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7aAaa3 DRB IIA 7 51 APPLICATION FOR PEEM
DBpARTBZEN'P OF BUILDIIIiG AND SAFETY r ��������
COUNTY OF LOS ANGELES
WILLIAM i FOX. CHIEF ENGINEER
FOR APPLICANT O FI INiA
ISTR7 NO GROUP ZONE PERMIT Na
ELECTRICIAN �` 1 10
� �/ C '3563
6 R6 VED Y READY FOR DATE ISSUED
ADDRESS 5 FIRST INSPECTION —
CITY TEL.NO
COUNTY LICENSE EXPIRE. DREIN 'r
PESMIT FEES
NUMBER EACH FEE LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROS.BT
WALL SWITCHES OWNER
TOTAL OUTLETS SD MAIL
ELEC RANGES 23 ADDRESS
ELEC HEATERS 2s CITY TEL NO
FIXTURES s I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MIBC APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
NUMBER HORBEPOWER rem
ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
NEW MVD HP av— INC EACH OF THE RESIDENTIAL PROPERTY DE HIED ABOVE
YX A LEES i 25 SIGNATURE OF
yx 2 s0 r PERMITTE o
3 2 s Ica INSPECTION RECORD
s Is 1 so
1 S SC 250
613200 Sao
200 SOO 1000 j
SOD 1000 1500 Z
OVER 1000 2000
M G HET FREq CHANGER HP
WELDERS AD KVA O
GENERATORS KW
TRANSFORMERS KVA
TEMP MOTORS (76 or Cum)
MOVED MOTORS (75% Dr DRIB)
MIBC
SIGNS
NO NO TRANS.
APPROVALS
NO NO LAMPS
FOR EACH PERMIT O E INSPECTOR S NAME
WIRING $100 (� CONDUIT
FIXTURES lei 00 WIRING
SUPPLEMENTARY__ s0 FIXTURES
POWER
TOTAL FEE i UTILITY DO NOTIFIED
FINAL
5 r �
76A668 088 BA 11 BO r APPLICATION FOR PERM
DEPARTMENT OF BUILDING AND SAFETY ��
COUNTY OF LOS ANGELES
WILLIAM J FOX CHIEF ENGINEER
FOR APPUCAY TO FILL IN DIS7 NO GROUP I ZONE PERMIT NO
ELECTRICIAN • Am
• R EIVED BY READY FOR DATE ISSUED
ADDRESS FIRST INSPECTION
CITY TEL NO
OUNTY-1 KENS NO EXP R BUILDING ® -
PERMIT FEES ADDRESS
FEE �
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST MOM
RECEPTACLES �� e
WALL SWITCHES OWNER '
TOTAL OUTLETS SC S MAIL
ELEC RANGES 25 ADDRESS
ELEC HEATERS 28 CITY TEL NO
FIXTURES g 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
tMACH
OF THE RESIDENTIAL PROPERTY CRIBED ABOVE
NEW MVD HP OVER INC 1 a LESS SIGNATURE OF/2 2PERMITTElff
2 s S INSPECTION RECORD
s 1s I so
1s s0 2 s0
SO 200 S 00
200 SOO 1000
Soo 1000 1500 ioind
Z
OVER 1000 20 Ro ` � t2
M G SET/FREQ CHANGER HP 7�
WELDERS AC KVA
GENERATORS KW
TRANSFORMERS KVA
TEMP MOTORS (75 OF CRIB )
MOVED MOTORS (75%OF ORI6 )
MISC
SIGNS
NO NO TRANS APPROVALS
NO NO LAMPS
DATE INSPECTOR S NAME
FOR EACH PERMIT
CONDUIT
WIRING $1 00 .� r
FIXTURES $1 00 WIRING
SUPPLEMENTARY s0 FIXTURES t i
POWER
TOTAL FEE i UTILITY CO NOTIFIED
® FINAL
A.
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