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DOS.5A359 APPLICATION FOR ELECTRIC PERMIT �.
785693
DIVISION OF BUILDING AND SAFETY
Department of County Engineer � t_
County of Los Angeles BUILDING J
WM.J. FOX. COUNTY ENGINEER ADDRESS /a/ // (NL(/:�i'l' C''✓
CASSATT D. GRIFFIN. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST F
PERMIT FEES CROSS ST.
LIGHT OUTLETS
NUMBER EACH FEE ( �..
OWNER
+�
RECEPTACLES / MAIL AS' /
ADDRESS
WALL SWITCHES � ((jj
TOTAL OUTLETS r2S
g CITY; /Y"LA(i-&' `ti TEL. NO. /�.
ELEC. RANGES ELECTRIC AN �ELEC. HEATERS ADDRESS
KW EA CITY TEL.NO.
FIXTURES LICENSE NO.
y
NUMBER OF LIGHT CIRCUITS DISTRICT.
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UO. ( GROUP ZOAIE ;EADY FOR I NSPECT ION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS }
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVO. HP OVER INC. EACH /D //-Sf G O/L//�L/-_"TF G-/PO UN'D/AVG'
r15I/2 a Less s .25 2 .50 5 1.00 15 1.50
50 2.50
zoo 5.00 �//_�.f=•r,�'("�/fjyt Ba17- ALL KWI) L✓lRF-�
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M ISC.
. NeT A�iFyro Rt.F- zvSn
GtfA •SL,/ I' /707/1=7 /1/Ef1,P 44//
�i1wA1J+e'r d' �frR s�P.iF ?R/#✓r r1PP
NO.SIGNS NO.TRANS.
NO.SIGNS . NO. LAMPS LFTo -I/ -Al /A/ R,9>#ROO w
FOR EACH PERMIT' Z ,AJ 1 . (�Te L•A
MRr-
WIRING 51.00 Dat/Fllf
FIXTURES S I.00
SUPPLEMENTARY .I APPROVALS dtJtn.�-2y
TOTAL FEE DATE /1 INSPECTORS SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT tl T II
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRINGLll
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES .��1✓,�I.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL UTILITY CO. NOTIFIED
PROPERTY. l�j,
SIGNATURE
TFEE 7 �• `:/`r
FINAL T
WILLIAM J. FOX, CO NTY E4N R VALIDATION A. C.VEIT,CHIEF ELECT. INSPECTOR
X08 8 4 1 OCT 11 2 3 .4 0 In