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BAoee-C1160610 APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
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DENNTY IVIER 13UILDIN
BUIL G AD SAFETY DIVISION. ADDRESS � per /' W&,oO/N4►,a
A�/2
JOHN A.L.AMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL 1N CROSS S'T. B
PER= FEES
I T E M NUMBER'I EACH FEE OWNER B
OUTLETS: $ MAIL -&, A
PON
ING FI
LIGHTS RECEPT. SW. .10 ADDRESS ��(( lib
LIGHTXTURES .10 CITY TEL.NO.!'C r/0"
E C.RANGES CLO.DRYERS / ELECTRICIAN
WATER HEATERS .50 ADDRESS
ELEC.SPACE HTRS. DISHWASHERS CITY TEL.NO.
GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTF ICT NO. GRMLOWPI ZONE I FR9CESSED BY
0— 1/2 .25
Ys— 2 .50 INSPECTION RECORD
.2— '5 1.00
6— 1S 1.50
IS— SO 2.50 ,j /�
50—200 5.00 -� /�� / l I!/,�i�.lEb
SIGNS:
NO.TRANS. erwI""
'
NO.LAMPS
SERVICE 0-600V 1.00 00 -� S A TQ 0-Af.
SERVICE OVER GOOV 5.00
MISC. n 'v a J T!�[Sl /fair
v
WIRING PERMIT 1.00 ���,•
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT 50
TOTAL FEE s -0LLY laF7F/�-/�'G7G�7d;F
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE Q
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT )' d
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR WIRING -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES -
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE A VE
DESCRIBED RESIDENTIAL PER POWER // Z
SIGNATURE -ICy UTILITY CO.NOTIFIED
OF PERMUTE
FINA' D 3f- f7 li A.4:d.�
�vv VAI.IDA ARTHUR C.VE
CK MO TT,
SUPERVISING ELECTRICAL ENGINEER
CASH
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