AND ONE CIRCUIT 3 00 Q / 116Lu
MARQUEE ADOITIONAL CIRCUITS 1 00
NOTES Z
SERVICE HOT OVER 000 VOLTS OR 200 AMP 2 00
SERVICE OVER 500 VOLTS OR 200 AMP S 00
TEMP SERVICE POLE Q APPURTENANCES 3 00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP POWER POLE
UL
WORK
DUIT
PERMIT FEE (SUB TOTAL)
FIXTURES
PLAN CHECK FEE (BOX PERMIT FEE)
HORIZED
PERMIT ISSUING FEE 2 00NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1 00
TOTAL FEE JOSEPH C ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M Q As
LAC�14 6 3 5,8 MAY 10 2 D 5.00^' d
IEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE