HomeMy Public PortalAbout9828 WOODRUFF AVE_Electrical__ 76A663C-461CO0613 13/,v APPLICATION FOR ELECTRICAL PERMIT
BUILDING A SAFETY DIVISION
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Pools
EACH NO, r FEE ADDRESS p(
1 &2 Finaily Sq. Ft. $ — $ LOCALITY
Multi-family Sq.Ft. — NEAREST
Residential Swimming Pools CROSS ST. .
OWNER OR
FIRM NAME
Outlets: Light,Switch&Receptacle MAI L
First 20 d ADDRESS
Additibnal Q CITY Tel. No.
PLAN CHECK
Lighting Fixtures '')' APPLICANT
First 20 [ ADDRESS
Additional CITY Tel.No.
PERMIT e
Fixed Appliances Not Over 1 HP APPLICANT
.Range_ Heater_ D.W. ADDRESS
Oven _ Dryer _ W.M. gema
Top _ FAU W.H. CITYTel. No. %P
Hood Ion
D sp. A C. 1•-r�b •� REG NUMBE Glass.
a
' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ag
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
Power Apparatus&Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
1.1.1
Size&Type HP,KW,KVA,or KVAR ELECTRICAL WIRING.
• a_
Up to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED D/OR
Over 1 to 1.0 Incl. LICENSED AS REGUI EO.BY LO5 A LES CCU Y AND TE OF
CA LIPORN IA OR T T 1 A'M T EGAL O R OF E ABOVE'
Over 10 to 50 Incl. DESCRIBED RESIDE JTIAL P Y.
Over 50 to 100 Incl. PERMITS °
Over 100 SIGNAT R
DISTRICT NO CE ED BY
Services
0-200 Amp. Under 600 V of
201 -1000 Amp. Under 600 V APPROVALS DATE INSP TOR'S
Over 1000 Amp.or Over 600 V SIGNATURE
TEMP.POWER POLE
Temp.Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit ROUGH CONDUIT
Additional Sign Branch Circuits n
(Other) WIRING ®/-'� T� ,J .3✓b9a„_r
FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total). UTI ILITY CO.NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL d-7 071
PERMIT ISSUING.FEE
TOTAL FEE NOTES
3. •3O
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT-VALIDATION CK. M.O. ASH
94. 6,r,-Nov 3 .2 a 3 8.30 ®z
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