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DBS-SA 12-54 _ APPLICATION FOR ELECTRIC PERMIT ],
BS-SA
OF BUILDING AND SAFETY
Department of County Engineer ,,//
County of Los Angeles BUILDING g
EER
' WM.J. FOX. COUNTY ENGINADDRESS (p ®1r
CASSATT D.GRIFFIN.SUR•T OF BUILDING
FOR APPLICANT TO FILL IN LOCALITY
PERMIT FEES NEAREST
CROSS ST.
HNUMBER EACH FEE
LIGHT OUTLETS OWNER
RECEPTACLES MAIL ADDRESS
' WALL SWITCHES ® •
TOTAL OUTLETS 50 5 CITY TEL.NO.
1 01
ELEC. RANGES 25 ELECTRICIAN• tr
ELEC.HEATERS 25 _ ADDRESS a 8�
KW EA �-- J CITY '�j��J p/� TEL. NO/Cd-
FIXTURES D LICENSE NO.
NUMBER OF LIGHT CIRCUITS
NUMBER OF RECEPTACLE CIRCUITS DISTRICT NO. I GROUP ZONE I READY FOR INSPECTION
MOTORS
NUMBER HORSEPOWERFEE INSPECTION RECORD
NEW MVD. HP OVER INC. EACH
_ ]fl&LESS $ .25 .
ift 2
2 5 1.00
5 15 1.50 -/7'rr J;?.% r Re
15 50 2.50 �hT lt• .f _
50 200 3.00
r. MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00 �p®
FIXTURES. $1.00 T - -
SUPPLEMENTARY •50
APPROVALS
TOTAL FEE $ 9 DATE. INSPECTOR SSIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -.
WITH .ALL .COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING. •_f 7 I
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES .COUNTY AND STATE OF POWER.
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PR ERTY,
UTILITY CO.NOTIFIED.T -,C. J
SIGNATURE
OF PERMITTEE V F*IINN7A�RL] UIY�m� �q p1
WILLIAM J.FOX,COUNTY ENGINEER V W+�/ �S n JM 14 p 2 ,9 5 �
.13Y
® DEPUTY -
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