70433 1142 Derbyshire Drive
Building Permit Confirm*Q'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR QELECTRr PERMIT
Date !_L ---------------� ------- 19.7 Permit No-----7��-23-----------------
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 t[j statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
`. San Jose City Business License #
I certify that inthk porformance of the work for which this permit is issued I shall not employ
,any person )) _
OWNER
ADDRESS
USE OF BUILDING `CH4 ll
FIRM l") 7t 77/ SIGNED
280-201n '
1.142 Derbyshire. D;7. HQ 1
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Switches /� /j Switchboards Size Service Wires
ReceptaclesPanelboards Size Service Switch 7G0
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 LoadsLighting Power
Miscellaneous
Rough Inspection III _ By
Final Inspection �j� - 'd
Remarks: 7 //- By
Yr tFial2r
280-201n