2492 NO:, TREGTjr LOT NO.
L. r4 Yft 1R
Gc\
x n PP,LICA� I,ON FOR ELECTRICAL PERMIT
o"Q CI L SOF CUPERTINO
Date — �` �— ^__ •,_19 Permit No. V
Oa 1^ Fee
a Application is hereby made'to the City of Cupertino for a permit to install electrical
w i 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
m -City of Cupertino,'
3 and all other laws applicable thereto.
03
oa
z_j Use of Premises '
J Z
J o �d N 1V �t N H 7 I � Address �0� /3 AJ4111Z( ty A
3 Owner
W w� By , ¢ A^ ^ldx GR (3<znLQZ _ Address g5 G UtA7 vla- '
Q0 ,PL CONTRACTOR, AGENT A _.
—U - Phonev'�7 PPCOVed ELECTRICAL rrrsrEctw
p S"Matte License:
A
0
r WE 0
It I e tyy E RPL FEES
J(...... 0
Size Service Conduit................_.:.Number of 0
Size Service Wires -.....Number of --- --------- -w.c-.)
,jac -------- I
pr
Size Service Switch -------Number of Receptacles.---...-.... 1-h------------
-----------------
G CI
size Sub Feed Conduit.............__.Number of Fixtures_......_..::... ---------- --- ----------
Size Sub Feed Wires-------------------Ranges:.r............. KW.....------ -- ----------- -------- . ..............
Numberof Circuits_--... .......... Oven ------------- KW------------- ---------- ---------- --------------
Number of meters........................Signs.......... Transformers--------1- ------- --------- -- ----- --------------
Misc....------- --------------------------------Dryers...--------------------------------- --- -------- ...
Motors----- -------------- HP----------------- -- Phase-------------------- Permit Fee $1.00
Motors-------------------- HP ..
-------------------- Phase....... ...........
Motors-------------------- HP------------------- Phase -------- -------- H P Charge----- ....._....
TOTAL
harge- --------------
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring---------------- ---------------------------- Fixtures ------------t---------- -------- ----
DATE INSPECTORDAT 5 INSPECTOR
....f Motors ................ ----------------------------
Finish Wiring
DATE INSPECTOR
Final ...1;1--no....
19 71NSPECTOR