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'BS-5A;1"5 APPLICATION FOR ELECTRIC PERMIT
DMSION OF BUILDING AND SAFETY
• Department of County Engineer BUILDING !?'L3 �'
County Of LOB Angeles ADDRESS�-•�J
JOHN A. LAMBIE, COUNTY ENGINEERD-
CASSATT D. GRIFFIN, SUPT of SU OINa LOCALITY )Z•f'�.
FOR APPLICANTTO FILL IN NEAREST �/ V
PERM FEES CROSS ST.
NUMB
J OWNER
LIGHT OUTLETS •
MAIL
RECEPTACLES ADDRESS
WALL SWITCHES FEE CITY TEL. NO.
crZ TOTAL OUTLETS @ 5Q S ELECTRICIAN /
ELEC. RANGES 25 g0DRESS [i� iL.
ELEC. HEATERS 25 /
KW EA CITY Y1/ L4EL. NO.
STATE
FIXTURES 5 LICENSE NO. /A..6 I//
MOTORS DISTRICT NO. GROUP ZONE READY FOR INSPECTION
. NUMS R HORSEPOWER FEE I I rA
O
NEW MVO. HP OVER INC. EACH
1/2 a LE59 s .zs INSPECTION RECORD
If2 2 .50
2 5 1.00
_ 5 Is 1.50
15 50 2.50
Wl' SO 200 5.00
{ MISC.
1
NO.SIGNS NO.TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING S1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
l
TOTAL FEE $ t; DATE INSPECTORS SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT II
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING , ;I
ELECTRICAL WIRING. 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 1 AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PRO ER
SIGNATURE I UTILITY CO.NOTIFIED
OF PERMITTEE FINAL V
JOHN A.LAMBIE,COUNTY ENGINEER 1YK4m- ATION ARTHUR C.VETT.CHIEF ELECT. INSPECTOR
CK J MO CABX
IX 6 7 1 �:; MAR18 2 7.60