1872 NO. EE LOT NO.
A P', ¢A ION tFOR ELECTRICAL PERMIT
qIITY OF CUPERTINO
Date 'y`/ ��++11fr�� 195— Permit No.
r kali dA4. �" 1O�y,_� '�' Fee
Ap�l io herdb4 Orirarl Eo�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 Prerm VL
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v
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.=t Owner v _ Address
N By �9—„��f�za — Address
U CONTRACTOR, AGENT
Ph .�'S,2) ApprovedEOLIC-1
rNsrecroi?'_y',
one:
NEW RPL PEES
Size Service Conduit......................Number of Outlets-------- ......... ../..... .......... ....--'d-d
Size Service Wires--------------------------Number of Switches................ .......... .......... ..............
Size Service Switch........................Number of Receptacles............ .......... .......... ..............
Size Sub Feed Conduit..................Number of Fixtures.................. .......... .......... ..............
Size Sub Feed Wires... ...............Ranges.............. KW.............. .......... .......... ..............
Number of Circuits--- Oven .............. KW.............. .......... .......... .....-........
N er of M rs- Si ns.......... Transformers........ .......... ..........
..'..
777
Misc. .-... C,-'- ------. .-.D yets'...-..�.'.-.A.{/....\. . ............. .......... .......... .....rl...t.
Motors.................... HP...... ...-._ Phase-.-.....1..1..--- 00
Motors........._--....... HP.................... Phase............---....
Motors-------------------- I --- Phase........... ........ H� ................ ..............
TAL FEES
RECORD OF INSPECTION APPROVA
Rough Wiring I. ': ....... Fixtures ......................I............ .............�
DATE IN0GCT0! ? ATE 1 GCTOR
Finish Wiring �. Motors ...... ... ----- .....
-...-..--.
---•DATR
INSPECTOR
♦7R } .. X OR
r L/��
Final --- .....-D-TZ. ..-. - ..----•
IMO GT ■
T. 'the undersigned do here y ce'rtifY that
I am the owner and occ pa d t e, i e
family dwelling at
for i is I a making ppli' a on to do
A� _wo k as homeowner.
I also certify oll not hire any . .
non-licensed or contractor,
but will do this work myself.
TELEPHONE NUMBER �GNATURE