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96A683
DBS.SA 3.55 APPLICATION FOR ELECTRIC PERMIT 1
DIVISION OF BUILDING AND SAFETY
Department of County Engineer s
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY it
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSSSr. lJt --0tLa �
NUMBER EACH FEE
LIGHT OUTLETS / p OWN ER "&0J�64� ✓MA IL
�1�ILLG/---t-%/�
RECEPTACLES ADDRESS Jam,�t7 GV(AL�L(� (.C!-"
WALLSWITCHES /� /��/
TOTAL OUTLETS U S CITY - TEL.NO. i/a
ELEC. RANGES 25 ELECTRICIAN • A'7,14tit Y�
_ELEC. HEATERS 25 ADDRESS IS 3L �L �'It✓ 4,-A—
KW EA CITY L/YI TEL.NO CIS 61,10
FIXTURES C O LICENSE NO. LS O« L• I
NUMBER OF LIGHT CIRCUITS DISTRICT
✓ I GR P ZO E I aNE-norT�FOR INSPECT
PECT ION
NUMBER OF RECEPTACLE CIRCUITS !
MOTORS > 7N
NUMBER .HORSEPOWER FEE INSPECTION RECORD
NEW MVO. HP I OVER INC. I EACH
I1j B LE55 S .25
_ f1 2 .50
2 5 1.00 _
5 151.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS
FOR EACH PERMIT:
WIRING _51.00
FIXTURES 51.00 ( C1 n
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE S J I��� DATE INSPECTORS SIGNATURE
1 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 S l On
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 TVyyAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESMEIITIAL PROPERTY,SIGNATURE 11LU/ UTILITY CO. NOTIFIED
OFPERM ITTEE' -�i� / °' � �, -i_ FINAL V
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR
C " J (D F�1 0 4 5S; AUG12 2
.3 20