892 1-0390 �S� Gcee.0
NO. STREET LOT NO.
® M OR`, ,EL CTRICAL PERMIT
®v ,A � CY OFF,CUPMRTINO
.t
Date 195— Permit No.
CI � Fee $
Application is hereby made to the City of Cupertino for a permit to install electrical
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
N) 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 Premises -
a Owner.G� Address n .Z—,
ro By JAddre 1414
TACO A
Appr d
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OU ELECTRICAL INSPEcro
NEW RPL FEES
Size Service Conduit...................... umber of Outlets..................�.�<?-- --------
�•�- - -----
N
Size Service Wires--------------------------Number of Switches......._...._. .
------- ----------L...----------
Size Service Switch--------................Number of Receptacles------------ ---------- ---------- -----'-".
Size Sub Feed Conduit------------------Number of Fixtures.................. .. 6 1q•(00
. ......_......
Size Sub Feed Wires--------------------Ranges..........:_... KW.......... ... .......... .......... ..............
Number of Circuits------------------ Oven ------------- KW....---------- -------- --------- ----- ---
Number of Meters........................Signs.......... Transformers_.....- ..............
Misc.l:a- {� ....Dryers_---'---'....... ......----.._---... ....---- ------.. .._x.75.
Motors........ ........ HP.-.-.-1'.f/P. Phase...J ...._... Permit Fee $1.00
Motors-------3....... HP-----a.11P--- Phase.. ./..X.........
' . Motors..:..------------- HP------------------ Phase._-------------------- H P Charge----------------
TOTAL FEES � I9 r/O
CO SPECTION APPROVALS
Rough Wiring��-/6----�--- - - --------------- Fixtures ---- --------
--
DATE INSPECTOR- DATE INSPECTOR
FinishWirin '-........ Motors . . ... ............ .
• ' +I. DATC INSPECTOR R
. . a Final ........ -....
3, 1^i v A!4✓, DATE INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers I 11 To ,Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers SEWER BOXES -t•,2h
Waste Disposals 1 ,
Wash Trays, STORM DRAINAGE
Washing Machines Size
Water Softeners Material j
Bar Sinks To Main Drain
Comb. Sink &Trays 1 11 To Curb
Dental Units I 1 11
Drinking Fountains
Floor Drains WATER SYSTEM '
Hoppers Size
Restaurant Sinks -Material '-!
Sand Traps �� rOTAL FEES. k_'.
Urinals Fixture Fee
Area Drains Main Dram Fee
Water Leaders TStorm Drain Fee
Sprinkler Valles II Water Sys. Fee
Typ t x¢o a'I++'AO u Permit Fee / 4
TOTAL I TOTAL FEE :'q!°y`
REC RD OF INS N
Partial Rough
Rough Complete
Final (}