HomeMy Public PortalAbout5821TEMPLE CITY BLVD_Electrical DOS-SA APPLICATION ■ Oia ELEC ■ ■ IC PERMIT 1
DBS-SA 9.36 /"!! E
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
COunty Of LOS Angeleg BUILDING
WM.J. FOX,COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING T ,
LOCALITY ! `
FOR APPLICANT TO FILL IN NEAREST
PERI IVIIT FEES CROSS ST. --
NUMBER EACH FEE
LIGHT OUTLETS OWNER
RECEPTACLES MAIL
_ADDRESS
WALL SWITCHES f
TOTAL OUTLETS Z 5¢ S [O CITY TEL.N
ELEC.RANGES 25 ELECTRICIAN �ys
_ELEC. HEATERS 25 ADDRESS r�v
KW EA CITY TEL.NO Z
h�
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS - DISTRICT N GROUP NE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS I I ' I
MOTORS �f
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD. HP OVER I INC. EACH
I%&LESS $ .25
lh 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 1 200 5.00
t'
MI
t NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS
FOR EACH PERMIT'
WIRING 51.00 b
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE g DATE INSPECTOR'S SIGNATURE
1 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.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RE51DFNTI ROPEi
SIGNATURE UTILITY CO.NOTIFIED
RMITT � g / C1>OA
OF PEI FINAL
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION A.C.VEIT,CHIEF ELECT.INSPECTOR
APO 0 3 0 4 N SEP 13 2 1 .10