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54978 1128 Derbyshire f r Building Permif Confirmed Not Required ❑' CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR ELECTRICAY PERMIT . �y / � 7r .. . 19 �ermrt No.Date.. ........ The undersigned hereby kes ap licefion the tricel ector of the City of San Jose for a permit to install M. c f' it ist o the reverse side. Exemption from requir a rn f ractor's License is hereby claimed Q J by undersigned: owner O statement filed �p 33 23 fl// Undersigned attests that his Stale of California Contractor's License is in full force and affec nd r erly out raeess�thi�s(epelicetiggx_ San Jose Cily Busi s e # {�3`� r'o�^W "'rfri� �� I certify that in th pa soca o the Lich p6rmi is issued I shall not employ any person in any manner so as to violate the workmen's compdFsation laws of California. OWNER Rx ISi110A ADDRESS 28 e b S J ® - r USE OF BUILDING �y, CYSt/d�doy�//'AL FIRIVI /— . /�N/. SIGNED 2 -201n� I 1128 Derbyshire R ,.. " del-mar ITEMIZE THE FOLLOWING New Old Ouflefs rG Panels, Cabinets Size Service Conduit Switches 7 Switchboards Size Service Wires `p2- Receptacles Panelboards Size Service Switch X00 Fixtures Festoon Lamps Size Sub Feed Conduit -. Mercury Lamps Dryees KW Size Sub Feed Wires _ Ranges KW Heaters KW Number of Circuits _ Signs Transformers Motors Number of Meters HP Phase Ampere Loads 8_ZLighfing Power Miscellaneous Rough Inspection _ -!P-/ P -�7 7 7 - Final Inspection B Remarks: 8-.5• ) 7 S£lAloe� s:' // )� �� 12-/q-77SEi 280-201n