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DAPPLICATION FOR ELECTRIC PERMIT
IT
A
DIVISION OF BUILDING AND SAFETY
Department of County Engmeer
County of Los Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PMUT FEES CROSS ST
NU ER EACH FEE
OWNER
LIGHT OUTLETS
MAIL
RECEPTACLES ADDRESS
WALL SWITCHES
TOTAL OUTLETS ° 52 $ CITY 19 TAL NO
ELEC RANGES 25 ELECTRICIA
_ELEC HEATERS 25 ADDRESS -)I-
KW
KW EA CITY TEL NO
FIXTURES 5LICENSE NO J
NUMBER OF LIGHT CIRCUITS
DISTRICT NO I GROUP I 0 E I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS /f-
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEWY MVD HP OVER INC EACH
I12&LESS $ 25 r ��
1/2 2 50
2 5 1 00
5 15 1 50
15 50 2 50
50 200 Boo
MISC
NO SIGNS NO TRANS r
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $100
FIXTURES $1 00
SUPPLEMENTARY 50 [ APPROVALS /
TOTAL FEE S I �/ DATE INSPECTOR S SIGNATURE 1
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDIN CES AND STATE LAWS REGULATING WIRING j'
ELECTRICAL WIRING s
I HEREBY CERTIFY T I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIR BY LOS GELES COUNTY AN S ATE OF
CALIFORNIA OR TH AM TH E L OWNER OF T AB POWER
DESCRIBED RESIDEN PROPE UTILITY CO NOTIFIED
SIGNATURE r FINAL �' - 7
r
OF PERM ITTE
WILLIAM J FOX COUNTY ENGINEER VALIDATION A C VETT CHIEF ELECT INSPECTOR
L3546U DEC 19 2 445
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