HomeMy Public PortalAbout5004AGNES AVE_Electrical (10) DB 5 A 4 41 23M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
y
CPUNTY OF LOS ANGELES ELECTRIC
WM J FOX CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT-NO GR�oruP I zoNE PERMIT Iv�
WIRING _��FIXTURES r SERVICE Jr O�j
RANGE HEATER I—I POWER RECEIVEBY FIRSTS INSPECTION DY FODATE/ISSUED
SIGNS MISCELLANEOUS
APPLICANT FILL IN HEAVILY-OUTLINED PORTION ONLY
= JOB
< NAME ADDRESS
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ADDRESS V LOCALITY ir
V ��a'� NEAREST �r�a
W CITY � fiqr!"� TEL NO CROSS ST
CERT NO EXPIRES IC NAME lis• e0r �d .
w MAIL
DESCRIPTION OF WORK 3 ADDRESS
NUMBER OF OUTLETS ON CIRCUITS 0
LOCATION BY ROOMS CITY TEL NO
LIGHT OUTLETS SW PLUGS FIX, 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
CIRCUIT
A B C D E I• G H ANGELES COUNTY CERTIFICATE OF QUALIFICATION
LIVING ROOM ELECTRICIAN
-------'--- I AM THE LEGAL OWNER OF THE PROPERTY �DESCRIBED
DINING ROOM -_------- ABOVE
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QQR.��BRFST RM y"�0 , ice" OWNER
BATH / ——— — — CORRECTIONS
ENT HALL _
HALL NO ---_ --_�
FRONTPORCH --------�
OUTSIDE
KITCHEN —_—__--_--__---_— /�
SERV PCH _— _---_--_ —�7
BDRM NO. ! !- Cz��j/
CLOSET
BDRM NO
CLOSET
I
TOTAL -----��-- —
NO OF OUTLETS ® $ APPROVALS
NO OF FIXTURES . $ �`i-� DATE INSPECTORS NAME
NO OF MOTORS H P $ CONDUIT
NO OF SIGNS TRANS $ WIRING
NO OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ yy— POWER
PERMIT FEE $ (! �7p�G UTILITY CO NOTIFIED f
e
TOTAL FEE $ t�f FINAL �"` �