23752 906 September Ave.
Building Permit Confirmed ®�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date------- -- - ........R - - - ------
--- --- - -- 19!.13.. Permit No........12— ---5. .-A -
......... ---
eo
The undersigned hereby mr as application to the Electrical Inspector of the City of San Jose
for a permit }o inshle
tall eecfri f' u s / g�','.J,{�sf reverse side.
Exemption from require � OICI or's License is hereby claimed
by undersigned: as ner ❑ statement filed ❑
11
Undersigned affesis that his State of California Cont ctor's Lice ns # 19QCi
is in full force and effect and properly author
San Jose
I certify that in the performance of the work for which }his permit is issued I shall no employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER h&K
ADDRESS _
USE OF BUILDING d j,4 A
FIRM SIGNED 6as0
FORM 280-10 (REV.3661 IOM
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Switches Switchboards Size Service Wires
Recepfacles _ Panel boards Size Service Switch
Fixtures Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers KW Size Sub Feed Wires c
Ranges KW Heaters KW Number of Circuits
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads .'(_Lighting Power
Miscellaneous
Rough Inspection � py
Final Inspection _ / — / ` By
Remarks: