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DBS 5A 9 55 APPLICATION FOR tLECTRIC PERMIT
DIVISION OF BUILDING AND SAFETY �-
Department of County Engineer
BUILDING
County of Los Angeles ADDRESS
WM J FOX. COUNTY ENGINEER f
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST J
PERMIT FEES CROSS ST AM
NUMBER EACH FEE s�
OWNER
LIGHT OUTLETS
MAIL
RECEPTACLES ADDRESS
WALL SW ITCHES
TOTAL OUTLETS 5¢ S CITY TEL NO
ELEC RANGES 25 ELECTRICIAN
ELEC HEATERS 25 ADDRESS
KW EA CIT' h TEL N
FIXTURES 5 LICENSE NO f
NUMBER OF LIGHT CIRCUITS
- DISTRICT NO GR24JP I ZO WE( READY FOR INSPECT IOR
NUMBER OF RECEPTACLE CIRCUITS I % I l
MOTORS -1 -
NUMBER I HORSEPOWER FEE INSPECTION RECORD
NEW MVD HP OVER INC EACH
I12&LESS S 25
Ifi 2 50
2 5 1 00
5 15 1 50
1550 2 50 y
50 200 Boo
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $1 00 a
FIXTURES $1 00
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE S DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES C ,UNTY AND STATE OF
CALIFORNIA OR THAT 1 E L AL NER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PER Y. UTILITY CO NOTIFIED -r%.?
SIGNATURE
OF PERMITTEE
FINAL
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION A.C.VEIT,CHIEF ELECT. INSPECTOR
�AP0 8 4 7 JUL 2 3 2 1 .2 5 �'
I� a COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER ELECTRIC 1
DIVISION OF BUILDING IS SAFETY
WILLIAM J. FOX, COUNTY ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO.
ELECTRICIAN
RECEIVED BY READY FOR DATE/ ISSUED
ADDRESS _ FIRST INSPECTION
' !ITYTEL NO
I7UNTY LICENSE NOEXPIRES / �'f`4 BUILDING\)
PERMIT FEES ADDRESS
�tl�i� �•�_�
I FEE NUMBER EACH LOCALITY
tLIGHT OUTLETS NEAREST
/RECEPTACLES 9 CROSS T
)WALL SWITCHES OWNERT-
TOTAL OUTLETS , J 5C $ MAIL
ELEC RANGES 25 ADDRESS
ELEC -HEATERS 25
FIXTURES 5 J CITY TEL NO
MISC I HEREBY ACKNOWLEDGE THAT 1 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 I POSSESS THE ABOVE, VALID LOS
- NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
New MVD HP OVER INC EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
1/2 a LESS $ 25 SIGNATURE OF
I/2 2 50 PERMME57
2' 5 1 00 . INSPECTION RECORD
5 1s 1 so
is 50 2 50
50 200 5 00
200 500 1000 J
500 1000 15 00 Q `
Z
OVER 1000 20 00 0
M G SET/FREQ CHANGER-HP _ Ix
WELDERS AC-KVA
GENERATORS -KW '
TRANSFORMERS-KVA
TEMP MOTORS (75% OF ORIG I
MOVED MOTORS (75% OF ORIG I '
MISC
�v SIGNS
NO NO TRANS APPROVALS
NO NO LAMPS
FOR EACH PERMIT DATE INSPECTOR'S NAME
WIRING $1 00 CONDUIT
FIXTURES $1 00 O WIRING
SUPPLEMENTARY 50 FIXTURES
POWER
r TOTAL FEE $ �� UTILITY CO NOTIFIED ie
FINAL
L-76A-689_DHB#—EA 4_E y