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APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY � ��
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICI
RECEIVED BY READY FOR DATE ISSUED
ADDRESS FIRST INSPECTION /
CITY Yf -01--1 �
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COUNTY LICENSE NO EXPIRES BUILDING �O�'0 5g 1 r 11-e IV
PERMIT FEES ADDRESS s
NUMBER EACH FEE LOCALITY Xj
e
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST
WALL SWITCHES OWNER
TOTAL OUTLETS b�j 5c
MAIL �/ t IV
ELEC RANGES 25 ADDRESS \
- _CITY
ELEC HEATERS 25 _ _ / TEL NO &O
—
FIXTURES _ 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS 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
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD HP OVER INC EACH OF THE RESIDENIAL PRO ERTY DESCRIBED ABOVE
V2 & LESS $ 25 SIGNATURE OF
I/2 2 50 PERMITTEE
V
2 s 1 DO NSPECTION RECORD
s is 1 so -_
is so 250
_ 50 200 5 00 _
_ 200 500 1131313 J
500 1000 is OD Q
Z
❑VER 1000 20 00
ED
M G SET/FREQ CHANGER-HP m
WELDERS AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS (75% OF ORIG) -
MOVED MOTORS (75% OF ORIG)
MISC
SIGNS
NO NO TRANS I APPROVALS
NO NO LAMPS
FOR EACH PERMIT DATE INSPECTOR'S-NAME
WIRING $1 00 ' CONDUIT
FIXTURES $i OO _+�V 1,/ WIRING
v
SUPPLEMENTARY s0 FIXTURES
POWER
TOTAL FEE $ n O UTILITY CO NOTIFIED /_
"f FINAL 4 j�ti' --L' y