2284NO. 5TREET LOT NO.
APPLICATION FOR ELECTRICAL PERMIT
CITY OF CUPERTINO
1 j : 2�
Date 195— Permit No. p
Fee $ 10 8S
QApplicationishereby made ,to the City of Cupertino for a permit to install electrical
wiring and/or fixtures as listed oh the reverse side hereof, and agrees to install said
v wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
v Use of Premi
Owner Address
By G7-, Address l G
/CONTRACTOR, AGENT Approved
(\ Phone: -7 7O Y -s-^`� ELECTRICAL INSPEGl01 fr
�
Size Service Conduit...-.
of Outlets.......
-NEW
.� I RP
Size Service Wires.. ... ._2--------------
Size Service Switch. "1. 2.._.Number
of Receptacles............
S. ..
Size Sub Feed Conduit
Number of Fixtures ..................
a f ..
Size Sub Feed Wires ....................
anges......-..------- KW..7.,Y----
.�
Number of Circuits .... L.�c.._.......
Oven ...2....... KW.o3.r..P...
_.�.�.....
Number of Meters.... ..._..........Signs
_........ Transformers ..................
L
2FEES
Yp
80 '�
MV�
O
I-S—a
Misc.----..- - --"----------------Dryers...... ) �'---�_.�.--------�---'..�5.
Motors .... -
............. HP .F.ts�c taraE�hase _a>. c.,.. Permit Fee $1.00
Motors .................... HP ----------_------ Phase ...............----
Motors -------------------- HP ------------ ..... Phase ......------------- H P Charge------...------- -5
TOTAL FEES—
RECORD OF INSPECTION APPROVALS
RoughWiring ...... _------- --------------------------- Fixtures ...................... ------ ---- ------------ --
OAT[ INSPECTOR .ATE INSPECTOR
Finish Wiring.....:.."-.....�.....-'.............. Motors.-----..._...----.....�---......---................
DATE INSPECTOR DATE 'INSPECTOR
Final----------- _.........-�.-.....' -- - ....--------
OAT9INSPECTOR
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