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D555A 9 55 Y APPLICATION FOR ELECTRIC PERMIT
1
BS S
DIVISION OF BUILDING AND SAFETY
F Department of County Engmeer
County of Los Angeles BUILDFADDRESSING
WM J FOX COUNTY ENGINEERCASSATT D GRIFFIN SUP T OF BUILDINGLITY /�7L/QLL'
FOR APPLICANT TO FILL IN NEAREST
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PERMIT FEES CROSSST
NUMBER EACH FEE /
OWNER 11Z,
LIGHT OUTLETS
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES /�
TOTAL OUTLETS 5¢ $ CITY L"/7 TEL NO
ELEC RANGES 25 ELECTRICIAN ,1 T/
_ELEC HEATERS 25 ADDRESS / ,a1
KW EA CITY /L/�L TEL NO
FIXTURES 5 LICENSE NO 606
NUMBER OF LIGHT CIRCUITS
- DISTRICT NO I GROUP ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER ( HORSEPOWERFEE INSPECTION RECORD
NEW MVD HP OVER INC EACH
1�&LESS $ 25
1/L 2 50
2 5 100
5 15 150
15 50 2 50
50 200 500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $100
FIXTURES $1 00
SUPPLEMENTARY SO J �7 APPROVALS
TOTAL FEE $ / x 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 3 '1Z SL
ELECTRICAL WIRING
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PROPERTY �g
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE FINAL V ~
WILLIAM J FOX, COUNTY ENGINEER VALIDATION A C VEIT CHIEF ELCCT INSPECTOR
{ ;.Al 4 3 0 O'U'O) MAR 2 0 2 125
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