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76A663 DBS 5A 11 50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
J WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO
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ELECTRICIAN R F i7
RECEIVED BY READY FOR DATE ISSUED
ADDRESS 5134 N. Acacia Street FIRST INSPECTION
CITY San Gab. TEL No AT 68583 &t4-� /p
COUNTY LICENSE NO 1104 EXPIRES - BUILDING
PERMIT FEES ADDRESS 4826 Alessandro Ave.
NUMBER EACH FEE LOCALITY Temple City
LIGHT OUTLETS NEAREST
CROSS ST
RECEPTACLES
WALL SWITCHES OWNER B. E. Turner
TOTAL OUTLETS 5c $ MAIL
ELEC RANGES 1 25 25 ADDRESS
ELEC HEATERS 25 CITY TEL NO
FIXTURES 5
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
NUMBER HORSiPOWER FEE
NEW MVD HP OVER INC
EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
1/2 &LESS $ 25 SIGNATURE OF
1/z 2 50 PERMITTEE
2 5 1 00 INSPECTION RECORD
5 15 1 50
15 50 2 50
50 200 5,00
200 500 10 00 J
Soo 1000 15 00 Z
OVER 1000 20 00
M G SET/FREQ CHANGER HP
WELDERS AC KVA O
GENERATORS KW
TRANSFORMERS KVA
TEMP MOTORS (75%OF OR1G )
MOVED MOTORS (75%OF ORM )
MISC
SIGNS
NO NO TRANS APPROVALS
NO NO LAMPS
DATE INSPECTOR S NAME
FOR EACH PERMIT
WIRING $1 00 1 00 CONDUIT
FIXTURES $1 00 WIRING
SUPPLEMENTARY 50 FIXTURES
POWER
TOTAL FEE $ 1 25 UTILITY CO NOTIFIED
® FINAL