94565 1143 Ilollyheacl Lane —/
Building Permit Confirmed k�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTM _Nj
APPLICATION FOR ELECTRICAL PERMIT
Date.--/- �- ------ 19---�.� Permi# No.--- --"----------------------...-----
The and rsig ned hereby s application to fko ectricel I ecto r of the City of San Jose
fora permit to install elect ' al i / iri i o the reverse lido.
Exemption from require at C n' or ontractor's License is hereby claimed
by undersigned: a owner ❑ statement filed ❑
Undersigned attests that his State o4 or Conj{dgTor'
is in full force and effect and properly aufWs a
San Jose City Business License #
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.
OWNER (Jd/iJ t* L�/�
ADDRESS �/ �3 ZSIVL 4"t t6e#-Zz L N
USE OF BUILDING
FIRM SIGNED
FORM 280-10 (2/87) 10M
I l A Q W-1 T -h-q T,,x, Dl.RR
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Switches Switchboards Size Service Wires
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
Rough Inspection -72��—� —By �'-
Final Inspection S �a�� By
Remarks: r--
�