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76A663 DBS SA 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES I C 1
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO
ELECTRICIAN R. F. Walton S 1 50 91-- 3
RECEIVED BY READY FOR DATE ISSUED
ADDRESS 5134 No Acacia St• FIRST INSPECTION
CITY San Gab. TEL No AT 68583 84411,
COUNTY LICENSE NO 1 EXPIRES BUILDING
PERMIT FEES ADDRESS 9533 Flaherty
NUMBER EACH FEE LOCALITY Temple City
LIGHT OUTLETS 13 NEAREST
RECEPTACLES 22 CROSS ST
WALL SWITCHES 18 O OWNER Meeker
TOTAL OUTLETS 5 2
3 5c $ 65 MAIL
ELEC RANGES 255 ADDRESS
ELEC HEATERS 1 25 25 CITY TEL NO
FIXTURES 13 5 65
MISC 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
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 HORSEPOWER ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
FEE
NEW MVD HP OVER INC EACH OF THE RESIDENTIAL PROP TY DESCRIBED ABOVE
4 1/2&LESS $ 25 25 SIGNATURE OF
1/2 2 50 PERMITTEE--
2 S. 1 00 INSPECTION RECORD
5 18� 1 50
15 50 2 50
50 200 5 00
200 Soo 10 oO J
500 1000 15 00 Q
Z
OVER 1000 20 00
M G SET/FREQ CHANGER HP i R
WELDERS AC KVA O
GENERATORS-KW
TRANSFORMERS KVA
TEMP MOTORS (75%OF ORIG )
MOVED MOTORS (75%OFORIG )
MISC
SIGNS
NO NO TRANS I I APPROVALS
NO NO LAMPS
FOR EACH PERMIT
DATE INSPECTOR S NAME
WIRING $1 00 1I 00 CONDUIT I - 2,
FIXTURES $1 00 1 oo WIRING Q 2-
SUPPLEMENTARY 50 FIXTURES
5 8o POWER
TOTAL FEE $ I UTILITY CO NOTIFIED
® 1 FINAL
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