63499945 Rose .gl'ossom
Building Permit ConfirmadW-00
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
L 3 y9-9----
Date --- -V-�.y-----aC.- J----------------- 19.�.$-- Permit No.... ..............
"i
The undersigned rb¢ q}Iy /n I' ion tot Electrical Inspector of the City of San Jose
for a permit to Inst a is u d r fisted on the reverse side.
Ezemplion from raquirem n} for
fete f i r ' or Contractor's License is hereby claimed
by undersigned: as owner 19 statement filed ❑
Undersigned atles}s that his State of Ca'fornia Contractor's License #CU 3S3�2S ].
is in full force and affect and properly au fh iz y Z app' ���,J'r� L
San Jose City Business License # _ 'sR /<
I certify that in the performance of the work far which this permit is sued I shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER mQ 0 ML;0Jr
ADDRESS 9 y S Rost D t s o m nD R
USE OF BUILDING
FIRM LOUg A L I ec.F. SIGNED
0-201n
945 Ro§e Blos4oz9 Cougar
ITEMIZE THE FOLLOWING
New
Old
Outlets _ I
3
Panels, Cabinets
Size Service Conduit
Switches
Switchboards
Size Service Wires
Receptacles
Panelboards I
Size Service Switch
A
Fixtures I
Festoon Lamps
Size Sub Feed Conduit
Mercury Lamps
Dryers KW
Size Sub Feed Wires
Ranges KW
Heaters KW
Number of Circuits
Signs Transformers Motors
Number of Me#ers
_
x\%
Phase Ampere Loads _8_?_(Lighting
Power
Miscellaneous Sk/ m m
'v Pa
0 L
Rough Inspection - By
Final Inspection _ 9v-
Remarks:%Zy-%ASF/N� By
280-201n