2688 (2) SrREr( � - LOT NO.
o :CC - OR ELECTRICAL PERMIT
5 U
VAPR 1 7 996AcIF cuppxTlrao
So
D 4
atc
4 F b95— Permit No.
oaUlly
• Fcc S
a w 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
0 o wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
> m City of Cupertino, and all other IIIc applicable thereto.
o J Use of Pr mises
O O
3 N Owner \ J O Address „ " —
w w By Address
QO ONTAACI'On, AGENT . A roved
—0 r Phone: �— O I O pp ELECTRICAL IMF UCTM
l\ 1"State License: _
l 11 NEW RPL FEES
—90
Size Service Conduit..... ...............Number of Outlets------------------ --- .... ---------- --------- ....
Size Service Wires----- %7...........Number of Switches._..._..._...
Size Service Switch..�7,—.N--- Number of Receptacles............ ..p?_.. .......... _....'. (`
Size Sub Feed Conduit.......7-.------Number of Fixtures..............---- ---S... . .... ... ....-..1.
Size Sub Feed Wires-.''I.Z..-._Ranges--------------- KW----------- ---------- .-..-.... ..---.----
Number of Circuits-----....... Oven _.. ......... KW-------------- -------- ---------- -------------
Number of Meters.......1--------.....Signs--------- Transformers....-.- --.--- .------- -----------
Misc.----...------_-_-----------... ..........Dryers......_._-------------'---... .... '------ ---------- -----........
Motors.... HP..........----..--- Phase---------_......... Permit Fee $1.00
Motors.................... HP--- Phase-----------.. .....
Motors------------------ HP-----------------_. Phase.................... H P Charge.----------...-- ------------
TOTAL FEES LJ' 61
RECORD OF INSPECTION APPROVALS
Rough Wiring....:._-- .- Fixtures ..._....__.....-.- -.-- "
..
8 S _ - - rr
vere IRRRc<rvR verz I irccrve��--���
Finish Wiring -----------.. ............... Motors . _.. ..— ---
--�'-- .......-----'
SPEC
vcTe IR[rccrve �T / ` `/ /�------ TOR__
- ------------
Final 1[--- - •- r
OST INSPECTOR
d
I, the undersigned'.do hereby- certif�i that
I am the owner and occupant of the single
family dwelling at341g03 , !9_1
for which ,I am making app5ication to do
`����^�-� ` work as a homeowner.
I also certify that I will not hire any
non-licensed or contractor,
but will do this work myself.
LsZ -
aioA-
TELEPHONE NUMBER SIGNATURE