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DOS SA APPLICATION TION FOR ELECTRIC PERMIT ],
D85 SA 12 94
DPVISION OF BUILDING AND SAFETY
Department of County Engmeer
County of LOS Angeles BUILDING Lr
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING
MOM
FOR APPLICANT TO FILL IN LocALITv
PERMIT FEES NEAREST
CROSS ST
NUMBER EACH FEE
LIGHT OUTLETS -� OWNER
RECEPTACLES ADDRESS
WALL SWITCHES
TOTAL OUTLETS St CITY TEL NO
ELEC RANGES 25 ELECTRICIAN
ELEC HEATERS _� 25 ADDRES J
KW EA TEL Nov, /
FIXTURES L(l 5 LICENSE NO
NUMBER OF LIGHT CIRCUITS DISTRICT NO I{If GROUP ZONE READY FOR INSPCCTI.N
NUMBER OF RECCPTACLE CIRCUITS �J
MOTORS _
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD HP OVER INC EACH AA
_ I�&LESS $ 25
IFI 2 50 �v
2 5 100
5 15 150
15 50 2 50
_ _50 200 500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $1 00 UQ
FIXTURES $100 �0
SUPPLEMENTARY 50
APPROVALS
TOTAL FEE $ DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I 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
ELECTRICAL WIRING
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE AL PROPE TY
UTI LITY CO NOTIFIED
SIGNATURE
OFPERM FINAL
U
WILLIAM J FOX, COUNTY ENGINEER VALIDATION '] 4,0 O �
_ ,03 6 9 1 u-)
MAY 13 G
BY
C
® _ DEPUTY
D B S SA 2SM SETS 111-47 , 'AC1<YVLCA HON FOR PESw ^
]DEPARTMENT Y I3YLOS NG FANDIX $A�'1'S �LEC I
COUN'T'Y OF I�D� ANGELES
WM-J FOX CHIEF ENGINEER 1
aNc.
NAME Q$,Q Q /� D13TRIC GROUff° ZONE "1=nF"9ii
- ADDRESS 7 ( 21-
61//I V� 5 �T� r1 — ,
U CITY 7-ow TEL NO / T F EI BY READY f OR DATE ISSUED
FIRST INSPECTION
J COUNTY >`
IJ CERT NO F-XPIR68 0 Yf
y� 7[� APPLIICANT FI�.IN HEAVMY OUTLINED PORTION ONLY
JOB
�lri
ESCRIyi OTWORK ORK ADDRESS
G t
°
NUMBER OF OUTLETS ON CIRCUITS �LOCALITY _
LOCATION BY ROOMS
NEAREST ,
_ LIGHT OUTLETS SW PLUGS ' FIXT CROSS ST _
CIRCUIT' /A , B C D E F G H W NAME r9}��t� eT r f� �G��
a Z MAIL emg wzrortoa / i
^f / ,: ADDRESS
- >O CITY TEL NO
1 AM, THE LEGAL POSSESSOR F THE E LOS
AN.�ELES COUNYY" TIFICATE
ELECTR CIAN
I AM THE"GAL ER O THE FTROPFRTY DESCRIB
ABOVE
OWNER
COIEC�IVS
Z
l7
`O
TOTAL
NO OF OUTLETS LTJ ffi Z J APPROVALS ,
NO OF FIXTURES ffi217— r DATE ' INSPECTOR'S NAME
NO OF MOTORSJ ` H P ! $ CONDUIT
NO OF SIGNS TRANS $ WIRING
NO OF RANGES HEATERS ffi FIXTURES
Mlsc;k.L,ANEOUS $ POWER
PERMIT FEES ffi ILITYCO NOTIFIED
TOTAL FE �' s FINA