1979 NO. S REST LOT NO. .
APPLICATION FOR ELECTRICAL PERMIT
CITY OF CUPERTINO
i
Date ' 195— Permit No. /J
Fee $ C-� 9 _
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 accAance with the provisions of the Electrical Code of the
City of Cuperti , 2all laws a ca thereto.
v Use of Premis—
Owner `�•`o' f�"r '�.�er�'e`°o`��H• Addres3 1 .4_._._`z"` .r
Addres
N CONTRACTOR, AGENT
Jai w�,r,7 Approved
Mt
..E ICA INSPECTM
NEW RPL FEES T'
Size Service Conduit----------------------Num$er'of Outlets------------------ ---------- --------_I-..-..-.......
Size Service Wires--------------------------Number of Switches................ .......... ..........
L_..--.-._..
Size Service Switch------------------------Number of Receptacles------------ ---------- ---------- -.---_-------
Size Sub Feed Conduit------------------Number of Fixtures...........!...... .......... .......... ..............
Size Sub Feed Wires----'-............Ranges---------------- KW............. .......... ----.... ..............
Number of Circuits----................... Oven -------------- KW .......... ..... .. .. .........
Number of Meters........................Signs.......... Transformers........ .......... .......... .....--------
Misc-----------------------------------'------------Dryers............. .......................... --------- .......... --"'----...-
Motors.................... HP-------------------- Phase-------------------- Permit Fee $1.00
Motors------------------- HP.................... Phase----------------
Motors-------------------- HP.------------------- Phase------------------ H P Charge------------- ----...---...
TOTAL FEES
RECORD OF INSPECTION APPROVALS
Rough Wiring ----------- Fixtures -------------------
OATE INSPECTOR NOATC /NSPCCTOR `
Finish Wiring ................ . . . Motors .. ........ .... . ...' .-- -'---
--------------
OATE INSPECTOR TF INSPECTOR
Final ..... . .. :IN-SPE-,-c-n....
OA '...Tf;.A�� IXSPCGTOR � I