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DBS-SA 12.54 gRpLICATION . FOR ELECTRIC PERMIT 1
DBS-
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer '
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS 6/ _ • W
CASSATT D.GRIFFIN.SUP'T OF BUILDING J� B
FOR APPLICANT TO FILL IN LOCALITY
PERMIT FEES NEAREST
FEE CROSS ST'.
MBER
NUJ EACH
LIGHT OUTLETS 7 OWNER
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS 5o $ a7 74 CITY TEL.NO.
ELEC. RANGES 25 JF
ELECTRICIAN
ELEC.HEATERS 25
• ADDRESS o-
KW EA
CITY TE
FIXTURES ::L, 5 LICENSE NO.
NUMBER OF LIGHT CIRCUITS
NUMBER OF RECEPTACLE CIRCUITS DISTRICT NO. I GROUP I ZO�NI READY FOR INSPECTION
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW 'MVD. HP OVER INC. EACH '
8 LESS $ .25
T 1� 2 .50
_ 2 5 1.00
5 15 1.50
15 50 2.50 Li B < / ��t"•
50 200 5.00 Al Ate
AWP
MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO.LAMPS
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00 _� d
SUPPLEMENTARY ,50
APPROVALS
TOTAL FEE $ DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT akk MC 7-Z4-AND
STATE
ALL• COUNTY HORDINANCESE ABOVE 15 CAND STATE CT D LAWS TO COMPLY
WITH REGULATING WIRING xa
ELECTRICAL WIRING. T�
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI PROPERY
SIGNATURE . UTILITY CO.NOTIFIED In'//p���) /�//®
OF PERMITTEE �+l ,:' 6A " FINAL � t� P 4 '�1 1 0
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
'AC,,,:' 9 4. 012 14AY 19 2 6.35 m
BY
® l DEPUTY/
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