HomeMy Public PortalAbout9628 1/4 BROADWAY_Electrical__ TG APPLICATION FOR ELECTRIC PERMIT 1
76AGG3 3 99
DIVISION OF BUILDING AND SAFETY
DepUTtment of County Engineer
County of Los Angeles BUILDING G�
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN, SUPT OF BUILDING 'e .
1 B' I-LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
NU BER EACH FEE y
OWNER SO
LIGHT OUTLETS MAIL
RECEPTACLES ADDRESS
WALL SWITCHES
TOTAL OUTLETS SC S CITY TEL. NO
ELEC. RANGES 25 ELECTRIC///IA1dN U 2o
_ELEC. HEATERS 25 ADDRESS `C'VoNr /,"/
KW EA CITY O TEL. NO. U�f�
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS - DISTRICT NO. I GROUP i ZONEI READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS iiJ}/IIITT-
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NFW V. HP OVER IND. EACH
I2 9 LESS S .25
/ 2 .50
2 5 1.00
5 15 1.50
IS 50 2.50
50 200 5.00
M ISC.
I
NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS
FOR EACH PERMIT:
WIRING 51.00 1
FIXTURES SI.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE S /D I'J- � DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APFLICAIION 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 AN STATE OF I
CALIFORNIA OR THAT 1 THE LEGAL 0 HE BOVE POWER I
DESCRIBED RESIDENTIAL P ERTY. 11''
• UTILITY CO. NOTIFIED ^W"
SIGNATURE VV -
OFPERMITTEE FINAL
WILLIAM J. F .COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR
A04454—un JAN24 2 5.25 n