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DSS-SA 8.88' APPLICATION FOR ELEC ■ RIC. ■ ERMI ■ 1
DSS-SA •
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County Of LOS Angeles BUILDING ��
WM.J.FOX.COUNTY ENGINEER ADDRESS
1 Z
CASSATT D.GRIFFIN.SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
2
NUMBER EACH FEE
OWNER
LIGHT OUTLETS
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS 5¢ $ CITY TEL.NO.
ELEC.RANGES 47 25 ELECTRICIA
ELEC.HEATERS 25 ADDRE S
KW EA CITY TE
FIXTURES 7 5 LICENSE N0.
NUMBER OF LIGHT CIRCUITS - DISTRICTN. 1GROUPI ZOVE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITSY o
MOTORS w
„ NUMBER HORSEPOWER FEE IINSPECTION RECORD
NEW MVD. HP OVER INC. EACH
Ih S:LESS $ .25
2 .50
2 5 1.00
5 15 1.50
15 50 2.50
50 200' -5.00
M ISC•
N0.SIGNS NO.TRANS.
-NO.SIGNS NO.LAMPS
i• FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE g DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT' I HAVE READ THIS APPLICATION CONDUIT I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING. I,
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES .COUNTY AND STATE OF
CALIFORNIA OR THATM THE GAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIA P )PFI A ,
UTILITY CO.NOTIFIED
SIGNATURE �e�
OF PERM I J FINAL 9
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR
LACO.4 9 1 3%18 APR 10 2 6.8 0 m
76A663 CE BOR`R 10/77 APPLICATION FOR ELECTRICAL PERMIT
4: -A COUNTY 00:LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
BUILDING AND SAFETY DIVISION ADDRESS
FOR APPLICANTTO FILL IN LOCALIT
New Residential Bldgs.&Pools EACH
H NO..$ FEE CARE S7.
g
1 &2-Family,Sq.Ft. OWNER T.
Multi-family Sq.Ft.. 02 — OR
FIRM:NAME
Residential Swimming Pools 25.00 MAIL �
/ ADDRESS
Outlets:Rec Light—Sw.
First 20 .50 PLAN CHECK
Total No. Additional .30 APPLICANT
ADDRESS
Lighting Fixtures First 20 .50 CITY Tel.No.
Additional .30 PERMIT
Total No. APPLICANT
Fixed Appliances Not Over 1-HP ADDRESS
Range—Heater_D.W._ CITY Tel.No.
Oven_Dryer_W.M. LICENSE OR
Top —FAU. —W.H._ REG.NUMBER Class.
Hood_Fan _Other_ I.HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION AND STATE
Disp. — Room Air Cond. 2.50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN-
ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING.
Power Apparatus-&Large Appliances
Size&Type HP,KW,KVA,or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES C TY AND TATE OF CALIFORNIA OR THAT I AM Y
Up to 1 Incl. 2.50 THE LEGAL OWNER OF THE D RESI NTIAL PROPERTY. C
Over 1 to 10 Incl. 5.00 c.7
Over 10 to 50 Incl. 12.50 PECR'M E � C
Over 50 to 100 Inc. 25.00
Over 100 40.00 DISTRICT NO.. PKXIWD BY a
Cn
Services OL
0.200 Amp.Under 600 V 12.50 INSP OR'S
25.00 APPROVALS DATE SI ATURE
201.1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V 50.00 TEMP.POWER POLE
UNDERSLAB WORK
Temp.Power Pole&Appurtenances 10.00
Sign with One Branch Circuit- - 10.00 ROUGH CONDUIT
2.00 WIRING f/
Additional Sign Branch Circuits
Misc.Conduits&Conductors 10.00 FIXTURES
Other ISee.Complete Fee Schedule) POWERAUTHORIZED
UTILITY CO.NOTIFIED
FINAL 9—r®-7O
PERMIT FEE (Sub-Total) NOTES
PLAN CHECKING FEE (One-Fourth Permit Feel
PERMIT ISSUING FEE $7.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.-
8 8 15'too JUN
.O.-
885'tooJ1N 9 . D 9.51 0 "
SEE'SACK OF APPLICATION FOR COMPLETE SCHEDULE / may
J
B
DBS-SA 9x99 APPLICAT-ION FOR ELECTRIC PERMIT 1
.SA
DIVISION OF BUMDMG AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDING
WM.J.FOX. COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN.SUP'T OF BUILDING
LOCALITY
FOR APPLICANT TO.FILL IN NEAREST
PERMIT FEES CROSS ST.
NUMBER EACH FEE
OWNER
LIGHT OUTLETS
RECEPTACLES MAIL
ADDRESS
t
WALL SWITCHES
TOTAL OUTLETS 50. S CITY- EL.NO. `
ELEC.RANGES 25 - ELECTRICIAN
_ELEC. HEATERS 28 ADDRESS
KW EA CITY TEL.N
c FIXTURES 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS - DISTRICT O. I GiUP I 7 READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER HORSEPOWER FEE. INSPECTION RECORD
NEW MVD. HP OVER INC. EACH
�2&LESS 8 .25
2 .50
2 5 1.00
5 15 1.50
IS 50 2.50
50 1 200 5.00
M ISC
NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS r
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00 �*
SUPPLEMENTARY .SO - APPROVALS
TOTAL FEE j
v DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THAPPLICATIONION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWTING WIRING
ELECTRICAL WIRING.
1HEREBY CERTIFY THAT 1 AM PROPERLY REGID/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY OFCALIFORNIA ORTH 1AMT LEGAL. OWNER OVE POWER
DESCRIBED RESIDEN 1 L PRO
SIGNATURE UTILITY CO.NOTIFIED ��a6e.Tr.
OF PERMITTEE FINAL :r
WILLIAM J.F6.\-.'COUNTY GINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR
LlIC04 1 4 9 MAR15 • 2 1 .10 �