26708,._%4-x.5': Plum B108807II DT. B 'Id' P it C f' d C4�"
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Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT J
APPLICATION FOR ELECTRICAL PERMIT �1
Date .... 1'71- I Permit No..v'------
a undersigned hereby. makes application to the Electrical Inspector of the City of San Jose
`(1 for a permit to install el ec} c rfiur sre nd or 1irTg,as i ffd�on the reverse side.
.. ep
Exemption from req�iremen for StIfto ofsC'alifornla for Contractor's License is' hereby claimed
by undersigned: as owner ❑ statement filed Ll
Undersigned, attests that his State of Cellfornia• Con}r e q-50 Lie
is in full force and effect and properly author x##his 116rfip,',,�.5/i
San Jose City Business License # Qom'
I certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS
USE OF
280-10
il
ITEMIZE THE FOLLOWING&f,,,/,,
Outlets Panels, Cabinets U
Size Service Conduit
Switches Switchboards
Size Service Wires _
Receptacles_ Panelboards
- Size Service Switch _
Fixtures la Festoon Lamps
Size Sub Feed Conduit
Mercury Lamps
Ranges
Signs
HP /
PAVAI
Transformers
Dryers KW Size Sub Feed Wires
Heaters KW Number of Circuits
— Motors _- Number of Meters
Phase ^—Ampere Loads %yo Lighting
New" Old
Gj
Power
Rough Inspection O B
Final Inspection By
Remarks:
® Remarks�y
" �`7P r.17 rte. b i-