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59 APPLICATION FOR ELECTRIC PERMIT
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DIVISION OF BUILDING AND SAFETY
r Depostmeut of County EnginBUILDING
eer
ADDRESS
County of Los Angelos i!
WM.J. FOX. COUNTY ENGINEER U �V I d7 rL[E.uv-sL.L'—'
CASSATT D. GRIFFIN, SUPT OF BUILDING _
LOCALITY 117,4
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSSST.
NUMBER EACH FEE
LIGHT OUTLETS f
OWNER-
MAI L
RECEPTACLES ADDRESS .4- Q V N —' • ' `•�
WALL SWITCHES
TOTAL OUTLETS 50 S CITY TEL. NO . P
ELEC. RANGES 25 ELECTRICIAN
_ELED_.HEATERS 25 ADDRESS 09
KW EA CITY TEL.NO.
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS D ISTRICT NO. GROUP ONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS I ���/
MOTORS e
NUMBER HORSEPOWER FEE INS CTION RECORD
.NEW MVO. HP OVER INC. EACH
1/2 A LESS S .25
1/2 2 .50
2 5 1.00 _
5 IS 1.50
15 50 2.50
'S0 200 5.00
MISC.
NO.SIGNS NO..TRANS.-
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING SLOG
FIXTURES SLOO
SUPPLEMENTARY .50 APPROVALS
_ TOTAL FEE I S DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE.THAT I HAVE READ THIS APPLICATION CONDUIT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY P
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING 'tel
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 T -LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PRO
SIGNATURE rq
UTILITY CO.NOTIFIED
OF PERMITTEE FINAL iL�-r.vG/Aw�/A
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION A. C.VEIT. CHIEF ELECT. INSPECTOR
LACpO.440N SEP 21 2 2.25 0