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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