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DBS-5A 3.55 " APPLICAT'ION FOR ELECTRIC PERMIT
DBS-5A -
DIVISION OF BUILDING AICD SAFETY
Department of County Engineer
Cozent-, of Los Angeles
FAIr
LDINGWM.'J. FOX, COUNTY ENGINEERRESS (OCASSATT D:GRIFFIN, SUPT OF,BUILDINGCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES_ CROSS ST.
NUMBER EACH FEE
LIGHT OUTLETS OWNER
AI
RECEPTACLES ML
- I - ADDRESS i• / 11" _�•t3"`WALL SWITCHES
SWITCHES _ /�• ...,� _
TOTAL OUTLETS n -5¢ $ "y/;'. -CITY -�r f! 5 4 TEL. NO. -
ELEC. RANGES -�`. . 25 ELECTRICIA •v �J'!
ELEC.-HEATERS - 25 ADDRE S
�. ✓
KW EA- CITY a i TEL.NO.
FIXTURES .q 5 1 0 LICENSE NO. �.�' L-•
NUMBER OF'•LIGHT CIRCUITS - DISTRIC-U4 O. I GROUP ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS 1 J
MOTORS �In
.NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD'. HP I- OVER I INC.' I EACH
dip p^I 1/2&LESS I-S. .25
...,1/2._ 2 .50 - -
2 5 1.00
5 15 1.50 -
75 50 2.50 - - - -
50 200 5.00
MISC
NO.SIGNS �NO.TRANS. '
NO.SIGNS 'NO:LAMPS _
FOR'EACH PERMIT:
WIRING - $1.00
FIXTURES - :$1.00 -
SUPPLEMENTARY, - .50 APPROVALS = _
TOTAL FEE I$ � 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
WITH ALL COUNTY,ORDINANCES AND "STATE LAWS REGULATING WIRING
ELECTRICAL WIRING.
I HEREBY CERTIFY TI4AT T AM PROPERLY. REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES.COUNTY AND.STATE OF
_ CALIFORNIA O;.,�E
ANA
I' AM T E LEGAL OWNER OF THE ABOVE POWER
DESCRIBED.RESL PR ER E_
SIGNATURE - UTIL+TY.CO.NOTIFIEDklL -' i _,S1Q•p,,.:,.--•-^"'�°
OF PERMITT �. FINAL V
WILLIAM J.FOX. COUNTY ENGINEER VALIDATION A. C.-VEIT..CHIEF ELECT. INSPECTOR
�. 65414LA my 31 . 2 6.25