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5A 12 54 APPLICATION FOR ELECTRIC PERMIT 1
A DIVISION OF BUILDING AND SAFETY
Department of County >Enff�
1 County of i.as Angel' BUILDING f'' /J
WM J FOX COUNTY ENGINEER ADDRESS ✓ �J
CASGATT D GRIFFIN BUF T OF BUILDING
FOR APPLICANT TO FILL IN LOCALITY
PERM FEES NEAREST
CROSS BT
NUMBER EACH PEE
LIGHT OUTLETS OWNER J
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS B# f CITY TEL NO 1
ELEC RANGES 25 ELECTRICIAN
ELEC HEATERS 25 ADDRESS Y A/
NW EA CITY TEL NO
XTURES B LICENSE NO
UMBER OF LIGHT CIRCUITS ra
DISTRaICT NO GROLIP N ( RE.°Y FOR INSFECT10x
LIMPER F EFTA I B Vr III
MOTORS
NUMSER HORSEPOWER PEE INSPECTION RECORD
NWN MVD HP OVGR INC GCH
&R L[°a • 25
2 50
2 S 1 00
B IIS i eo
_
III __50 260
BO 200 Soo
MISC
NO SIGNS NO TRANS
O SIGNS NO LAMPS _
OR EACH PERMIT
WIRING $100
FIXTURES 1111 00
SUPPLEMENTARY BO _
J^ APPROVALS
TOTAL FEE 5 'DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICEN BED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT 1 AM TH LQGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPE
UTILITY CO NOTIFIED
SIGNATURE
PERM
I
OF PERMITTEE ic FINAL 11 $C—
WILLIAM J FOX.COUNTY ENGINRMR VALIDA Z Z S
BY
DEPUTY -
® /l�
COUNTY OF LDS ANGELES APPLICATION FOR PERMIT
Department of County Engfneer p n
'DIVISION OF BUILDING & SAFETY ELECTRIC�Tit�C 1
WILLIAM J roll. Ceuuty re[l.w
FOR APPLICANT TO FILL IN OIEITRICCTT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN
RECEIVED READY FOR DAT[ IW[D
ADDRESS IIRRTINBP[CTION
COUNTYLIO[NBr M BUILDING
PERMIT
ERMIT FEES
ADOR[pp j
f�Ywi• rcr
NUMBER EAGH LOCALITY
LIGHT OUTLETS rZ I NEAREST
RFCEPTACL[B CROSS ST
WALL SWITCHES OWNER
TOTAL OuTLrTB Sc MAIL
FLED. RANGES YB ADDRESS
[LER HEATERS EE
>td CITY TEL NO
rIXTURES •
I HEREBY ACKNOWLEDGE THAT 1 NAV[ READ THIB
MI APPLICATION AND STAT[ THAT THE ABOVE IB CORRECT
NUMBER Or LIGHT CIRCUITS AND AGREE To COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Or RECEPTACLE CIRCUITS AND STAT[ LAWS R[OULATING ELECTRICAL WIRIMS
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
Nur R HORSCPOWER RE ANGELES COUNTY LICENSE. OR I AM THE LEGAL CWNER
N[W ww HP OVE[ INR EMr Or TH[ RESIDENTIAL PROPERTY DESCRIBED ABOVE
• S s 10 EB 81ONATURE Or
V. R BO PERMITT
9 B , DD INSPECTION RECORD
6 15 1 30
TB BO FSO A P, ji
Bo ZOO BOO
700 Sao 10001
J
BDo IDCO to Do Z
OVER 1000 20=10
_MOV[O MOTORp (T6 or GRIR)
M al aWMM CHANGER-HP O
WELDERSI AC-KVA
GENERATORS - KW
TNANvrORMKRS - KVA
MISC
SIGNS
NO NO LLAA
NO NO MPN APPROVALS
rap EACH PERMITS DAT[ INUPCCTORIG NAME
WIRING 1.00 o-0 CONDUIT
OrIXTURES •1 CO WIRING
ANUPPLEMENTARY BD FIXTURES
O D POWER
TOTAL FEE • ,uTI LITT CO MOTlrlco Q 5�
� FINAL S .
t;�b 11-53