2493 NO. S'rRE` \ LOT NO.
N Q
Y o ®APPPLICAT11ON �OR ELECTRICAL PERMIT
sU CI Y' <�F CUPERTINO
NOV 2 7 1963 dJ t'
o Date
0 W
° CITY OF CUPFR T Min peC y
a Application is hereby'made to the City of Cupertino for a permit to install electrical
w
w s wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
o0 wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
> 0 City of Cupertino, a all other laws applile thereto.
z_j Use of Premises
J
O
OwnerL / .z4>/// hlJ
`3Q ��'�'�� Address �d �•�-�e.0T7
.w w By
R7
Q CONTRACTOR, AGENT A [OVed
-U Phonc:-Y Jz - �G!e _ / ( pp E ECTRuC ' msrE
State License V.�•�'�►�Y'-'` `
PTA __
NEW RPL FEES
Size Service Conduit...............:......Number of Outlets.....:..._
.. .......... .......... ........ ....
Size Service Wires..........................Number.of SWitches--- ..... `"----- ---------- ....._---_--
Size Service §wiich.L----------------------Number of Receptacles_.......... C5(
............
Size Sub Feed Conduit..................Number'`of'Fixtures------------------ !......... .......... ..............
Size Sub Feed Wires-------------------Ranges.-----------. KW---------- ---------- - --- ---- ------------
Number of Circuits......-:.......... Oven ------'------- KW--- ------ - --- -- --------
Me I Meters........................Signs.................... Transforme"----
Number of 's ------------
00
Misc---------- .:..............................Dryers.:...................fy I .
F---1 4 . . .......... .......... ......
Motors......._--------- HP-----.....--------- Phase....................
Motors------------------- HP............------- Phase.................... Permit Fee $1.00
Motors-------i------------ HP.................... Phase.......... --------- H P Charge---------------
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring .............. ---------------------------- 'Fixtures --------------I------17-----------------N,
DATE INSPECTOR ;A'K TOR
Finish Wiring ------------ Motors -----
---------------------- --- --------------
DATE INSPECTOR DATESM
;TOR
...............t
INSPECTOR