54978 (2) 1128 Derbyshire
f
r Building Permif Confirmed
Not Required ❑'
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAY PERMIT
. �y / � 7r
.. . 19 �ermrt No.Date.. ........
The undersigned hereby kes ap licefion the tricel ector of the City of San Jose
for a permit to install M. c f' it ist o the reverse side.
Exemption from requir a rn f ractor's License is hereby claimed Q J
by undersigned: owner O statement filed �p 33 23 fl//
Undersigned attests that his Stale of California Contractor's License
is in full force and affec nd r erly out raeess�thi�s(epelicetiggx_
San Jose Cily Busi s e # {�3`� r'o�^W "'rfri� ��
I certify that in th pa soca o the Lich p6rmi is issued I shall not employ
any person in any manner so as to violate the workmen's compdFsation laws of California.
OWNER Rx ISi110A
ADDRESS 28 e b S J ® -
r
USE OF BUILDING
�y, CYSt/d�doy�//'AL
FIRIVI /— . /�N/. SIGNED
2 -201n� I
1128 Derbyshire R ,.. " del-mar
ITEMIZE THE FOLLOWING New Old
Ouflefs rG Panels, Cabinets Size Service Conduit
Switches 7 Switchboards Size Service Wires `p2-
Receptacles Panelboards Size Service Switch X00
Fixtures Festoon Lamps Size Sub Feed Conduit -.
Mercury Lamps Dryees KW Size Sub Feed Wires _
Ranges KW Heaters KW Number of Circuits _
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads 8_ZLighfing Power
Miscellaneous
Rough Inspection _ -!P-/ P -�7 7 7 -
Final Inspection B
Remarks: 8-.5• ) 7 S£lAloe� s:' // )� ��
12-/q-77SEi 280-201n