67165 1191 Stafford Dr. � /
Building Permit Confirmed Ly'
Not Required ❑
iu5
CITY OF SAN JOSE BUILDING DEPARTMENT
'.ItieS�(s `�� / APPLgICATION FOR ELECTRICAALL/P-EERM/IT
"�t Date---`--,/� - -.ice--------------------. I Permit No _---Ifp ,
The undersigned hereby makes application to the Electrical Inspector of the City of San Jose
for a permit to install electrical fixtures and/or wiring as listed on the reverse side.
Exemption from raquiromeniYfor 54afe of California for Contractor's License Js hereby claimed
by undersigned: V Sd�owner ❑1r -'O�Gsfefern {fled Y9
Undersigned attesfs that his State of California Contractor's License #
is in full force and effect and properly aufhoriYVhipplicaliiu�
San Jose City Business License #
1 certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER O //Ali226R
ADDRESS //9% STa Z5? " n M
USE OF BUILDING 5 '.+1ji=,& Zo2,dVeIL
FIRMA-IA SIGNED
260-201N
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Swi+ches / Switchboards Size Service Wires
Receptacles n_/2 Panelboards Size Service Switch
Fixtures Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers KW Size Sub Feed Wires
Ranges KW Heafers KW Number of Circuits
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads Lighting Power
Miscellaneous
tea,
Rough Inspection �/ By �
Final Inspection n2 • 02 7—,33 By
Remarks: �a9
290-201N