1967t ET to .'
NO. STREET t � /. LOTINO.
L'TI FOUR ELECTRICAL PERMIT
Ii/MAR
OF CUPERTINO
22 1963 . 4 !
Date (+� nC /� pip , 1195— Permit No. b�
PP fATY IoJ yhn� �€ERTT.J�t y� p p!er e�
A li n.is eb a e ,alt of Cu ertmo for ermit 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, 5an:; other taws applicable therettoD W
�r
v Use of Premise,�C.�1 — ,
c �� %
a Owner) �-r &D ^" A6-' CD Address
By Address % ¢ o /VE Ii/G UE _
CONTRR�AC"TOR, AGENT I
A roved
Phone:,-PP E ECTRICAL INSPECTOR
NEW
Size Service Conduit ...................... urPber„of, Outlets ......... .........
Size Service Wires .........................Number of Switches.................... :...I..............
Size Service Switch ..... ..............._.Number of Receptacles .......-.... .........::....�...
Size Sub Feed Conduit..................Number of Fixtures ------------ :.....
Size Sub Feed Wires ... _ ..............Ranges................ KW.
Number of Circuits------------------- Oven -------------- KW.
Numbei of Meters........................Signs.........: Transformers......-.
Misc.................................................
Dryers ----------------------------------
-......
------ I-------- I ------- .----.
Motors .....................HP
--------------------
Phase --------------------
'Permit
Motors --------------------
HP --------------------
Phase ..............
..... Fee $1:00
Motors --------------------
HP ....................
Phase.. ...........
...... H P Charge...--...-------
- --
TOTAL FEES—
EES
RECORD
RECORD
OF INSPECTION APPROVALS
RoughWiring
................ I---------------------------- -_
' DATE INSPECTOR �
Fixtures ....--------....._...I .... .... ------
p DATE ,j„ X, OR
Finish Wiring ................ I........---`--......
DATR INSPECTOR
I,
I
the undersigned
am the-own er
do hereby of �.
YY-that
fa
ala:
1 dwelling at :-Occup
uccu nt f the.si gle
fo
ich am rhak
ng a pplica ion to do
I
lcertify
work as a homeowner,
I yl
• no
-llicensed
not-hire any
tractor, but w 11
r con-
0 s work myself.
�M$ER.:
TEL PHONE .. IGN TURE