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DBS-SA 8.55APPLICATION
sICATION 'FOR Is�L� .E-.C_T__ me. .�. C:..�PE. _ MIo qs®nEY
DIMION OF,BUII.DngG•-AND SAFETY. -
Depar"nt of County Engineer "J
Ccmnty Of Los Angelis BUILDING
WM.J.FOX COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUP'T.'OF BU.ILGING
LOCALITY
FOR APPLICANT TO.-FILL IN
PERMIT FEES NEAREST
CROSS ST. 6del Li 1'.1/1
NUMBER EACH FEE „
+• OWNER-
LIGHT OUTLETS 1;
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS 5¢ $ CITY EL.NO:
ELEC.RANGES25 ELECTRICIAN
ELEC. HEATERS 25 DDRESS
KW EA CITY TEL.NO.
FIXTURES 5 LICENSE NO.
NUMBER'OF LIG14T CIRCUITS ~
;DISTRICT NO. _GROUP ZONE READY FOR•INSPECT ION.
NUMBER OF RECEPTACLE CIRCUITS � I r
MOTORS
NUMBER :HORSEPOWER �+ INSPECTION .RECORD '
.FEE
NEW . MVD. HP OVER INC. EACH -
Y2'&LESS $
1f2 2 .50 q .
2-. $ 1.00
5 15 1.50
•15 .50 2.50 { -„9 Q
50 1 200 5.00'. W
MISC. x
f ' WO 14
NO.SIGNS NO.-TRANS. ' n
NO.SIGNS NO.LAMPS.
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE. - $ DATE INSPXQTOR',S SIGNATURE
I HEREBY ACKNOWLEDGE*THAT 1'HXVE READ THIS4 APPMdATIOH � .
CGNDU<IT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES-AND .STATE LAWS REGULATING WIRING a' l� I Cf
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS,ANGELES OUNTY AND.STATE OF
CALIFORNIA OR. THAT.I'AM THE LEGA -WHER .OF THA ABOVEPOWER
DESCRIBED RESIDENT / E TY.
SIGNATURE �/' UTILITY CO.N07IfiIED J 'O
OF PERMITTEE FINAL
WILLIAM J.FOX.COUNTY ENGINEER. VALIDATION A.C.VEIT.CHIEF.ELECT.INSPECTOR
i�o7'Q 5 3lln SEP 8 2 4.4J5 i