1868 (2) � ` -
NO. / STRA!,9C
-} r LOT NO. • r`'
APPLICAN 1 ._ ECTRICAL PERMIT
Ci Pr
PERTIN0
Date l 195— - Permit No.
`— Fee tS A'•
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
wiring and/or fixtures in accordance with the provisions of the,Electrical Code of the
City of Cupertino, all otlu"r laws appli 1e reto.
v Use of Premi "�
' c
u / /
a OivneAddress Q� a
v.
'By Address
S. CONTR TOA, AGENT
E IUL INSPECTOR
FRPL FEES
Size Service Conduit......................Number ofWts.._..M-w-- ---- -- ----------- ------D-.
Size Service Wires..........................Number Sl `ches........._..... .......... ..........L._...--..-.
Size Service Switch------------------------Number of Receptacles----------- --------- ----...... ..------------
Size Sub Feed Conduit..................Number of Fixtures.................. .......... .......... ..............
Size Sub Feed Wires...........---------Ranges................ KW.............. ......--- .......... .......---....
Number of Circuits................... Oven -------------- KW-............ .......... ..-...... ..............
Number of Meters........................Signs.......... Transformers.....-.- ---------- ---------- --------------
Misc-----._...----:------------------------------Dryers......_--__--- ,------------ - --------- -- ------ ---:.*?S...
Motors.................... HP------------------- Phase-------.-.-_...... F+grmit Fee $1.00 .
Motors------------------. HP------------------ Phase--- -r>�2" 8J
Motors------------ ------ HP-------------------- Phase-._- --.......... Clzzar
- e................ ..............
TOTAL FEES
RECORD OF INSPECTION APPROVALS t'
RoughWiring................1--------------------------- Fixtures ---------------------- ---------------------------
DATE INSPECTOR DATE INSPECTOR
FinishWiring ................I------------------------ Motors ------------- -.....--. ............................
DATE INSPECTOR A- DATE INSPECTOR
Final ........................-1---`----------------------
DATE INSPECTOR
I, the undersigned ea'hereby certify that
I am the owner and occupant of the single
family dwelling at //j?/j- Oli;4�,010e"VIX2
for is 'a 7making application to do
work as a homeowner.
I also certi ;t at wjll not hire any
non-lic �or contractor,
but will do this work myself.
TEI&PHONE NUMHKI IGN T•J