HomeMy Public PortalAbout9728 BROADWAY_Electrical__ oa=ssA,2. r APPLICATION FOR ELECTRIC PERMIT
-,DIVISION OF BUILDING AND SAFETY
Department of County Engineer 9 C
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS % ' /✓YU '�G L✓Ml//
CASSATT D. GRIFFIN. SUR'T CIE BUILDING
FOR APPLICANT TO FILL IN LOCALITY
PERMIT FEES CCROSS S
FEE
NUMBER EACH
LIGHT OUTLETS �_ OWNER
RECEPTACLES MAIL
T ADDRESS
WALL SWITCHES / _
TOTAL OUTLETS 5f S �O CITY TEL.. NO.
ELEC. RANGES 25 ELECTRICIAN
ELEC. HEATERS 25 ADDRESS
KW EA /
—� CITY GtJ� .s�UO/�i2 TEL"NO.
FIXTURES 5 d S - LICENSE NO. -2–
NUMBER OF LIGHT CIRCUITS DISTRICT NO. GROUP ZONE REAor EOH Ixsp Eci lox
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVO. HP OVER INC. EACH
�CALLzL0
@ LESS $
2 50 V
_ 2 5 00
_ 5 S 50
15 50 2.50
50 200 5.00
MISC.
NO. SIGNS NO. TRANS.
NO, SIGNS NO. LAMPS _
FOR EACH PERMIT: _
WIRING $1.00
FIXTURES 51.00 _L�
SUPPLEMENTARY ,50 APPROVALS
TOTAL FEE $ t?S DATE IN5PECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT 'I
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING eI FUS
ELECTRICAL WIRING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIALJP$ ERTY. 9 UTILITY CO. NOTIFIED
SATURE
OF PERMITTEE -�_ _ FINAL
OF PERMITTEE //TLLC6 KKK =, /
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION
Iain 208os BAR30 2 2.65 4
BY
{-(nom DEPUTY