NO PERMIT NUMBER /CSR/1719 r T,._ LOT NO.
NO. STREET
CITY OF CUPERTINO
G:^ ="A PP LICATION FOR ELECTRICAL PERMIT
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Permit No.
Date n 11 19= Fee E�
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Application is hereby made to the City of Cupertino for a permit to install electrical
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino,and all other laws applicable thereto.
use of Work To Be
Premises //II Performed
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OwnerC4,10111- �- ..Z5 x'01 Address C,42:-eltio VA)
Phone
5'If- 0 5-:C!r ' Ca.eca 3
By Address
Contractor,Agent
Phone (� (C
State License R �L ed I%-7' Approved Electr' nspector
I AGREE I WILL NOT VIOLATE ANY OF THE WORT EN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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