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DBS 5A '35 ■APPLICATION FOR ELECTRIC PERMIT 1
DIVISION OF BUILDING AND SAFETY
Deportment of County Engmeer Rat
County of Los Angeles BUILDING ® ,
WM J FOX COUNTY ENGINEER ADDRESS
15
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST
NUMBER EACH FEE
LIGHT OUTLETS OWNER
MAIL
RECEPTACLES ADDRESS
WALL SWITCHES
TOTAL OUTLETS 5¢ $ CITY14 NO
ELEC RANGES 25 ELECTRICIA
ELEC HEATERS 25 ADDRESS I -
KW EA CITY �— TEL NO
FIXTURES 5 LICENSE NO
NUMBER OF LIGHT CIRCUITS DISTRIC-LSW0 GROUP I ZONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS � I � I �/
MOTORS ,I
NUMBER I HORSEPOWER FEE L INSPECTION RECORD
NEW MVD HP OVER INC EACH
1/2&LESS $ 25 _
1/7 2 50
2 5 1 00
e
5 15 150
15 50 2 50 !
50 200 500
MISC
NO SIGNS NO TRA
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $100
FIXTURES $1 00
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE $ DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I 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 I AM PROPERPY`� REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELEr COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LE OWNER OF HE ABOVE POWER
DESCRIBED RESIDE R PE TY
SIGNATURE %. UTILITY CO NOTIFIED
OF PERMI i FINAL
ammmsima
WILLIAM J FOX COUNTY ENGINEER VALIDATION A C VEIT CHIEF ELECT INSPECTOR
4 1 7 2 U° MAR 16 2
z�
3
DES 5A 11 BS ' APPLICATION TION FOR ELECTRIC RIC PERM IT 1
DBS SA
DIVISION OF BUILDING AND SAFETY
Depm ent of County Engineer BUILDING
Count�yp of LOS Azgeies ADDRESS 5-2D I
JOHN A LANIBIE COUNTY ENGINEER
CASSATT D GRIFFIN SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CEASE sT W-0PERMIT FEES
NUMBER OWNER
110 LIGHT OUTLETS
MAIL
RECEPTACLES ADDRESS
WALL SWITCHES FEE CITY TEL N 0a
TOTAL OUTLETS ® s2 $ ELECTRICIAN e G
ELEC RANGES 25 ADDRESS 6ith
A ° _
ELEC HEATERS 25 CITY �� � TEL NO 5J
KW EA G',zt,a,.,AP
STATE !�
FIXTURES 5 LICENSE NO
MOTORS DISTRICT NO GROUPZONE READY FOR INSPECTION
NUMBER HORSEPOWER FEE I j— I
NEW MVD HP OVER INC EACH •L I'�
&LESS $ 25 INSPECTION RECORD
31i 2 50
2 5 100
5 1s ISO ,
15 50 2 50
50 200 S 00
M ISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $100
FIXTURES $100
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE $ DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPMCATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING C
ELECTRICAL WIRING WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELESOUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGA OWNER OF THE ABOVE POWER
DESCRIBED RESIDE PROPERTY 4We
SIGNATURE s UTILITY CO NOTIFIEDJ A
OF PERMITTEE FINAL �"-� , ,/P/�i
JOHN A LAMBIE COUNTY ENGINEER ATION ARTHUR C VEIT CHIEF ELECT INSPECTOR
CK MO CASH
L'Co 4 7 0 3 L APR 3 2 495 �'