22277 I
1191 Crestline Dr. Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT �—
Date ...:. ................ 19r, 7 Permi# No.-------..�..Z.v.?.../---- -'---------
Thee undersigned hereb ma es app licat'on o the Elgcfric ecfor of the City of. San Jose
fore permit }o install el r,~
i a wvl s o the reverse side.
Ezemp}ion from rag ' a f r o actor's License is hereby claimed
by undersigned: s owner statement filed ❑
Undersigned attests that his State of California Contractor's License # r
is in full force and effect and pr erly aut orizes } li n
San Jose City Business Licen
I certify that in the perfor ca f e wo r which this pemi
rt i issued I shall not employ
any person In any A fo to t en=ensafion laws of California.
OWNER n
ADDRESS Y1 C `t ! DS P
USE OF BUILDING
FIRM SIGNED-VN&Lo W, - ( kvt,6
290.10
;1191 Crestline Dr. 12-2-7S/ "HO -9
ITEMIZE THE FOLLOWING New Old
Outlets ' Panels, Cabinets Size Service Conduit
Switches �7 Switchboards Size Service Wires
Receptacles (:i Panelboards Size, Service Switch 1 119V-�
Fixtures / 1 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 72) Power
Miscellaneous
Rough Inspection _ 7 By
Final Inspection By ,T,_
Remarks: