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DBS-65A 11.5[3; APPLICATION FOR ELECTRI PERMIT !,
DMSION OF BUILDING AND SAFETY
Depax out of County Engineer FB7
County of Los Angeles JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT OF BUILDING
FOR APPLICANT TO FILL IN CROSS s
PERMIT FEES T.
NUMBER OWNER
LIGHT OUTLETS MAIL /J
RECEPTACLES ADDRESS :f/ ,
WALL SWITCHES FEE CITY TEL. NO.
TOTAL OUTLETS @ 5¢ 1 7S ELECTRIC AN e
ELEC. RANGES 25 ADDRESS3 d-u-c
LEC. HEATERS 25
KW EA CITY ' TEL. NO. G
STATE
D FIXTURES 5 LICENSE NO.
MOTORS DISTRICT NO. I GR RP
READY FOR INSPECTION
NUMBER HORSEPOWER FEE 7^�/
NEW MVD. HP OVER INC. EACH
'h&LESS $ .25 INSPECTION RECORD
1h 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00 o-0
FIXTURES $1.00
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE $ V DATE INSPECTOR'S SIGNATURE
1 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 WIRING
ELECTRICAL 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 FINAL
JOHN A.LAMBIE.COUNTY-ENGINEER LIDATION ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR
CK MO CASH
1 .09 0 ) 5 4..5 L,
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