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Des 5A 3 53 APPLICATION FOR ELECTRIC PERMIT
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DBS SA
DMSION OF BUILDING AND SAFETY
Deportment of County Engmeer
County of Los Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS D
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
PERMIT FEES T TO FILL IN NEAREST �Q
CROSS ST '
NUMBER EACH FEE a
OWNER J?—
LIGHT OUTLETS
RECEPTACLES MAIL
ADDRES
WALL SWITCHES
TOTAL OUTLETS 5¢ $ CITY TEL O /7
ELEC RANGES 25 ELECTRICIAN
_ELEC HEATERS 125 ADDRESS
KW EA CITY TEL NO 1'78 7
FIXTURES 5 LICENSE�NOI (O
NUMBER OF LIGHT CIRCUITS i !
- � DISTRICT N I GAUP I ZONE READY FOR INSPECTION
J
NUMBER OF RECEPTACLE CIRCUITS I - I p-
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD HP OVER INC EACH
I/2&LESS $ 25 2-1
1/2 2 50
2 5 100
5 15 1 50
15 50 250
50 20C 5 00
i
MISC
421-4-1
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $1 00 G O
FIXTURES SI 00
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE $ 16 DATE INSPECTOR S SIGNATURE
I 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
I 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 TH LEG L OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTI OPER
SIGNATURE UTILITY CO NOTIFIED �-
OF PERMITTE FINAL Z
WILLIAM J FOX COUNTY ENGINEER VALIDATION A C VEIT CHIEF ELECT INSPECTOR
_Ar 5 5 1 5 U APR 2'7 z 12 5 1n
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