HomeMy WebLinkAbout3581A76A663C - Cri006B 12/75 APPLICATION FOR ELECTRICAL PERMIT
BUILDING
FILL IN
AND
SAFETY
DIVISION Tract 34808
,JOB ,�-y
ADDRESS Northwest Corner Clear
of
$2
cr�
12
u,
01-
cn
FOR APPLICANT TO
New Residential Bldgs. & Pools
1 & 2 Finaily Sq. Ft.
Multi -family Sq. Ft.
Residential Swimming Pools
Outlets: Light, Switch & Receptacle
First 20
Additional
Lighting Fixtures
First 20
Additional
Fixed Appliances Not Over 1 HP
Range Heater D.W.
Oven Dryer W.M.
Top FAU W.H.
Hood Fan
Disp. A.C.
Power Apparatus & Large Appliances
Size &Type HP, KW, KVA, or KVAR
Up to 1 Incl.
Over 1 t0 1O Incl.
Over 10 to 50 Incl.
Over 50 to 1001 nc1.
Over 100
EACH
NO.
FEE
$
—
$
LOCALITY ®$1111110n1 Gannon Drive Diamond
—
NEAREST
CROSS ST.
OWNER OR
FIRM NAME Anden Corp®
MAIL ADDRESS 6zg Covina Blvd.
Ci
CITY San Dimas Tel, No. 599-8°91
PLAN CHECK
APPLICANT
ADDRESS
CITY Tel. No.
PERMIT
APPLICANT Builders Per o Inc.
ADDRESS P.O. Box 37
{�
CITY Orange Tel. No. 633-9094
LICENSE OR 2�L7� 0��
REG. NUMBER Class.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
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 RESIDENTIAL PROPERTY.
PERMITEE�
SIGNATURE
Services
0 - 200 Amp. Under 600 V
201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
Temp. Power Pole & Appurtenances 10.0o 1
Sign with One Branch Circuit
Additional Sign Branch Circuits
(Other)
23 sub Poles
PERMIT FEE (Sub -Total)
PLAN CHECKING FEE (One -Fourth Permit Fee)
PERMIT ISSUING FEE c
TOTAL FEE
CHECK
CK. M.O.
APPROVALS
dUNDERSLABWORK
TEMP. POWER POLE
i®
OUGH CONDUIT
(RING
4.FIXTURES
OWER AUTHORIZED
-23 0
-32 0��
CASH
UTILITY CO. NOTIFIED
FINAL
VO TES
PERMIT VALIDATI!
Gd
01
DATE
CK.
CAS