775 * NO—"' STTREET a LOT OfC�
4� ' , ""AA RICASL PE'RMi T
P,P�LICATION. R" EL CT
-
CI OF �PERTINO.
•"
Date , 19 _'i Permit No=
Fce $
n 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 accojdance with the provisions of the Electrical Code of the
City of Cupertino, and alr other laws applicable thereto.
v Use of Premi
c ��) _
a Owne�L 4e Address
ByIAARa. �4 t.> Address��:
CONTRAS OR, AGENT
''r _ Approved ' •-�1�--�-�
Phone: 'Z// .! S (�% �' • ELECTRICAL INSPECT03t "
! ia
d\l-,�F7`T N NEW RPL FEES
Size Service Conduit......................Num Ou-le ---------------- ---
m ----- ... - -----
Size Service Wires-------------------------Num r of sl------- ..... .It--- ----
Size Service Switch------------------------Number f'Riec les............ .....
' Ires
Size Sub Feed Conduit..................Number of l res;------------------ ----V-- ---------- ----
Size Sub Feed Wires....................Ranges...------------- KW---------- -- ---------- ---------- --------------
Number of Circuits................... Oven .............. KW------------ ---------- ---------- --------------
Number of Meters--------------------...Signs---------- Transformer ---------- ----------
Misc................................................Dryers.................. ..........
Motors-----------------.- HP-------------------- Phase.................... Permit Fee $1.00
Motors.................... HP.................... Phase--------------------
Motors.................... HP-------------------- Phase-------------------- H P Charge--------.---- -------------
TOTAL FEES
RECORDeQF INSPECTION APPR
x A ., e, $
Rough Wiring Yz� :? ;0 P
......... Fixtures
Finish Wiring, -------
ro[
DATE INSPECTOR to
A..I.- --.f Pioal's-_7
DATE