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7GA663 DS-55A 11.49 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN ,0 r / ` 35^ 2—S-,
REC IVED BY READY FOR DATE ISSUED
ADDRESS FIRST INSPECTION
�.. 7
CITYTEL. NO. --'-"'-
COUNTY LICENSE NO. `� -EXPIRES BUILDING
PERMIT FEES ADDRESS D
FEE
NUMBER_, OUTLETS EACH LOCALITY
LIGHT Sc9 NEAREST
CRO5S ST.
RECEPTACLES 5 —0
FIXTURES s OWNER
WALL SWITCHES 5 C MAILRESS
ADD
ELEC. RANGES _25
ELEC. HEATERS 25 CITY I./ *TEL.
MISC.
NUMBER alF CIRCUITS INSTALLED: 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
TOTAL APPLICATION AND STATE THAT THE ABOVE IS CORRECT
LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING.
NUMBER HORSEPOWER FEE I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NEW MVDO
. HP VER INC. EACH ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
%Z a LESS $ .25 OF THE RESIDENTIAL PROP6iqTY DESCRIBED ABOVE.
%z 2 .50 SIGNATURE OF _
2 5 1.00 PERMITTEE,4
5 15 1.50 INSPECTION RECORD
is so 2.50
so 200 5.00
200 Soo 10.00
Soo 1000 15.00 J
OVER 1000 20.00 Z
M.Q. SET/FREQ. CHANGER-HP - a
WELDERS:AC-KVA It
GENERATORS - KW O
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% of ORIG.)
MISC.
SIGNS
TYPE: NO.TRANS.
TYPE: NO. LAMPS
APPROVALS
FOR EACH PERMIT:
DATE INSP DRIB NAME
WIRING $1.00 ✓? CONDUIT
FIXTURES $1.00 ? WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE >8� UTILITY CO. NOTIFIED
FINAL .x. .,7.0 `r.!