NO PERMIT NUMBER (2) ` NO. STREET '�,W LOT NO.
'. fi�M1�> t. yi>'. f• G. Pie
'F " ,;APPGCATION`'FOR
ON
PERMIT
f CITY OF CYJPE -T
Date 196=-d Permit No. �"k
t:U . . Pee $ 1 J
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
wirii!W and/or fixtnre5 in accordance wdK the provisions of the Electrical Code of the
City of Cupertino,.,and all other laws applicable thereto.
J Use of Prernkeg
i f /
Owner ��K y '�� ��- . ' % � �-- Address
�� r /
By _�s Address f ,
CONTRACTOR, AGENT
Approved
(� Phone: ELECTRICAL INSPECTOR
4-xe
joy NEW RPL FEES
Size,Service Conduit---- X.........N,mber,o Outlets...........-._.. ....
. -----------IV ----
Size Service Wires----------------------- Tumbe of Switches..._...._..... . 0
------ ---------- --------------
Size Service Switch..... of Receptacles............ ... . .......... :9_j1e.....
Size Sub Feed Conduit..................Number of Fixtures.. - ---- ---------- -----------
Size Sub Feed Wires._-..............Ranges....... ....... .KW..----:----..... .....----- ----- ---
../ .
Number of Circuits................... Oven .. ........ KW.............. .......... ...... --- ---
Number of Meters........................Signs.......... Transformers.......- ---------- ---------- --------
Misc-----_------ ..............................Dryers---! --
--------------------- ----------- - ------- ..
. ....... ......7
Motors......_...----...... HP........._----...-. Phase------:....---.... Permit Fee $1.00
Motors........-.......... HP........ --_------- Phase---_---------------
-0
Motors......................... HP..... -------- Phase-------------------- H P Charge---------------I
harge---------------- - '- ---
TOTAL
5,:---------
TOTAL FEES
RECORD- OF INSPECTION APP�OVALS�I
is.:...
Rough Wiring................ ........... Fixtures --------- ------- -------
'ATE'
INSVE C'OR D /'INiPECTO R
AnY
Finish Wiring ........ ............. otors ......
DATE INSPECTOR DATE' I INSPCCTOR,
Final .......................... ......�1......-`-----
DATE
.......DATE INSPECTOR
ELECTRIC' SE T�ENOTICE OFFICE
COPY
BUILDING IN ECTOR'S OFFICE
3 ,
CITY CUPERTINO
-----------------------X711-11
.................................. l96/..
To
You are hereby authofizt connect th�ELEGTRIC service for
Owner or Tenant ---
At--------le
----------------......
. ....................................................................... ----
N9. ... Size of Wires...........
-------------- Size of Switch
1
•
MotorLoad -------------------- Voltage ................................ Phase....................................
Heating.;Load ....................... K. W. -............................
---- Voltage ..... ..........................
No. of Meters ...../.......... Ligfitt 110 .4-�........New Service...4�----_.Reconnect ........-----
Heat .... ....220 . ........Three Wire ..................More Service ..........
No. of Add. Meters .......... Power ------------- --------------,-Move Meter ............
.Fl -
. . ........ .............1� ..........................................
104 1/60--500 IiLECTRICAL INSPECTOR