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COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER ELECTRIC 1
DIVISION OF BUILDING&SAFETY
WI LIAM J. FOX COUNTY ENGINEER
FOR APPLICANT TO FILL INDISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN 5 r � / /D
r
RECEIVED By READY FOR DATE ISSUED
ADDRESS A& FIRST INSPECTION / F- �,.
CITY EL•. O. p 6C�
COUNTY LICENLe SE NO. - epX2-EXPIRE r7"�✓� BUILDING V` 9
PERMIT 6
ADDRESS
A PL
NUMBER EACH FEE
LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS ST.
WALL SWITCHES OWNER •a
TOTAL OUTLETS Sc
MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25
FIXTURES 5 CITY TEL. NO.
M18C. r- 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
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 FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
11EW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROP�RDESC IBED ABOVE.
V.a LESS $ 25 SIGNATURE OF
V2 2 .50 PERMITTE
2 s 1.00 SPECTiON REC
S 15 1.50
15 so 2.50
so 200 5.00
200 soo 10.00 J
Soo 1000 15.00 a
Z
OVER 1000 20.00 (;
M.G. SET/FREQ. CHANGER-HP O
WELDERS: AC-KVA
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OP DRIG.)
MOVED MOTORS (78% OF ORIG.)
MISC.
SIGNS
NO. NO. TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 06 CONDUIT R
/
FIXTURES WIRING
L
SUPPLEMENTARY 5O FIXTURES
j POWER `I
TOTAL FEE $ /df� UTILITY CO. NOTIFIED /l l`c� tJ
//11 ,� FINAL •� w 's
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