28889 4899 "September Building Permit Confirmed G
Not Required ❑
CITY OF SAN JOSE '^ BUILDING DEPART J
APPLICATION FOR ELECTRICAL PERMIT
Dafe---.(..! �.�'�../_ 19.75/ Permit No..._,2.999-.x?---------------------
The undersigned hereby m os application 4o the Electrical Inspector of the City of San Jose
for a permit to ins{all electr'.al i+ in s/ M e he reverso side.
Exemption from require rn or o ctor'z License is hereby claimed
by undersigned: a owner ❑ statement filed
Undersigned attests that his State of California tr is Li nse �❑ '7Cl
is in full force and effect and properly au4horizex {h' cation.
San Jose City Business License QV U
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any ma,ryopr so/ax viola#e the workmen's compensation laws of California.
OWNER //I✓ /
ADDRESSQ
USE OF UILDING
FIRM SIGNED
280-10 (9-73)
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ITEMIZE THE FOLLOWING New' Old
Outlets Panels, Cabinets Size Service Conduit
Switches !i Switchboards Size Service Wires //�`
Receptacles Panelboards Size Service Switch •_ .6.U_V
Fixtures Festoon Lamps Size Sub Feed Condui}
Mercury Lamps Dryers KW Size Sub Feed Wires
Ranges KW Heaters KW Number of Circuits _
Signs Transformers Motors Numberof Meters _
HP '�i Phase—Ampere Loads 0-Qf Lighting Power
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Miscellaneous /`�fJ
Rough Inspection ' / py
Final Inspection �- `t—7�-� By < 2---j
Remarks: J-LF-)�f- F•� ''�_ "" �o
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