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NO. � R Y p _i �A /U4t LOT NO.
APPLI f0N FOR ELECTRICAL PERMIT
,'CITY OF CUPERTINO
DateL
, I 9�i� Permit No.
y
Fee
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 accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
v Use of Premises <=-
C
.Owne Address �0 ��� u •w. /!�P
By _;_r.. .� C .lti �.i, Address
I CONTRACTOR, AGENT1 v
Approved
Phone: _ ,�.`l�' ��,�._,Q �..
• ELECTRICAL INSPECTOR
L y NEW RPL FEES
Size Service Conduit......................Number Of Outlets-1-:11------I.......... ---- --- ---......_--
Size service wires..........................Number of Switcheg ----- ---------- ---------- -------------
Size Service Switch......-_ S..... ----
.....................Number of Receptacl s
I s
Size Sub Feed Conduit------------------Number of Fixtures....... ------- --------- --- --------------
----------- - ---------- --------- --------------
Size Sub Feed Wires....................Ranges................ KW.
Number of Circuits..._-------...... Oven -------------- KW-----------
---------- ---------- --------------
Number of Meters...... ........ ........Signs-,..... Transformers...-----
---------- --------- --------------
4/.!.ht,Dryers............ --------------------------- ------------- ---------- ------
Motors..-.....t.....----. HP.......X--------- Phase-- -- ----------- Permit Fee $1.00
Motors-------------------- HP---------------- - Phase--------------------
Motors-------------------- HP-------------------- Phase.................... H P Charge................ --------------
TOTAL FEES
RECORD OF INSPECTION APPROVALS
Rough Wiring................ ---------------------------- Fixtures .........DA........... INSPECTOR
.. - .. -.......
DATE
INSPECTOR 'idiNkMotors ........
Finish Wiring ...------------ ---------------- ..../-----;....... *OR
DATE INSPECTORFinal F!
IT f DATE INSPECTOR