95389 (2) 7610 Hollandery
.r Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE —RUlL[IING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date----------------�l-_ - ---------- 19-��..�. Permit No.J�'5 �E7.
The undersigned hOreb aka a 'c io fo a lectr' Inspector of the City of San Jose
for a permit to install el ct ' al I r a s c on the reverse side.
Esem pfion from re o r Si o a d r onfracfor's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his Staten �ar'rnia S `c� L,jc
is in full force and effect and properly s tJs�}a3""^'✓"" .
San Jose City Businasi License # 1..,0/Z
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 OF-
ADDRESS ADDRESS C
i
USE OF BUILD NG y
FIRM -SIGNED `
FORM 280-10 18/681 IOM
7r10 T4^11anegary .!_ Dodd /Vf�
ITEMIZE THE FOLLOWING New Old
Outlets //�/ Panels, Cabinets Size Service Conduit �f
Switches 10 Switchboards Size Service Wires
Receptacles f� Panelboards Size Service Switch
Fixtures Festoon Lamps--Size Sub Feed Conduit
Mercury Lamps Dryers __I— KWht,R_' Size Sub Feed Wires
Ranges KW Heaters KW Number of Circuits •�
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads Lighting Power
Miscellaneous �y�
Rough Inspection 2 �` �� T py
Final Inspection /L—//o'—t� By '
Remarks:-2%?7`6 f'��p,7 C[ u/�s., / / � 6
�,or c"/W ori ��c.../✓o. �ti ciS� 4rr