HomeMy Public PortalAbout5817 GOLDEN WEST AVE_Electrical__ DBS-5A 3.55 9 A LICATION FOR ELECTRIC ■ ERMI`l� .i
DBS-5A
DIVISION OF BUILDING AND SAFETY
Department of County Engineer /
County of Les Angeles FAODRN;� -Se /1lolerleWM.J. FOX. COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT OF BUILDING •�OCALITY /
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
NUMBER EACH I FEE
OWNER ®�
LIGHT OUTLETS '
MAIL
RECEPTACLES ADDRESS
WALL SWITCHES _
TOTAL OUTLETS _ 5¢ $ CITY TEL. NO.
ELEC. RANGES 25 ELECTRICIAN
_ELEC. HEATERS 25 ADDRESS c.
KW EA CITY TEL. 6v✓
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS - DISTRICT,NrO. GRP ON READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS I OJ�Uj I .s
.MOTORS t/ (T`
NUMBER HORSEPOWER FEE _ INSPECTION RECORD
NEW MVD. HP I OVER I INC. I EACH
I/2&LESS $ .25 _
1/2 2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
MISC.
Q
NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS
FOR EACH PERMIT:
WIRING $1.00 'I
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE $ , CLQ/ DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 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.
1HEREBY CERTIFY THAT 1 ROPERLY REEGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY OS A G ECAINTY AND STATE OF
CALIFORNIA OR THAT•I M TH L AL ER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL E
SIGNATURE UTILITY CO. NOTIFIED Fa
OF PERMITTEE FINAL ~
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR
0 4 1 0 7 MAR 14 1 .0 0 in