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76A663 DBS SA 11 60 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
�SCOUNTY OF LOS ANGELES ELECTRIC 1
W
N ILLIAM J FOX CHIEF ENGINEER
a FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO
ELECTRICIAN R, F 1
RECEIVED BY READY FOR DATE ISSUED
ADDRESS 5134 N. Acacia St. FIRST INSPECTION
CITY San Gab. TEL No AT 68583
COUNTY LICENSE N01104 EXPIRES ADDRESS 4920 Alessandro Ave.
PERMIT FEES
NUMBER EACH FEE LOCALITY Temple City
LIGHT OUTLETS 10 NEAREST
RECEPTACLES 19 CROSS ST
WALL SWITCHES I8 OWNER Tufner Homes
TOTAL OUTLETS 47 5C $ 2 35 MAIL
ELEC RANGES 25 ADDRESS
ELEC HEATERS 25 CITY TEL NO
FIXTURES 10 5 50
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 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
FEE OF THE RESIDENTIAL ;PROPERDESCRIBED ABOVE
NEW MVD HP OVER INC EACH
1 2 &LESS $ 25 •SIGNATURE OF
1/2 2 50 PERMITTEE y
2 5 1 00 INSPECTION RECORD
5 15 1 50
15 50 2 50
50 200 5 00
200 500 10 00 J
500 1000 15 00 Q
Z
OVER 1000 20 00
M G SET/FREQ CHANGER HP
0
WELDERS AC KVA
GENERATORS KW
TRANSFORMCRS KVA
TEMP MOTORS (75%OF ORIG )
MOVED MOTORS (75%OFORIG )
MISC
SIGNS
NO NO TRANS APPROVALS
NO NO LAMPS Eli
DATE INSPECTOR 8 NAME
FOR EACH PERMIT CONDUIT I
WIRING $1 00
WIRING
FIXTURES $1 00 100
SUPPLEMENTARY 50 FIXTURES /
POWER
5 lO /
TOTAL FEE $ I UTILITY CO NOTIFIED /,)A n,r,AA-~ ,e
0 FINAL