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APPLICATION FOR ELECTRIICCA PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS L�1A7 C
JOHN A LAMBIE COUNTY ENGINIIER ,
COLEMAN JENKINS, SUMRINTBNDBNT CF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN IrROSS ST
NO A
RECEPT_ OWNER `
MAIL
LIGHT_ TOTAL FIRST 20 20 ADDRESS
SWITCH_ OVER 20 10 CITY TEL NO
PLAN CHECK
LIGHTING TOTAL FIRST 20 20 APPLICANT
FI%TURES OVER 20 10 ADDRESS
RANGE—DRYER_WTR HTR CITY TEL NO J�
STA COOK_DISP _F A U CONTRAC�iJOR Woy
C c.!
SPACE HTR _AIR COND __ ADDRESS 5 1
CLOTHES WASH —DISHWASH CITY TEL NOt1 O
_
FAN—OTHER 1 00 LICENSE NO t0 CLASS/--10
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE B TYPE OVER TO AND !TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE! AND STATE LAW! REGULATING
0 - I 1 00 ELECTRICAL WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AMD/OR
I10 3 00 LICENSED AS REQUIRED BY LO! ANGELES COUNTY AND !TATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AMD INTEND TO
10 60 S DD RESIDE IM THE ABOVE OESCPIPED RLII TIAL PROPERTY
SO - 100 10 00 SIGNATURE
OF PERMIT FU
100 - SOO 15 O
DIST RI G,T NO �UP _ P ESSED BY p
916N GAS SIGN AND ONE CIRCUIT 3 00 T v t3
TUBE Oq
W
MA ROU EE ADDITIONAL CIRCUITS 100 NOTES h
2
SERVICE NOT OVER 600 VOLTS OR 200 AAP 2 00 Z OD
SERVICE OVER 600 VOLTS OR 200 AMP S 00
TEMP SERVICE POLE 6 APPURTENANCES 3 00 APPROVAL! DATE INSPECTORS SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (SOK PERMIT FEE) POWER AUTHORIZED '
PERMIT ISSUING FEE 2 00 ow, U T RLI TYCO N OTI FIFO
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 1 FINAL I IAN
TOTAL FEE 4 UI1 I JOSEPH C ROOHAN
SUPERVISING ELEC ICAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M O CASH
LAP- 0 8 8 2 JUL 9 2 D 4.0p-
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ��
09
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APPLICATION FOR ELECTRIC PERMIT ],
MSION OF BUHMING AND SAFETY
Department of CGan•g Fmglne
CGanrt of te. xngeles BUILDING y y
WM J FOX COUNTY ENGINEER ADDRESS 4
CABSATT D GRIFFIN, SUP T OF BUILDING
FOR APPLICANT TO FILL IN LOCALITY 1
PERMIT FEES NEAREST
PEE
CROSS ST
NUMBER EACH
OWNER
LIGHT OUTLETS
I I
RECEPTACLES MAIL
ADORES6
WALL SWITCHES _
TOTAL OUTLETS ad f CITY TEL NO
ELEC RANGES 25 ELECTRICIANac
ELEC HEATERS 25 ADDREb6 6
KW FA CITU TEL NO 1-7672
FIXTURES 5
LICENSE NO
NUMBER OF LIGHT CIRCUITS DISTRIX NO GROUP ZONE READY MR INSPECTION
NIJMBrR R PTACIRCUIT* {. 'z
MOTORS ..a//J
NUMOX HORSEPOWER FEE INSPECTION RECORD '
NRW MVD HP OVER INC EACH
_ eLBee f 25
2 aO
2 a 1 00
—__— a fa t 50
_ 15 DO 250 _
50 200 500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
OR EACHP MIT _
WIRING SI 00 00
FIXTURES $100 _
SUPPLEMENTARY 50
APPROVALS
TOTAL FEE f 00
DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT 4 f—' �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES —S r
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT 1 AM THE GAL WNER OF THE ABOVE
DESCRIBED RESIDENT AA v. UTILITY CO NOTIFIED
SIGNATURE J��`,//
OF PERMITTEE t FINAL
RMNA
WILLIAM J FOX.COUNTY ENGINEER VALIDATION -� 1 .00 '
dol 7 5 9S W21 2
DY
DEPUTY
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