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D85-SA 3 55 APPLICATION PLIVTION FOR ELECTRIC PERMIT �.
DIVISION OF BUILDING AND SAFETY -
Deportment of County Engineer
County of Los Angeles BUILDING LL''J? �}�-.�I
WM.J. FOX, COUNTY ENGINEER ADDRESS ✓ � � O /—YR / yS
CASSATT D GRIFFIN, SUPT OF BUILDING '
LOCALITY ZG_WIIAIC-
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST ' V
(NUMBER EACH FEE
OWNER Ja 77 S I,:l
LIGHT OUTLETS
a MAIL `
RECEPTACLES ADDRESS Q Ci
WALL SWITCHES r f L_
TOTAL OUTLETS 5¢ S (ij r CITY /e ''W9�Ioi. 'C:T✓ TEL NO
ELEC RANGES 25 ELECTRICIAN
_ELEC HEATERS 25 ADDRESS `
KW EA , CITY NO
FIXTURES .i 5J� LICENSE NO
NUMBER OF LIGHT CIRCUITS I - DISTRICT NO I GROUP I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS r
MOTORS _
NUMBER HORSEPOWER INSPECTION RECORD
FEE
NEW MVD HP OVER INC EACH
lh&LESS $ 25 � `J(� 'iiC 'g -1J t�T-ty7. CbAt,QL,--
1h 2 50
2 5 1 00
5 15 1 50
15 50 250
50 200 Boo
MISC
NO SIGNS NO TRANS -
NO SIGNS NO LAMPS
FOR EACH PERMIT -
WIRING $t 00 L7 C
FIXTURES S1 00 On
SUPPLEMENTARY 50 APPROVALS
TOTAL'FEE 4I /�D DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUITAND I
LY
WITH ALL COUNTYTHAT HE ABOVE ORDINANCE LAND CSTATED LAWS TO REGULATING WIRING Ai Z �� �.lf.,.Qcl)�t4e-•�+• -
ELECTRICAL WIRING oo
I HEREBY CERTIFY THA' 1 M PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED Y S ANGELES CO TY AND ST TE OF -
CALIFORNIA OR THAT 1" A THE LEGA O ER T ABOVE POWER
DESCRIBED RESIDENTI L PR ER
SIGNATURE UTILITY CO NOTIFIED /
OF PERMITTEE FINAL S 3I S�
WILLIAM J. FOX, C6UNTy ENGINEER MVJ=ATION A. C.VEIT,CHIEF ELECT. INSPECTOR
k �,AC0 3 6 6 7 U MAR 2 2 2.8 0 �'
DBS-5A
12.54
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DAPPLICATION LICATION F®R ELECTRIC PERMIT ,
],
DBS-SA
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING
WM J FOX. COUNTY.ENGINEER ADDRESS 2 �y'�� /Y♦ -�/ /L AT�
CASSATT D. GRIFFIN, SUP T OF BUILDING
FOR APPLICANT TO FILL IN LOCALITY
"
PERMIT FEES __CROSS s
FEE
NUMBER EACH
OWNER
LIGHT OUTLETS
/T
RECEPTACLES MAIL `
ADDRESS
WALL SWITCHES
TOTAL OUTLETS _5_Q_ $ CITY TEL NO
ELEC RANGES 25_ ELECTRICIAN
pp _e_A
ELEC HEATERS 25 ADDRESS X 7p- 7 ��`//��" -
KW EA - CITY J i�C'C".+._^f�/? v TEL No
FIXTURES 5 �n 9476 F
LICENSE NO I .e
NUMBER OF LIGHT CIRCUITS DISTRICTN GROU ( Z I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS I I
MOTORS h
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD HP OVER INC EACH
_ 111&LESS $ 25
1/2 2 50
2 5 1 00
5 - 15 1 50 -
15 50 2 50
50 200 Soo
MISC _ r,
NO SIGNS NO-TRANS -
NO SIGNS 'NO LAMPS ,
FOR EACH PERMIT
WIRING $100
FIXTURES $1 00
-SUPPLEMENTARY 50 -
a� APPROVALS
TOTAL FEE $ DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS'APPLICATION CONDUIT '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYJ�—
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING
II
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTI L PROPERTY _
SIGNATURE i� UTILITYCO NOTIFIED l!/� S �1
OF PERMITTEE FINAL - Y
WILLIAM J. FOX, COUNTY ENGI i ER VALIDATION 1.
w _ ,7 0 u 3 ' 2
UTY