13696 5825 Bollinger Rd.
Building Permit Confirmed ❑
Not Required 14-K
CITY OF SAN JOSE 1 ,2e - > Z BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT /
Date --- -- - -.................... 19�..,Perrnit No. ' L3.l°-g -' - -=
The undersigned hereby makes application to the Electrical Inspector of the City of San Jose
for a permit to install electrical fixtures and/or wiring as listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California,Contractor's License # 150063 C.-10
is in full force and effect and properly authorizes t is application.
San Jose City Business License # 42'DD-
I certify that in the performance of the work for which this permitisissued I shall not employ
any person in any manner so as to violate ff�/a workmen's compensation laws of California.
OWNERi Cy
ADDRESS
USE OF BUILDING
FIRMA �►1 -i.��SIGNED
"✓VVV✓✓ - U�
200-10' q
5825 Bollinger Rd. Butcher
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Switches Switchboards Size Service Wires 6
Receptacles _Panelboards Size Service Switch
Fixtures Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers KW Size Sub Feed Wires
Ranges KW Heaters KW Number of Circuits _
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads Lighting Power
Miscellaneous yu_ 6��. �`,��
Rough Inspection By'
Y
Final Inspection / . /oF Z By
Remarks: