959 bs 1 Or, WV1 Lt_1:E-- . :
NO. SHEET -LOT NO.
OR ELECTRICAL PERMIT
C _OF CUPERTINO
FEB 196E p
Date T'{�/ (� ((�� [[p� IInn''((,77195_ Permit No.
�Jl11 OFh CtlRial�I1[IlhY i Fret 1 _�
Ap ton her dy 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 Premi W L
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a Owner 1 U , Address >C��sii/ K
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By Address
✓ CONTRACTOR, AGENT Approve
U CA X"9I, Z�96 d
eLemuuL arseeerrn
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I, the undersigned do hereby certify that L am
the,owner and occupant of the single family dwelling at
'J
for which I am making
application to do I p C i rte •cork ;as a home owned
I also certify that I will not hire. an .non-licensed
contractcr,. but will do this work myself. !
T��,Ti�HGI•,rE p� 'Q C� 7� r �^�(:t�i C.� .
SIG duTURE .