911 NO. STKETF LOT
4PP)&jQHR ELECTRICAL PERMIT
8 IFCUPERTINO
tO7E
Date /11�
9 Permit No.
CITY OF CUPERTI'I� Fcc �, ,
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
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 Prem 11q
c
a Owner Address
n By �) Address
l / R`Af�rpYN �i
�- Approved
_ Phone: 1'1 IUL INSPECTM
/ CI
NEW RPL FEES
Size Service Conduit......................Number of Outlets-----... _ - -----
._...
Size Service Wires.........................Number of Switches................ .......... .....:----I---
...........
Size Service Switch........................Number of Receptacles------------ --------- -------- ..............
Size Sub Feed Conduit------------------Number of Fixtures.................. :......... .......... ..............
y i
Size Sub Feed Wires...................Ranges......I-------- KW..---- -----` -------- -------- -
i
Number of Circuits--'-- --------- Oven .(............ KW------------- --------- -------- -----:-7�
Number of Meters........................Signs.......... Transformers........I...------- ---------- ---------------
Misc............... Dryers-----------------..:........------------
-------- -------- ------------
Motors-------------------- HP------------------ Phase----------- Permit Fee $1.00
Motors.----------------- HP...:................ Phase--------------
Motors.................... HP------------------ Phase......... .......... H P Charge------------ -------------
TOTAL FEES h�t-�n
RECORD OF INSPECTION APPROVALS
RoughWiring....'----------- ---------------------------- Fixtures ---_.-------------- -------------------------
DATE INSPECTOR D/TE INSPECTOR
Finish Wiring ....... otors ........................
DATE INSPECTOR Q 4q Ty OR
Final Z .':?.::.IF's�!....�.... .-
DATE INSPFCTOR