85032 (2) 7611 Hrbj1and2rry Plaae /
Building Permit Confirmed IW
Not Required ❑
CITY OF SAN JOSE JUIILLD_ING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
I
Date----------3—/7------------------------ 19'�. Permit No.------ 5�3�-
The undersigned hereby makes application to the Electrical Inspector of the City of San Jose
for a permit to instal t� iri listed on the reverse side.
Exemption from r e or or Confractors License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ S_ S,S
Undersigned Vast' Chef his Sta�(g of California Contractor's License
is in full force and effect and pr000fl�l adzes this p�a�Qn���
San Jose City Business License..//�yyy�i%% �(�/j
I certify that in the performance of the work for which thissued 1 shall not employ
any person in any manner so as to violate the ork�mjep-'ss compensation laws of California.
�— / [ LY
OWNER
ADDRESS
USE OF BUILDING
FIRM �e� G' �t SIGNED ,
FORM 280.10 (REV. 366) IOM p
7611 Hollanderry P1 Dodd /
ITEMIZE THE FOLLOWING New Old
Outlets
—'/—Panels, Cabinets Size Service Conduit �Y
Switches Switchboards Size Service Wires 2-
Receptacles •5 Panelboards Size Service Switch /
Fixtures '/ Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers KW Size Sub Feed Wires -7
Ranges KW Heaters KW Number of Circuits
Signs Transformers, Motors Number of Meters
HP Phase Ampere Loads Lighting Power
Miscellaneous
Rough Inspection — , Ry li
Final Inspection /'2'—/, d By y
Remarks: /IA / W
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