1626 iT _
NO. STREET LOT NO. �• r
A,PP1�16q�TION, FOR ELECTRICAL PERMIT
;OF CUPERTI[VO'
" I 1
:�AS�P ,n, a1;z,I� '[�e;
Date "-195— Permit No.
co
Fee
Appli",t ooh is(h�ereby maHe�t�yt6�+4'�`q of Cupertino for n permit to install electrical
wiring and/or fixtuies as list-3 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 ppljcable thereto.
i
v Use of Premii- 'l le,zI"
� C
Own*CNTRACTOR,
•' Address CGS G By Address AGENT A pprove ,
y. JI Phone: ELECTRICAL INSPB _
NEW RFL FEES
Size Service Conduit....1...�4 .......Number of Outlets.................. ..c .. .......... .1.<..Q.
Size Service Wires.....�......_�ct-.Number of Switches...._.......... .......... ..........
Size Service Switch......1.0.Q.......Number of Receptacles............ .......... .......... ..............
Size Sub Feed Conduit..................Number of Fixtures.................. .......... .......... .............
.
Size Sub Feed Wires....................Ranges.......Z..... KW.............
....
......
..........
.........777.�
Number of Circuits..._.............. Oven .../....... KW.............. . ...._ .......... ..........l...5
Number of Meters..._...................Si `yvces.......,.. Tra Sf ers........ ......... .......... .......:.x...
�r0..h.G4....G �.....
Motors. h:...... HP.................... Phase.................... r/ Perrnit Fee $1.00
Motors....... ......... HP.................... Phase....................
Motors.................... HP.................... Phase..............---... HP Charge................ ...... .0 n
1
TOTAL FEES v£ J
RECORD OF INSPECTION APPROVALS
RoughWiring................ ............................ Fixtures ................. ...........................
DAT[ IRSP[CTOR DAYS IR[P[CTOR
Finish Wiring ................�...:�................ .. Motors.......---- �-
DAT[ - IRSPICY ORV R �1
y Final :... �- -.t........
DAT[ IR[P[CTOR
e --$I-, the undersigned do hereby certify tna°t
I.-am the owner and occupant of the single
1• family dwelling at ,
f' wh ch I, ar�� making application o do
PI �--- a� work as a homeowner.
also certify t will not hire any
non-licensed a ea „ei• or con-
tractor; but will do this work myself.
TFLEPHONE. NUMBER WGNATURE
L