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DBS85A 12.54 '�"'-F-PUC. TIO tl FO�, E����Y \�� PERMIT * 1
DIVISION OF BUILDING''AND SAFETY ` , t
Department JI-County Engineer
Coun oi.'Los Angeles
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WM.,-J. FOX, COUNTY ENGIMEER ADDRESS
CA S S ATT.D.rG RI F F I N, SUPT OF BUILDING - y h /+ '
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•FOR APP.LICANT•'TO FILL A, �r--c
IT'FEES NEAREST
PERM
CROSS ST.
_ .1,r - - -s FEE
NUMBER EACH
LIGHT OUTLETS- - OWNER
RECEPTACLES- MA I
'WALL SWITCHES
TOTAL•OUTLETS 50 S CITY • TELAO
ELEC RANGES ��Y 25 , EL-ECTRICIAN s
ELEC HEATERS - 25 ADDRESS K�
KW`EA CITY TEL N07�O
FIXTURES, 5 -v•-• ,fit` L'ICENS'E NO IX 0
NUMBER OF LIGHT CIRCUITS
DISTRIC,,T NO' GFtPUP ZONE READY ors INSPECTIOJI
NUMBER OF RECEPTACLE CIRCUITS - if �
MOTORS _3
NUMBER 'HORSEPOWER FEE \ . INSPE ION RECORD
NEW MVD HP OVER INC EACH
lck
_ I12&LESS S 25 pp 1i`
1�2 2 50 v5.t1F_IAS1�• ' J•! S..r
- 2 - 5 1 00 `i 'fir .ra�r.v .l ��A►1� dt<
5' 15 1 50
15 50 250
50 200 1 500 - -
MISC Y'
, F _
_NO SIGNS NO TRANS
NO SIGNS NO' LAMPS-
FOR EACH PERMIT -
WIRING" $1 00
FIXTURES $1 00
SUPPLEMENTARY 50
APPROVALS
TOTAL FEE I $ DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT, I HAVE READ THIS APPLICATION CONDUIT \ >1
AND STATE THAT THE'ABOVE IS CORRECT AND AGREE TO COMPLY- + �
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING S� '�LJ.�Cr _
ELECTRICAL WIRING '
• 1 HEREBY. CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES•COUNTY AND STATE OFF , POWER '
CALIFORNIA OR THAT 1 AM THE -LEGAL OWNER THE ABOVE: - q -
DESCRIBED RES]DENTI •PROPERTY. z
UTILITY CO NOTIFIED _
SIGNATURE
-OF PERMITTEE `FINAL
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WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
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BY ..
DEPUTY ,