7204 ,
NO. STREET �' LOT NO.
tIFOR ELECTRICAL PERMIT
+ JUL 7 cl'fY)OF CUPERTINO
Date /19O Permit No.
CITY OF CUPERTINO l=ee /.
Application is hereby made to the City of Cupertino for a permit to install electrical
�'3\ 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 Premi
-:=4 Owner rry��/y` ; Address
417
1' tcc ,✓r': ; '�'
By Address
Ln CONTRACTOR, AGENTp
it pp.,r .a Approved.-
:' Phone: 4� ti - f.," n (, r I ,
1 Z" Cr'RIUL INSPECTOR
Size Service Conduit_....................Number
nf�,0ukt......
Phase .....
Motors -------------------
Size Service Wires.._...................._Number
Size Service Switch.......................Number
of S tcs_.
of Releptacle
Size Sub Feed Conduit ------------------Number
of Fixtures.....
Size Sub Feed Wires --------------
i
...... Ranges ................ KW.
Number of Circuits ...................
Oven .............. KW.
Number of Meters........................Signs..........
Transforn
Motors --------------------
HP ...........
Phase .....
Motors -------------------
HP ....................
Phase -----
Motors ....................
HP ----------------
Phase ----
RECORD OF
INSPECT
Rough Wiring
................ ................
..
. DATE INSPECTOR
Finish Wiring
................ ............... '.
, ..
DATE INSPECTOR r
......_------------- I-------- I---------- I-'--------
"""' Permit Fee $1.00
HP Charge..................._.......
...
TOTAL FEES C/o
VN AFrWJVALJ
Fixtures----------------- --------------------
•, DATE INSPECTOR
Motors
Final•--,••'DATE-.IXSPCTOR
/......-----T .
•IJUJI _____