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DBS-SA 11.54 APPLICATION IO9V FOR ELECTRIC PERMIT
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
. County of Los Angeles BUILDING
WM.J. FOX,.COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN.SUPT OF BUILDING Or
FOR APPLI.CA.NT TO FILL IN LOCALITY .2911y/ddr C�.,
PERMIT FEES hEARE
ST
CROSS ST. �,¢�!>t�/�j✓•-,9-yr
NU EACH FEE �I� p� ,
LIGHT OUTLETSAwl _OWNER /'S. LE of AAIA
RECEPTACLES MAIL 99, 6
• ADDRESS Ro G• O
WALL SWITCHES A
TOTAL OUTLETS 5$ S !� CITY TEL NO..
ELEC. RANGES 29 -ELECTRICIAN . ed.
ELEC.HEATERS 25 ADDRESS �3
KW EA CITY % r TEL. NO.�
FIXTURES 5
LICENSE NO.
NUMBER OF LIGHT CIRCUITS
NUMBER OF IRCUITS
DISTRICT NO. GROUP ZONE READY FOR INSPECTION
• RECEPTACLE C � •I � e � ..,•
MOTORS -
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH _
Y2 a LESS $ .25
Yt 2 .50
2 5 1.00
5 15 1.50
15 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 gp
®� APPROVALS
TOTAL FEE $ DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1'HAVE READ THIS APPLICATION y CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
t. WITH ALL COUNTY ORDINANCES AND, STATE LAWS REGULATING WIRING
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
CALIF
LICENSED. AS REQUIRED. BY LOS ANGELES COUNTY AND STATE OF
CALIF .I
ORNIA OR THAT 1 AM THE L 0 ER OF THE ABOVE POWER
DESCRIBED RESIDENTIA�LLVOgRTY a UTILITY CO.NOTIFIED.
SIGNATURE
OF PERMITTEE FINAL
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
Q
.�� BY '10T
DEPUTY
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DRS-9A 12-54 APPLICATION FOR ELECTRIC ISEAISIT
BS.
a DIVISION OF BUILDING AND SAFETY
Department of County Engineer r� t
County of Los Angeles BUILDING
WM.J.FOX, COUNTY ENGINEER ADDRESS
CA98ATT D.GRIFFIN,SUp•T OF BUILDING A
FOR APPLICANT TO FILL IN LOCALITY P
PERMIT FEES NEAREST
CROSS ST. JI/�
NU BER EACH FEE
LIGHT OUTLETS OWNER AlARE
° RECEPTACLES MAIL
h ADDRESS
WALL SWITCHES
TOTAL OUTLETS 5o S CITY TEL.NO.
ELEC. RANGES 25 ELECTRICIAN
l ELEC. HEATERS 25 ADDRESS 67 ,
KW EA
J CITY TEL. NO. O
FIXTURES. 5 LICENSE NO.
Ar Ae
NUMBER OF LIGHT CIRCUITS' , T
DISTRICT NO. ~I GROUP I ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS RI
MOTORS �^
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH.
• ]�tk LESS S .25 .
1fl 2 .50
2 5 1.00
5 15 1.50
15. 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $4.00
SUPPLEMENTARY 50
APPROVALS
TOTAL FEE $ g DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATI N CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND. AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING L Sit ,�✓�.� _.__.�
ELECTRICAL WIRING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ND 0 FIXTURES
LICENSED AS REQUIRED BY ANGELES CO Y. N TAT F r
CALIFORNIA OR THAT I HE- LEGAL N H I POWER
DESCRIBED REST TIAL P ERTY.•
+ UTILITY CO.NOTIFIED
SIGNATURE
OF PERMI'rr L U
nk
simm-
y.
WILLIAM J:F COUNTY ENGINEER VALIDATI®N
. - •• . 345 M.
. 0°s, 2'1 01S. l 3�. : a