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+� DBB� 11 APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY ������'�
COUNTY OFF LOS LOS ANGELES
WILLIAM J FOX, CHIEF ENGINEER '
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT ND.
ELECTRICIAN ' G fT 2
RECEIVED BY READY FOR DAT[ ISSUED
ADDRESSFIRST INSPECTION
CITY -zT[L NO QUI Q�— ^ -`�-+c
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COUNTY LICENSE NO C� EXPIRES BUILD "' S tl �� ram
PERMIT FEES
NUMBER OUTLETS EACH FEE LOCALITY
LIGHT Se NEAREST
CROSS ST.
RECEPTACLES 6
FIXTURES s OWNER
WALL SWITCHES S MAIL *S
ELEC RANGES ZS ADORERS V
ELEC HEATfRB 23 CITY TEL NO
BC
NUMBER OF CIRCUITS INSTALLED I HEREBY ACKNOWLEDGE THAT I HAVE READ THIN
TOTAI APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING
Nu" HORSEPOWER FEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
N¢w MVB HP av¢R INC ¢ clf ANGELES COUNTY LICENSE, OR I AM THE LEGAL,OWNER
OF THE RESIDENTIAL OPERTY2 DED ABOVE
Is ` LE.¢ S 28 -'
Ix 2 30l _ SIGNATURE OF /
2 S 1 00 PERMITTEE_
5 is 1 so INSPECTION RECORD
is Bo zao
HO 200 3 OO
200 BOO 10 OO
300 10130 1500 J
OVER 1000 2000 Z
MO BET/FRED CHANGER-HP [J
WELDERS AC-KVA R
GENERATORS - KIN - D
TRANSFORMERS - KVA
TEMP MOTORS (75% OF BRI.)
MOVED MOTORS (7S% OF ORIS)
MIBC
SIGNS
TYPE NO TRANS
TYPE NO LAMPS APPROVALS
FOR EACH PERMIT DAT[ INSPECTOR'S NAME
WIRING Si 00 (h P) CONDUIT
FIXTURES Sim WIRING TIG �� �.Gsr.!/��-✓
SUPPLEMENTARY s0 FIXTURES /
c POWER
TOTAL FEE B iJ UTILITYCO NOTIFIED t�
FINAL N'6