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Des.sA 3 55 APPLICATION FOR ELECTR �P RMIT 1'
DIVISION'OF BUILDING AND SAFETY II Be Z
Department of County Engineer
County of Los Angeles BUILDING �O ��
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BUILDING
BS� LOCALITY J
FOR APPLICANT TO FILL IN NEAREST /
PERMIT FEES CROSS ST. K/
NUMBER EACH FEE
LIGHT OUTLETS OWNER
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES —RE
TOTALOUTLETS 5¢ S CITY - TEL. NO. //JJ
ELEC.RANGES 25 ELECTRICIAN 40
_ELEC. HEATERS 25 ADDRESS
KW EA CITY TEL. NO. •/ �
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS
DISTRICT NO I GROUP I ZO, / I REACT FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBERHORSEPOWER FEE INSPECTION RECORD
NEW MVO. I HP OVER MG. EACH
th&LEBB S .25
/2 2 .50
2 5 1.00
5 5 1.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING 51.00 0
FIXTURES 51.00
SUPPLEMENTARY .50 APPROVALS
_ u
TOTAL FEE S DATE INS
PECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT-1 HAVE READ THIS APPLICATION CONDUIT /1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING -1 5-7 C n
ELECTRICAL WIRING. \ �l
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - .FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES O Y A ST TE OF 11
CALIFORNIA OR THAT I THE LEG ABOVE POWER I
/�
DESCRIBED RESIDENTIAL R PERT. t UTILITY CO.NOTIFIED �1 t I__pro61+._��,
SIGNATURE
OFPERM ITTEE FINAL
WILLIAM J. O . COUNTY ENGIN ER VALIDATION A. C.VEIT, CHIEF ELECT. INSPECTOR
LAG04 8 7 4& FEB 6 2 5.0 5 "'