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NO., I STREET
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APRLICATION
LOT NO.
FOR ELECTRICAL PERMIT
CITY OF CUPERTINO
Date 1195— - Permit No. l 11
Fee $ /1
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 iastali 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. i
Use of Premi—
V \,
a Ow : �` -�=_ �+' `�- � /�="• � Address
LBy Add re
,_�� CONTRACTOR, AGENT
Phone: rX G_ 2 %1 Approved
tL8CIA1G1 INSPH
. RECORD OF INSPECTION APPROVALS
RoughWiring ............... �j ............................ Fixtures ---------------------- ----------------------------
DATE INSPECTOR RATE INSPECTOR
Finish Wiring................ I...._..... ............. Motors - ---- --- ---
PATE INSPECT
RATE ZINSPICTOR
NEW RPL FEES
Size Service Conduit ..........::.:......Number
of
Outlets..................
-------- ---....._L..........
. ,;..
Size Service Wires --------------------------
Number of
Switches ................
....I...... ..........
............. ;
Size Service Switch ........................Number
of
Receptacles..................----
----------
------------
Size Sub Feed Conduit__..............
Number of
Fixtures------------------
---------- ................._.._S'
--------
------- --
Size Sub Feed Wires ............ :- ......
Size
Ranges ................
KW-------------
---------- ----------
-------------
Number of Circuits._ ................
Oven ...............
KW------------
---------- ----------
-------------
Number of Meters........................Signs..........
Transformers ........ .......... ..........
..............
Misc ----- --------------------- -------------------.Dryers_....----------------------------
---------- -----------
----- --------
4
:N"
Motors -------------------- HP --------------------
Phase --------------------
Permit Fee
$1.00
Motors .................... HP .........
Pha.<, I f. -------------
. RECORD OF INSPECTION APPROVALS
RoughWiring ............... �j ............................ Fixtures ---------------------- ----------------------------
DATE INSPECTOR RATE INSPECTOR
Finish Wiring................ I...._..... ............. Motors - ---- --- ---
PATE INSPECT
RATE ZINSPICTOR
I, the undersigned do hereby ce t fy that
I am the owner and occupant f t sing
f it dwelling at ca'?-
f ich I am making applic tion to do
I work as a homeowner.
I als cer ify a I w']1 `not, hire any
non -licensed I 0� con-
tractor, but wi o is work myself.
TE PHONE NUMBER / SIGNATURE