1421 NO. STR 'T LOT NO.
® P 1 OR ELECTRICAL PERMIT
OF CUPERTINO
f MW 18 1962 .
Date •�— a IO/r Permit No.
CITY OF CU ff f TIN
pe��� ads
n ' Application is hereby ma a to he City of Cupertino for a permit to install electrical
+'0 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.
J Use of Premi
Q
C
U v
V
4 Owner Address:
Address A " dd PDQ,
CONTRACTOR, AGED
Approved-
Phone: 7� �B' �o'Iy3l 4,
� 61.E ICAL'INSPRCIW
NEW RPI. FEES
of Outlets---------.-_--Service Conduit----------------------Number ......... ......... _..---- .----
Size Service Wires-----.-_-----------------Number of Switches ---- ---------- __------I-- S.?-
Size
--------- --
Size Service Switch........................Number of Receptacles-..:----,._ ---------- -------- - -------------
Size Sub --
S b Feed Conduit--- ------------Number of Fixtures.'---------------- ---------- --------
, -- -
`'Feed Wires--------------------Ranges----....*------ ----------
Size Sub KW-------------- ---------- ------
Number of Circuits------------------- Oven -------------�KW.''.
-------- -------- --------------
.. ......
Number of Meters........................Signs----...... .Transformers--.----- .....'V..
-- --------------
*�misc.--------- ----- - --....................Dryers---------......---------------------
-- ----- --------- ---........
•
..VM Motors
-----L---- ------------------- Phase.........*-------- Permit Fee $1.00Mo ----------- -- HP_:................ Phase.... ...... ....
Motors--------------------- HP-- ----------------- Phase------------------- H P Charge---------------- --------------
• TOTAL FEE
RECORD OF INSPECTION APPROVALS
Rough Wiring................ ...........---------------- Fixtures ---:_ .... .. ------------A -------------
DATE INSPECTOR (A DATE INSPECTOR
Finish,Wirin'g .:.*:.----------- ------------------------ otors --------------I........... -----------....... .
INSPECTOR DATE INSPECTOR
J R< ;.........................
�" Final ...:.......DAT[- .......... INSPECTOR
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