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5A553-CESOB 5-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING r
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
OR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE
oUILE75 FIRST 20 jvlo S OWNER
LIGHTM AIL
A DD'L ADDRESS
SWITCH. OVER 20 .10 ,
LIGHTING
CITY TEL. O.
T-TOTAL .20FIXTURES ADD'L ,10 ELECTRICIAN
OV R 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS qqL 4Z
GARB.DISP. STA.COOKEZ
- /
CITY TEL.NO. -� F9
DISHWASH. AUTO.-WASH'. STATE
SPACE HTRS. STA.APP.(Va H.P.MAX.) .SO LICENSE NO.
MOTORS, OVER NOT OVER H.P. DISTRICT O. GRO P N 1 4-01 P ED BY
O f 1.00
I 3 ti.so INS-IF TION RECORD
3 s 2.00
8 1S 2.50 ! ` O
Q
t5 So 3.00 ! U
s0 100 5.00
SIGNS,
O
NO.TRANS. ~
LU
NO.LAMPS C
IA
SERVICE 0.600V.NO'T OVER 200A 1.00 Z
SERVICE 0.600V-OVER'200 A. 2.00
SERVICE OVER BOOV 5.00
MISC.
Y`
PERMIT ISSUING FEE 2.00 t
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'881GNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY - CONDUIT /J
WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING9/ff
/
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA .OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE x.',
DESCRIBED RESIDENTIAL.P ERTY. �• POWERG%37r
SIGNATURE
OF PERMITTEE FINAL. CO.NOTIFIED
s
VALIDATION WRTRUR C. VEI'I'
MO CASH SUPERVISING ELECTRICAL ENGINEER
LAUD 7 42 0 ADL 12 2 D 3.4 0^' v