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DBS-5A 12-54 APPLICATION FOR ELECTRIC PERMIT
BS•3A
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles B U I L-D 1 NG'
WM. J. FOX, COUNTY ENGINEER ADDRESS Z&piv{
_ CASSATT D. GRIFFIN, SUPT OF BUILDING
FOR APPLICANT TO FILL-IN LOCALITY Al_ r
NEAREST
PERMIT FEES
CROSS ST
- NUMBER EACH FEE
41
LIGHT OUTLETS OWNER
RECEPTACLES - MAIL
ADDRESS
WALL SWITCHES l
TOTAL OUTLETS 50 S ,I �y� CITY TEL. NO. ,yam
ELEC RANGES 25 ELECTRICIA R� i(�'i 2_
ELEC HEATERS - 25
ADDRESS
KW EA
CITY
FIXTURES g ®
LICENSE NO. TEL. NO
NUMBER OF LIGHT CIRCUITS
NUMBER OF RECEPTACLE CIRCUITS DISTRICT GROUP ZONE I READY FOR INSPECTION
MOTORS
NUMBER HORSEPOWER FEE - INSPECTION RECORD
NEW MVD HP OVER INC EACH
&LESS $ 25
12 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 7�W
FIXTURES $100 _
SUPPLEMENTARY - .50
APPROVALS
TOTAL FEE r $ 1444
DATE INSPECTOR'S SIGNATURE -
A
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ'THIS APPLICATION CONDUIT -736 �N
AND STATE THAT THE ABOVE IS C_QkRECT AND AGREE TO COMPLY .A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERp AND/ORS FIXTURES
LICENSED AS REOUIR BY 0 .ANGELES COUNTY A D SATE —T
CALIFORNIA OR T,
A HE LEGAL OW �R� O T E A80VE POWER
DESCRIBED RESI L PR -C..
SIGNATURE UTILITY CO NOTIFIED 172 ,p
,�� /-
OF PERMITT FINAL
f /�
WILLIAM J. FOX,COUNTY ENGINEER I T MAR 2 4.0 5 m
By '�
' - - DEPUTY