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7GA663 DBS 5A 3-SD APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICA T TO ALL IN DISTRICT NO. GROUP ZONE ;PERMIT NCO.
ELECTRICIAN • 0 A
RECEIVED BY READY FOR DATE ISSUED
ADDRESS FIRST INSPECTION
CITY TE ,NO. •/meq 4 /2/,
2 G
L �S
COUNTY LICENS N13. EXPIREB BUILDING
ADDRESS �+ V
PERMIT FEES
NUMBE EACH FEE LOCALITY _
LIGHT OUTLETS tjA NEAREST ,
RECEPTACLES CROSS ST.
WALL SWITCHES OWNER
TOTAL OUTLETS CAJ Sc MAIL
ELEC. RANGES Akp 25 ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIB
MIBC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIG CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWB REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSEHB THE ABOVE VALID LOS
NUNSER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEw MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY D CRISED ABOVE.
a LEBB # .25
SIGNATURE OF te ,
2 .50
PERMITTEE
7s2
5 1.00 INSPECTION RECORD
15 1.50
50 2.50
2130 5.00
200 50010.00
500 1000 15.00
OVER 1000 20.00 G• C Q
M.G. BET/FREQ. CHANGER-HP
WELDERS:AC-KVA
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF DRIG.)
MOVED MOTORB (75% OF CRIo.)
MIBC, ZD
SIGNS
NO.TRANS. APPROVALS
NO. NO. LAMPS T
DATE INSPECTOR'S NAME
jkOR' EACH PERMITS
'WIRING $1.00 CONDUIT _ n
v
FIXTURES $1.00 WIRING
SUPPLEMENTARY ,50 FIXTURES
3 POWER
TOTAL FEE ®/ UTILITY CO.NOTIFIED
FINAL -