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COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department ot County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer ELECTRIC 1
FOP. APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
S iJA
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ELECTRICIAN
RECEIVED BY READY FOR DATE ISSUED
ADDRESS
� ,�� �] FIRST INSPECTION
CITY e
o TEL NO. ,pd�
COUNTY LICENSE NO. �'�� EXPIRE- If. BUILDING—
PERMIT FEES < ADDRESS
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES GROSS ST.
WALL SWITCHES 4. OWNER
TOTAL OUTLETS Sc 9 MAIL
ELEC. RANGES 2S ADDRESS _
ELEC. HEATERS 25
CITY TEL. NO.
FIXTURES 5
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND OTATE LAWN REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSEHB THE ASOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
/2 s LESS $ .25 ,
SIGNATURE F
%2 2 .60 PERMITT
2 5 1'013 INSPECTION RECORD
5 15 1.50
15 SO 2.50
50 zoo 5.00
200 Soo 10.00 ..J
Soo ICOO 15.00 Q
Z
OVER 1000 20.00
M.G. SET/FREQ. CHANGER-HP Of
WELDERS:AC-KVA 0
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIB.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO. NO.TRANS. APPROVALS F
NO. NO.LAMPS
FOR EACH PERMIT: D fE INSPECTOR'BNAME
WIRING !$1.00 CONDUIT
FIXTURES $1.00 WIRING /:•� _2�:. ^_G.,..G-= �. .�
SUPPLEMENTARY .50
FIXTURES / / � t_�e "V 2.
,
TOTAL FEE >f/— POWERUTILITY CO.NOTIFIED
FINAL /" G��'- �)• b�J
76A663 DBS#5A 4-52