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7SA66 3DSS A 11 49 1 # APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRI GROUP ZONE PERMIT NO.
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ELECTRICIAN ''XD ,� A;
(J! �/B f REC D BY READY FOR DATE ISSUED
ADDRESS
FIRST INSPECTION
CITY ,.) „�'yJ ( iii TEL.
COUNTY LICENSE NO /O�- EXPIRES A=IN113 i /• _�
PERMIT FE19S
FEE
NUMBER OUTLETS EACH LOCALITY
NEAREST G '
LIGHT Sc $ 0 CROSSST
p RECEPTACLES 5 /
/I FIXTURES 5 OWNER • [_ L. e
170 WALL SWITCHES 5 OO' MAIL
n ADDRESS
EIEC RANGES 25 .G
ELEC HEATERS 25 CITY TEL NO
MISC I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF CIRCUITS INSTALLED
TOTAL i APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LIGHTS 7 RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING
NUMBER HORSEPOWERFEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NEW MVD HP OVER INC EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
y� Pl OF THE RESIDENTIAL PROPERTYDESCRIBEDABOVE
1/z 6 LEBB $ 25 oo"^
ol %2 2 s0 SIGNATURE OF
2 S 1 OD PERMITTED
1
5 15 1 513 INSPECTION RECORD
15 50 250
SD 200 Soo
200 Soo 10 DO / /°d C V�:? R! A�/b✓ '� GL
Soo 1000 15 00
' OVER 1000 2000 pZr
O a'7
M G SET/FRED CHANGER-HP O_
WELDERS AC-KVA
GENERATORS - KW J'`/Ff sd/ICJ G
TRANSFORMERS - KVA
TEMP MOTORS (75% OF ORIG)
MOVED MOTORS (75% OF ORIG)
MISC
SIGNS
TYPE NO TRANS
TYPE NO LAMPS APPROVALS
FOR EACH PERMIT
DATE INSPECTORIS NAME
WIRING $1 00 A 00 CONDUIT -PIT T
FIXTURES $100 &Q WIRING -
SUPPLEMENTARY 50 FIXTURES A
POWER
TOTAL FEE $ G UTILITY CO NOTIFIED
FINAL
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