28243 1117 Steeplechase Lane /
Building Permit Confirmed Bd'
Not Required ❑
CITY OF SAN JOSE BIDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date........ ---�-'S--------------------- 19Permit No.-----�..-:�W3-------------
The undersigned hereby make pplicat'on to the ElecfO al ns for of the City of San Jose
for a permit to install electrical v} d in sr reverse side.
Exemption from requirement or alt nia r onirattor's License is hereby claimed
by undersigned: as ow or statement filed ❑
Undersigned attests that his'State of California Confr''a�NQrs,License #
is in full force and effect and properly authorizes this apprV� /L'w /�/�' /
San Jose City Business License # CVVV/ 499 CX
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS / ,�+M
USE OF BUILDING �Qwt t 1 �41/ —
FIRM SIGNED
280-10 (9-73)
S'
1117 Steeplechase Lane HO /y
ITEMIZE THE FOLLOWING New Old
OutletsPan Vii, CabinetsSize Service Conduit
Switches .Switchboards - Size Service Wires '
Receptacles Panelboards Size Service Switch Q
Fixtures _/—Festoon Lamps Size Sub Feed Conduif
Mercury Lamps Dryers KW Size Sub Feed Wires
Ranges KW Heaters KW Number of Circuits _
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads 7D Lighting Power
Miscellaneous
Rough Inspection — a — _ By
Final Inspection
.
Remarks: By