48284 1137 Rollingdell
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE 1`1--77 BUIWING DEPARTMENT
APPLICATION FOR ELECTRICAL �PERRMIT
Date------(- ------- L----------------------- 19 - Permit No.----.5:r--Ll- - - -------------
The undersigned hereby makes application to the Electrical Inspector of the City of San Jose
fora permit to install alae ai rr i ted on h verso side.
Exemption from requiat a i a f or' icense is hereby claimed
t by undersigned: a owner ❑ statement filed 1 pry
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorize/q��}his agplication /yy
San Jose City Business Licensee ! v� z4fb��—
I certify that in the performance of the wv�f which r((p�-armi} is issu I all oT employ
any-person in any manner so as to violate the workmen's compensation laws of California.
OWNER T S G e0 N.7 C-27 A�
ADDRESS .. /VO4/ `/V�L ,&-e-`L
USE OF BUILDING `a
FIRM U � T�� SIGNED
280-10(9-73)
113 1137 Rollingdell P 6 R RlLrr_
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Switches Switchboards Size Service Wires
Receptacles SY Panelboards Size Service Switch —/00
Fixtures le Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers __L KW Size Sub Feed Wires
Ranges _ KW Heaters KW Number of Circuits _
Signs Transformers Mofors 3—/.u0_ .Number of Meters _
HP Phase Ampere Loads Lighting Power
Miscellaneous �Z yp f4
Rough Inspection By
Final Inspection B �A "�l
Remarks: