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DBS-SA 12.64APPLICATION. pgR ELECTRIC PE RMI-T .7i..-.
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County .of Los Angeles BUILDING p�o
WM.J. FOX. COUNTY ENGINEER ADDRESS •�O',��5 /d/ly /"///ti+����
CASSATT D.GRIFFIN.SUPT OF BUII:D..a
FOR APPLICANT TO FILL IN LocALlry
PERMIT FEES NEAREST
CROSSST.
NUMBER EACH FEE
LIGHT OUTLETS OWNER ( . (f/GL,{y,
RECEPTACLES AAUL
DDRESS
WALL SWITCHES
TOTAL OUTLETS 5.4 S _ CITY TEL. NO.
ELEC. RANGES 25 ELECTRICIAN C /;' o,/
ELEC.HEATERS 25 ADDRESS—fV 40
KW EA CITY TEL. NOA
FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS
DISTRICT O. I GR I ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS "
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH ,
V1&LESS $ :25
Y2 2 .50
2 5 1.00
5 18 1.50
15 50 2.50
50200 5.00
MISC.
` .,
NO..SIGNS NO.TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING
_81.00
FIXTURES $1,00
SUPPLEMENTARY 50
APPROVALS
TOTAL FEE $ f .3 Q/ DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ^A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AN.THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PR FE
SIGNATURE Y UTILITY CO.NOTIFIED. Z
OF PERMITTEE FINALfil 95
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION `
falZ1g`� DEC2? 2 1o30 m
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