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DBS-663
SA 3.89 APPLICATION FOR ELECTRIC PERMIT
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DIVISION OF BUILDING AND SAFETY
I Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS {f Cl n1 I� a l�(iY✓I'�S
CASSATT D. GRIFFIN. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST i
PERMIT FEES CROSS ST. LL( CIn U
NUMBER EACH FEE
LIGHT OUTLETS OWNER
MAIL
RECEPTACLES ADDRESS O �/
WALL SWITCHES
TOTAL OUTLETS 5¢ S CITY TEL NO
ELEC. RANGES 25 ELECTRICIAN
_ELEC HEATERS 25 ADDRESS
KW EA CITY / / ( p TEL NO.�t i �
FIXTURES 1 LICENSE NO
NUMBER OF LIGHT CIRCUITS - DISTRICT NO. GROUP ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS �� f q_ R,/"7 Lr
MOTORS I A 7
NUMBER I HORSEPOWER I FEE INSPECTION RECORD
NEW MVD, HP OVER INC EACH
1�&LESS $ .25
1/2 2 50
2 5 100
5 15 1.50
15 50 2_50 _
50 200 500
MISC.
NO.SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT*
WIRING $1 00 l7
FIXTURES $1 00 O Cj
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE $ yV DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT /
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �7
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING l
ELECTRICAL-WIRING. • »
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDEN 1 L PROPERTY. 4
SIGNATURE (_j UTILITY CO.NOTIFIED Z .•cam _
OF PERMITTEE l9 FINAL a a
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT.INSPECTOR
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0 i 0 r: JUL 11 2 3?