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DB5-5A 11-$5 APPLICATION FOR ELECTRIC PE IT
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer BUILDING
County of Los Angeles ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CAB
SATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN NEAREST
PERM FEES CROSS ST. /,,
NUMBER OWNER Ile,, �
/40 LIGHT OUTLETS pDDRES3
RECEPTACLES
WALL SWITCHES FEE CITY TEL. NO.
TOTAL OUTLETS @ 5Q $ ELECTRICI N
ELEC. RANGES 25 ��r Ott �7 0
ELEC. HEATERS 25 ADDRESS ,,
CITY V` B M/l(� TEL. NO.
KW EA STATE
FIXTURES 5 0 LICENSE NO.
MOTORS DISTRICT NO. GROUP �WEADY FOR INSPECTION
NUMBER HORSEPOWER FEI
NEW I MVD. HP OVER I INC. EACH
1h a LESS $ .25 INSPECTION RECORD
Yz 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
M 1 Sc.
NO.SIGNS NO.TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00 dfl
FIXTURES $1.00 f!
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE $ -11 ,50 DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING �.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE .� UTILITY CO.NOTIFIED
OF PERMITTEE 0 FINAL
JOHN A.LAMBIE.COUN ENGINEER )FAMATION ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR
/C Mo CASH
9 0 5 3 guy 1 2 4.5 In