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76A663 CE-806 (11 / 78) APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs. & Pools EACH NO. FEE ADDRESS J 2
I & 2- Family, Sq. Ft,.. T 0-25 LOCALITY LITY 117
. I --- li po v,
Multi -family Sq. Ft. .02 NEAREST
Residential S Pools 25.00 CROSS ST.
57
a s OWNER OR 4' FIRM NAME _Zl)i 1/4
Outlets; Rec— Light —Sw, — MAIL
First 20 .50 1 1 ADDRESS
Total No, Additional .30 CITY Tel. No.
Lighting Fixtures First 20
Total No. Additional
Fixed Appliances Not Over I HP
Range— Heater— D.W.
Oven— Dryer — W.M.
Top —FAU — W.H.
Hood ® For, — Other
Disp. — Room Air Cond,
Power Apparatus & Large Appliances
Size & Type HP, KW, KVA, or KVAR
Up to I Ind,
Over I to 10 Incl.
Over 10 to 50 Ind
Over 50 to 100 Inc.
Over 100
1, Services
0 - 200 Amp. Under 600 V
201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
,j Temp. Power Pole & Appurtenances
Sign with One Branch Circuit
Additional Sign Branch Circuits
Misc. Conduits & Conductors
Other (See Complete Fee Schedule)
PLANCHECK
APPLICANT
.50 ADDRESS
30
CITY
2.50
2. 50
5.00
12.50
25.00
40.00
12.50
2500
50.00
10.00
LO-0 0
2.00
10.00
PERMIT FEE
(Sub -Total)
IL1,231
PLAN CHECKING FEE (One -Fourth Permit Feel
PERMIT ISSUING FEE $7.00 ;7,9
TOTAL FEE
INSPECTION FINALED
1
date: By
7ZIl -,) li"-'-2
ADDRESS 4f '-
CITY Tel, No.,",
Y
LICENSE OR
REG. NUMBER, Class.
L_ 1
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA.
TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING ELECTRICAL WIRING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT IAVPROPERTY.
PERMITEE SIGNATURE
DISTRICT NO.
PROCESSED BY
INSPECTION
INFORMATION
ON REVERSE
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