1305 NO. STREET NO.
AP r,4°1 � R __-ECTRICAL PERMIT
V CITY OF fERTINO
,f J N 2 91967 `.111,
i] ,�
Date 1,30
I Permit No.
q� IY OF CUPER NO 1'ee�S+ / 70
Application 1 ereby made Rothe 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
wirin'gtand/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 Pre
22Gwc7
Owner ' ^ .'Addes,9F '
G
ti dd es`56 � .
CONTRACTOR AGENT,",
ELECTRICAL INSPffiRpt '
NEW RPL _FEES
IEES
Size Service Conduit.....:.............: Number of Outlets.................. - _
-- ----.. .. .t?....
Size Service Wires.........................Number of Switches................ f u
Size Service Switch....... Qumbe
tumber
r of Receptacles........__ .------... .._------ .�:0..
Size Sub Feed Conduit........ of Fixtures------------------ .......... ---------- --------------
Size Sub Feed Wires--------------------Ranges................ KW.............. _....._. ....._... -------------
Number of Circuits.........-------- Oven .............. KW------....... .......... ...
....... .............. .
.'Number of Meters........................Signs---------- Transformers-------- --.----- ---.----. ------------
Misc...........-.....................-----------Dryers.%..............._...--- ------ ------- ---------
- ----
Motors.. ---------------- HP.......:---------- Phase.- ,:--------------- c.
Motors................_.. HP...:_.............. P1&gn--------------- Permit Fee $1.00
Motors..................... HP-------------------- Phase"!-----------------',H P Charge..------------
I
TOT.AL•'FEE_k I
RECORD:OF INSPECTION ARPROV•AL-S
1 Rough Wiring-.............. ....................... Fixtures_.;----- ------------.-. ..
pq-
OTE IX9PE<TOfl Er SJTL.r•� I INSPECTOR
Finish Wiring -:..-.� ........5........
? Motors; . . _ --
� DATE IXBPCETOfl t' OFA C T om'kIMEPKTOfl'r'
-'T .1► ''. Final ? iyFs.Taxa:;_ i
DATE _ .) f:INSPE TW -t�K%moi
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