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COUNTY OF LOS ANGELES - APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER ELECTRIC � 1
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOB, COUNTY ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO
ELECTRICIAN l/
/3 y®
RECEIVED BY READY FOR, _ DATE ISSUED
ADDRESS -' FIRST INSPECTION
CITY T2 NO 5 ^�j y �y +- iI►��
COUNTY LICENSE NO EXPIRES �_� BURaIISIG v
PERM FEES
FEE
NUMBER EACH LOCALITY ,
LIGHT_OUTLETS NEAREST V/[1�
RECEPTACLES S
WALL SWITCHES OWNER
TOTAL OUTLETS 5C $ MAIL
ELEC RANGES 25 ADDRESS
ELEC HEATERS 25,
FIXTURES 5 CITY TEL NO
MISC I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE-TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBBR HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD 'HP OVER INC EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE TM
I/2&LESS $ 25
SIGNATURE OF I ,
I/2 2 50 PERMITTEFE
2 5 10o INSPECTION PJRD
5 15 1 50 ,z �,y'�/�
15 SO 2 50 /111 Al/ U��-7ZL
50 200 5 00 -
200- 500 10 00
Soo 1000 18 00 _
OVER 1000 20 00
M G SET/FREQ CHANGER-HP _ Ir _
�WELDERS AC-KVA , °
GENERATORS KW
TRANSFORMERS-KVA
TEMP MOTORS (75% OF ORIG
MOVED,MOTORS (75% OF ORIG ) l L
MISC %
SIGNS
w
NO NO TRANS - APPROVAL
NO NO LAM w���p ��
FOR EACH PERMIT ^ � V`4"cUfE INSPECTOOR'S NAME
WIRING $1 00 F✓� CONDUIT /
FIXTURES $1 00 WIRING
SUPPLEMENTARY 50 FIXTURES
POWER
TOTAL FEE $ 9 7T UTILITY,CO NOTIFIED
/
FINAL
76A 669 DBS# SA 4-62