601/Q�90
NO. STREET ;J;" .) LOT NO. .
.-w, rb &
APPLICATION FOR ELECTRICAL PERMIT
CUPERTI[VO
Date . Permit No.
AR 8 , Fee 4
Application is hereby made to the C; of Cupertino for a permit to install electrical
wiring aJgr�fies l�I�®reverse side hereof, and agrees to install said
ng a /�ojj fi res }i�4e c r ante with the provisions of the Electrical Code of the
ZCity of Cupertino, and all other laws ap ' A
I.
Use of Prre i
a Owner 6 �Zti
y `I
By "r
An COtNt TRACTOR, AGENT
Phone: /Le �� ����
le thereto.
Address
Size Servicc;COnduft ----------------------
Number .of'Outlets........
Size Service Wires..:.......................Number
of Switches......
Size Service Switch ........................Number
of Receptacles..
Size Sub Feed Conduit ------------------
Number of Fixtures........
Size Sub Feed Wires...................Ranges................
KW....
Number of Circuits ...................
Oven --------------- KW....
NEW
RPL FEES
Number of Meters........................Signs.......... , Transformers ........ I ----------
Misc.----- ._ ...................Dryers..........._...............-- I--- ------ I....._... ------------
�... .
Motors..........StZ... HP..........._.. -- Phase .................... Permit Fee $1.00
Motors ---------------_-- HP ... !.......... Phase ....................
Motors ------------------- HP .................... Phase ------------------ H P Charge.-------------_ � ...i%
TOTAL FEES®-�
RECORD OF INSPECTION APPROVALS
Rough Wiring ------ D -A T _ F -- IX9PFCTOR Fixtures ........D.I..._TE ------
DA
Finish Wiring ...---------- ----------------`----- Motors .....---'---- `-----`-- -'--`.. ..—
DAT, INSPECTOR ^/DyT�.� `
Final ��r.0/./..C?�...�.a .._...--'—'-----•
ATL INSPECTOR
'undersigned do hereby. certif that I am
the owner and cupant of the lsinkloiamily dorelliri; at
0Lr�p' e k�Oo iorich I'am. making
application to do ^ ,.Iaor'•as. a hcpe owner..
I also certify that I.will not, hire any non -licensed.
�r cointractor, but will qo this work ,m �sqa-f.
sI n T�
TEZ-t'HONE 1dU2_�ER �, -.. r• ,,,E