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DS-5A 3.35 i� PLICATION FOR ELECTRIC ■ ERMIT � 1
DBS-5A
DIVISIFN'OF BUILDING AND SAFETY
D"apartment of County Engineer
County of Los Angeles rBUILDING
DDRESSWM.J. FOX. COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT OF BUILDING
OCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST. /
NUMBER EACH FEE
LIGHT OUTLETS OWNER
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS 5¢ $ CITY TEL. NO.
ELEC. RANGES 25 y ELECTRICIAN
ELEC. HEATERS 25 Y.5 ADDRESS �T Q"7TT�" �L='« ,�j s%
KW EA CITY �j/� ��////y TEL.NO.jefj I.�
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS
DISTRICT NO. GROUP J?E READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITSOL�
MOTORS L ■
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH o
I/2&LESS $ .25 _ / nel
2 5 1.00r'•
r'
_ 5 15 1.50
15 50 2.50
50 200 500 �1...��N/9 �• /ted
. N R
MISC. (°X
YLV I •D ..I1/"` /C/v
/ D �alisr//P
U,,�ryry/1 ldrP Aad
+-�
NO.SIGNS NO..TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00 0'0
FIXTURES $1.00 00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE gy� �® DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I 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. -�� >sv�/
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT V AM T#IE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL P EFFTY^
SIGNATURE UTILITY CO. NOTIFIED /�✓ .�
OF PERMIT.EF�y�c Y�. a / ,,a /
� FINAL d i1�p�� .f/!1!,yn..•�lr{.'�'e+S
WILLIAM J. FOX,.CO NTY E GINEER• VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR
MAR 15 2 5.7 � In
/6A663-CE806 5-62 APPLICATION FOR ELECTRICXL PERMIT •�
COUNTY OF-LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING ��3
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST i
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT,. TOTAL NO. EACH FEE
OUTLETS FIRST 20 /� $20 $ OWNER `
LIGHT 1j/ / MAIL
ADD'L - f0 ADDRESS
SWITCH. OVER 20
LIGHTING TOTAL FIRST 20 .20 CITY TEL. NO.
FIXTURES I-Y--I ADD'L 10 ELECTRICIAN
0 V R O
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS zm
GARB.DISP. STA.COOK
- CITY TEL.NO.
DISHWASH. AUTO.-WASH. STATE D ` �/�
SPACE HTRS. J STA.APP.('/,H.P.MAX.) .50
LICENSE NO. �/
MOTORS: OVER NOT OVER H.P. DISTRICT O, GR iJP Z NE PR ` ED BY
O 1 1.00 1:
I 3 1.50 INSPECTION RECORD
3 S 2.00
CL
8 is 2.50 D_
O
15 50 3.00 C1
50 0 100 5.00 O
F-
SIGNS: NO.TRANS - U
NO.LAMPS ,x
SERVICE 0.600V.NOT OVER 200A 1.00 Z
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
�qf z' ,
PERMIT ISSUING FEE 2.00 p` 0 YAR
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ ��
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURC/
AND STATE THAT THE-ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT ' Qt
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING --
WIRING
-_
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR r , f
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTU REB
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY POWER , R
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL �141G i
LIDATION A HUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
LAGO.7 6 3 9 NOV 3 0 2 D 7.l O N