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SAA 9 55 APPLICATION FOR ELECTRIC PERMIT
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DIVISION OF BUILDING AND SAFETY
Deportment of County Engmeer
County of Los Angeles BUILDING 55 Avon
WM J FOX COUNTY ENGINEER ADDRESS 61 1
CASSATT D GRIFFIN SUP T OF BUILDING mommmi, LOCALITY Temple le C it
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST
NUMBER EACH FEE
OWNER B
LIGHT OUTLETS
RECEPTACLES MAIL
ADDRESS
WALL SW ITCHES
TOTAL OUTLETS 40 5¢ $ CITY TEL NO
ELEC RANGES 25 ELECTRICIAN
_ELEC HEATERS 25 ADDRESS 1800 S. CUrtjS
KW EA CITY lh U7�,
ra TEL NOO
FIXTURES 5 LICENSE NO
NUMBER OF LIGHT CIRCUITS - DISTRICT I /J
GR IJP I ZONE READY FON INSPECTION
NUMBER OF RECEPTACLE CIRCUITS � i• I
MOTORS
NUMBER HORSEPOWERFEE INSPECTION RECORD
NEW MVD HP OVER INC EACH ....�y
1f2 iw/�l NAre
G
&LESS $ 25 - /"����►� r—,yo
1h 2 50
2 5 1 00 V r
5 15 1 50 ,�l Z =S efa Cy'/'►"JI(�/G ��..�����"L
15 50 2 50
50 200 5 00 1 G yet/15C77AL6 Qr/
MISC /,
NO SIGNS . NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $100 YVV
FIXTURES $1 00
SUPPLEMENTARY 50 'APPROVALS
TOTAL FEE g •55 DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY r
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING "c7 r �dOtr�
ELECTRICAL WIRING
I HEREBY CERTIFY THAT 1 AM RE ISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LO ES C01U Y AND STATE OF
CALIFORNIA OR THAT 1 AM GAL OF THE ABOVE POWER
DESCRIBED RESIDENTIAL P .may
� UTILITYCO NOTIFIED
F,
SIGNATURE f'� O
OF PERM ITTEE FINAL �S(�
WILLIAM J FOX COUNTY ENGINEER VALIDATION A C VEIT CHIEF ELECT INSPECTOR
IAC04754Zu-R APR 4 2 455
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