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APPLICATMN FOR ELECTRIC PERMIT
SBS-5A 11-55 .
DMSION OF BUMDIIVG AND SAFETY
DepOSlment of'Camtp Engineer. BUILDING �� t
County Of Los Angeles ADDRESS t-1 s
JOHN A.LA BIR.COUNTY ENGINEER
CASSI D.GRIFFIN,SUPT OF BUILDING LOCALITY .
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES c oss sr. rJv
NUMBER I OWNER ��O'
LIGHT OUTLETS MAIL
RECEPTACLES ADDRESS
WALL SWITCHES FEE CITY TEL.N0.
TOTAL OUTLETS 5¢ $ ELECTRICIAN'
ELEC.RANGES 25
ADDRESS
ELE..C.HEATERS 25
KW,EA CITY TEL.NO.. T
STATE
- FIXTURES 5 LICENSE NO.
r-
MOTORS DISTRICT NO GROUP ZONE READY FOR IRBPEOTIOR `
NUMBER HORSEPOWER FEE J Q�-�+�/�/� _
NEW MVD. HP OVER INC. EACH. II�TSPECTION RECORD '-
1A2 2 .50
E 5 1.00
5 15 1.00
15 50 2.50
50 200 5.00
M ISC.
NO.SIGNS NO.TRANS.
NO.SIGNS: NO.LAMPS
FOR EACH PERMIT:
WIRING $1•.00
FIXTURES $1.00.
SUPPLEMENTARY .50 APpROVAI.B
TOTAL FEE $.^ V DATE INSP.,ECTOWS SIGNATURE '
I HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLICATION
AND- STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT /
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING �f J
ELECTRICAL WIRING.
I HEREBY .CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES �7
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I ABI THE L•GAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIA P 0
SIGNATURE UTILITY CO.NOTIFIED0�
OF P$RMITTEE FINAL. - y-
OHN A.LAMBIE,COUNTY ENGINEER VALIDA ARTHUR C.YKIT.CHIEF ELECT.INSPECTOR
CK ME H
L.Co6 1 7 3 MR•19 . 2 1.2 5