NO PERMIT NUMBER /0 11e15-X1 �'ln�c. C� CI46- LOT NO.
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NO. ,tt STREET
NcjCO CITY OF CUPERTINO
/APPLICATION FOR ELECTRICAL PERMIT
�+ 6 7 g-- Permit No.
Date 6 19_ Fee$�
/T
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.
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Use i /CjjC� Work To d
Premises `p�� //y'�/am Performed
Owns!?Agf U�}�AXA� ` ess�7'Y..S�B
Phone .S'r� — 70s-10 f,y-/19
Contractor,Agent Address ROx.SZS
Phone37�- /6 9v/6 9 — 9sva Y
State License S�-77-5 Approv
Electric nspector
I AGREE I WILL NOT VIOLATE ANY OF THE WORK S
L COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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