10555 870 Feriigrove
Building Permit Confirmed
Not Required
CITY OF SAN JOSE 6 1lpf A/ BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
fG)�ilzp
'--
Date-' —1'--N.-�-`-`�.t�i---� 19-71. Perml# No.-------------`-'---------------`-------
The dersigned h b p do oytfya E rl al Inspector o{ the City of San Jose
for a permit to insf tot o I sfed on the reverse side.
Exemption from requir ent for State of California f r Confractor's Lic nse is hereby claimed
by undersigned: as owne ,G—� �fQ/y(/ �'�w�,,','v ile
Undersigned attests that his State alif6rnia/Conrec#4 or's License
3 i is in full force and effect and properly authorizes this/application. _
San Jose City Business License
1 Icertify that in the performance of the work for which this permit is issued I shall not employ
�+ + any person in any manner so as to violate the workmen's compensation laws of California.
`l OWNER TOr/ F/Sr/EQ
ADDRESS 17 0 �EIZ/✓ARD UV2 Q R ;
USE OF BUILDING ✓Gr/�E/
FIRM Cy Sr�i� �LEC�' SIGNED_, ���F,l' �
FORM 200-1012/6]1 IOM `°j
870 Ferngrove Custom Electric 7
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit 1/
Switches Switchboards Size Service Wires 2—
Receptacles Panelboards Size Service Switch
Fixtures Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers KW Sire Sub Feed Wires
Ranges KW Heaters KW—Num 6er of Circuits
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads /Lighting Power
Miscellaneous � e � �
Rough Inspection By
Final Inspection 01-13-7/ By
Remarks: