HomeMy Public PortalAbout5411 CLOVERLY AVE_Electrical__ ]?MS5A 12 34 APPLICATION FOR ELECTRIC PERMIT
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DBS 6A
DIVISION OF BUILDING AND SAFETY
Department of County Engineer plammm
County of Los Angeles BUILDING
WM J FOX COUNTYYENGENdIIa EER ADDRESS ! �!
CASSATT D GRIFFIN, SUP T OF BUILDING
FOR APPLICANT TO FILL IN
LOCALITY
PERMIT FEES NEAREST
CROSS ST R�
NUMBER EACH FEE
LIGHT OUTLETS _'OWNER
RECEPTACLES T MAIL ��/// //� _.�`,
!
WALL SWITCHES ADDRESS
_
TOTAL OUTLETS _ 50 $ CITY �'��"� .�( TEL NO
ELEC RANGES 25 ELECTRICIAN
/ELEC HEATERS 25 ADDRESS J
KW EA
T CITV TEL Nca
FIXTURES / 5 O LICENSE NO
NUMBER OF LIGHT CIRCUITS
NUMBER OF RECEPTACLE CIRCUITS DISTRICT NO GROUP ZONE READY FOR IhSPc CT ION
_ C
MOTORS ✓ �Oy
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD HP OVER INC EACH
_ 1�3 LESS $ 25
1/2 2 so
2 5 1 00
5 15 1 50
15 50 250
50 200 500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $100
FIXTURES $100 �,0
(I SUPPLEMENTARY 50
APPROVALS
TOTAL FEE $ DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
D
ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING Z
ELECTRICAL WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR TH 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESID EN L PROPER Y
UTILITY CO NOTIFIED
SIGNATURE T
OF PERMIT.'E FINAL ''� 1a(�!'�� c.JC� Lti{�•`^'--^'"
WILLIAM J F X, COUNTY ENGINEER VALIDATION
J"'V 7. 7 3 i^ 'M 23 2 2-55
BY _
P
DEPUTY
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