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DBS-.5A55 12-54 APPLICATION FOR ELECTRIC PERMIT- ],
DIVISION OF BUILDING AND SAFETY
Department of County Engineer //��
County Of LOS Angeles FADDR=ESS /7-,f,:t0 �7�WM.J. FOX. COUNTY ENGINEER `��//
CASSATT D. GRIFFIN,HUP•T OF BUILDING
FOR APPLICANT TO FILL IN LOCALITY
PERMIT FEES NEAREST
CROSS ST.
NUMEIER EACH FEE 4 �G? ....,
LIGHT OUTLETS OWNER
RECEPTACLES MAIL 1--. _ ,!• nJ, -
ADDRESSa.'r
WALL SWITCHES g� "rte"
TOTAL OUTLETS Be S sj CITY { 1 `�-_ TEL. NO.
ELEC. RANGES 25 ELECTRICIAN MCROBERTS ELF .TBJC
ELEC. HEATERS 25 ADDRESS 15006 ARROW HWY.
KW EA CITY
NO.
FIXTURES 5 ` a LICENSE
NUMBER OF LIGHT CIRCUITS
DISTRICT NO. GROUP I ZONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS:
MOTORS ��
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD, HP OVER INC. EACH
_ I/2&LESS S .25
1/2 2 .50
I 2 5 1.00
7 -
5 15 1.50
1 15 50 2.50
1 • -
50 200 5.00
misc.
NO.SIGNS NO. TRANS. -
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00 ®�
FIXTURES $1.00 60
SUPPLEMENTARY 50
��(y 7 APPROVALS
TOTAL FEE S o! / DATE INSPECTORS SIGNATURE
1HEREBY ACKNOWLEDGE THAT 'I HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING. FIXTURES —/� ✓ liter
I HEREBY CERTIFY THAT 1 AM� PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN STATE OF POWER
CALIFORNIA OR TH I AM THE LEGAL OWNER OF HE ABOVE �.-
DESCRIBED RESIDE14PROPERTY.
SIGNATUREdJ`j� UTILITY CO.NOTIFIED t, Y:. y=�I'.�L-�i• �"
OF PERMITTE 2�` FINAL
WILLIAM J. FOX, COUNTY ENGINEER VAU'4T'F� '7 Ln
� Uu1V ?� `� 3.7 Jt-
✓ - �
BY
DEPUTY