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'°•°°° DL°°B 488 APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER euILOING
BUILDING AND SAFETY DIVISION ADDRESS 7 a iw a CST
JOHN A LAMBIE, COUNTY ENGINUER
COLEMAN WI JENKINS, SURRINTSIND6NTOI BUILDING LOCALITY —_ //
42
FE
PPLICANT TO FILL IN NEAREST
CROSS ST
OWNERN /MAIL FIRST 20 20 ADDRESS
OVER 20 10 CITY TEL NO
PLAN CHECK
FIRST 20 20 APPLICANT
OVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR _ CITY TEL NO
STA COOK_DISP _F A U _ CONTRAC FOR o
U LL'TC-�T
SPACE HTR _AIR COND ADDRESS2-
CLOTHES WASH _DISHWASH CIT S t TEL NOVAr04ZZ-
PAN_OTHER 1 001 LICENSE NO 1Q CLASS 10
MOTORS TRANSFORMERS RATI NO
IND HEATERS ETC HP KW KVA IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE Q TYPE OVER TO ANO STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW! REGULATING
ELECTRICAL WIRING
0 - 1 1 00
I HEREBY CERTIFYIR THAT I AM PROPERLY REGISTERED AXOMR Or
1 10 3 00 CALIFORNIAAS REQUIRED BY LOS LEGAL
COUNTY AND STATE Dr
ULIfRMOR THAT 1M THE L[OAL OWNER Of AND INTEND i0
10 SD 5 DD RABID[ IM •BOVC n[BCR rteD R DC NTIAL PROPERTY
- Y
SIGNATU
50 - 100 1000 OF PERM TT G
U
100 - 500 15 00
DIST/{��I GR UP N PR ESSED BY o
TUBE SIGN A SIGN AND ONE CIRCUIT 5 00 S. V C~j
W
MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES y
SERVICE HOT OVER GOO VOLTS OR 200 AMP 2 00SERVICE OVER 600 VOLTS OR 200 AMP 5 GO
TEMP SERVICE POLE 3 APPURTENANCES 9 00 APPROVALS DATE INSPECTOR'!SIGNATURE
TEMP POWER POLE
IFIXTURES
DERSLAS WORK
UGH CONDUIT
PERMIT FEE (SUB TOTAL) RING
PLAN CHECK FEE (SOS PERMIT FEE) WER AUTHORIZED 7 .jq/&
PERMIT ISSUING FEE 200 Z ILITYCONOTI FREDSUPPLEMENTARY PERMIT ISSUING FEE 1 00 NAL aTOTAL FEE JOSEPH C ROOHAN
SUPERVISING ELEC ICAL ENGINEER
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o CASH
I er,o s 7 JUL 9 2 D 4.00- /v
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE A"a _ /
DII:EOR 12 eA APPLICATION FOR ELECTRIC PERMIT 1
DIMON OF BUILDING AND SAFETY
Department of County Engineer
County Of LOB Angel" BUILDING //�Q H- � Iv
WM J FOX COUNTY ENGINEER
ADDRESS �7 l
CASSATT D GRIFFIN SUP T OF BUILDING
FOR APPLICANT TO FILL IN
LOCALITY �E
PERMIT FEES NEAREST
CROSS ST _
NUMBER EACH PE!
LIGHT OUTLETS OWNER RECEPTACLES MAIL
MAIL
ADDRESS
WALL SWITCHES _
TOTAL OUTLETS BI i CITY TEL NO
ELEC RANGES 25 ^ ELECTRICIA�+N
ELEC HEATERS ZB ADDRESS QS
KW EA CITY 401�Y(77
T!l NO L-E
FIXTURES B LICENSE NO
NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP Z NE READY FOR INSPECTION
NUMBER OF RECEPTACLET
MOTORS L+
NUMBER HORSEPOWER FEE INSPECTION RECORD
N[W MVD HP OVER INC EACH
%at-Ess f 25 _
---_}�_ 2 BO _
_ 2 B 1 DO
B 1B 150
18 BO 280 _
80 i 200 Boo
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS _
FOR EACH PERMIT _
WIRING •100
FIXTURES $100
SUPPLEMENTARY 80
APPROVALS
TOTAL FEE B I DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT 3-2/
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING 9-21
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES '
+
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT 1 AM THE LEGAL WNER OF THE ABOVE
DESCRIBED RHSIDENTI P R 3-ZI
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE C FINAL 1
WILLIAM J FOX.COUNTY ENGINBiR VALIP�1 76 on W21 2 1255 1° .
BY
J DEPUTY /
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