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DBSSAA 3 55 - APPLICATION FOR ELECTRIC PERMIT
DBS5A355
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of LOS Angeles BUILDADDRESS d /]
WM J FOX COUNTY ENGINEER
67/va
CASSATT D GRIFFIN SUP T OF BUILDING _LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSSST
NUMBER EACH FEE _
OWNER U YlJ L
LIGHT OUTLETS
MAIL
RECEPTACLES ADDRESS
WALL SWITCHES
TOTAL OUTLETS 5¢ $ CITY TEL NO
ELEC RANGES 25 ELECTRICIAN
_ELEC HEATERS 25 ADDRESS O
KW EA CITY i TEL NO
FIXTURES 5 0 LICENSE NO O U
NUMBER OF LIGHT CIRCUITS - DISTRICT NOGROUP I ZONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS 5� I I 144
MOTORS
NUMBER HORSEPOWERFEE INSPECTION RECORD
NEW I MVDI H
t� (P� OVER I INC EACH ^ ►�
is O L_ &LESS 25 d4J J
1/Z 2 50
2 5 1 00
5 15 1 50
15 50 2 50
/r� T 50 200 500
MISC MOVA /'Akv Z7 L_
14-0 oK Ii IP Al r zz2�`12—
/0a ✓u.0
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $1 00 V
FIXTURES $1 00
SUPPLEMENTARY 50 ?'1 APPROVALS
TOTAL FEE $ DATE INSPECTOR SSIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES A c
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER G.' A
DESCRIBED RESIDENTI L PROPERTY
SIGNATURE UTILITY CO NOTIFIED ' // /I
OF PERMITTEE o �� FINAL i /V
WILLIAM J FOX COUNTY ENGINEER VALIDATION A C VEIT CHIEF ELECT INSPECTOR
X05 5 9 2U-1 FEB 2 7 2 270 In
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