2691 (2) ._.s,
m Q - N6�'/.p-=`jJr,•' :STREET - LOT NO.
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' 0 C ELECTRICAL PERMIT
01 PR 21 190cuPERTlydo
LL r DateY OF 1VV�pllu— Permit No. -
o a Fee 5 a
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N Application is hereby made to the City of Cupertino for a permit to install electrical
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wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
0-0 wiring and/or fixtures in accordance with.the provisions of the Electrical Code of the
r City of Cupertino, and all other laws applic le thereto. _
oz._j Use of Premises
3 a Address
Own
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W w Byt _ Address
q 1Phonc: ^^ nn CO ACTOR, AGENT
a l� 16 3/Z _ APProved —
ELELlA1CAL INSPECTOR
State License — I
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T, .the. undersigned do 'hereti'y certifA Ytait
and occu ant,.' f to .single
am the- ownerp �,�``�
'family dwelling at,�'0J17 `'!tZ
for.rlsihr1 I �m makingr'app�li ation .to do
��f/ work 'assa,. homeowner.
I also certify t at I �willt n t hire •any' O
non-licensedcQ2ccccti- ,s `or contractor,
but 'will do this work myself.
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TELEPHONE NUMBER GNATU� RE;