1647 (2) NO. STREET LOT NO.
D IQR ELECTRICAL PERMIT
p a� CI F CUPERTINO
Y 6 196 M .
c (,
Date 7 /�r��yy gyp'—fly', 195— Permit No.
( TX ��J� 60� I Fee
Apl3li titin I hereby made to t�e City of Cupertino for a permit to inktall 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,
and
all other laws applicable thereto.
,Use of Premises �-
c
v
a Owner Address
u '1�
fg By Address
CONTRACTOR, AGENT
`�., �� Approved
Phone: 9 ® EffICTRICAL nVSPBChDl
NEW RPL Fees
Size Service Conduit..... ..... .......Number of Outlets.................. .......... .......... ..............
Size Service Wires.....3—.Z..Number of Switches.» ........... .......... .......... ..............
Size Service Switch.....r�A.Number of Recegtkes.....:...... .......... ......_.. .......I......
r
Size Sub Feed Conduit..................Number of Fixtures.................. .......... .......... ..............
Size Sub Feed Wires.....................Ranges.....L....... KW.............. ......... .......... ....7
Number of Circuits Oven ............. KW.............. .......... .......... ..............
Number of Meters..... ...............Signs......... TcanSfor
Misc......-----....................................Dryers...
Motors ............ Phase.................... r Permit Fee $100
Motors.................... lip.................... Phase..............,..... $1.00
Motors.................... HP.................... Phase.................... H P Charge................ .... ......
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring................ ............................ •Fixtures ...................... ...,-... ,'—...........
OAT[ IND r tcTON DATE fYtCTOR
Finish Wiring ................�......,.......... .... Motors .. .. . �.... .......
DATE INDNEDToN � 3
Final � �^�b 7�- .... ................
DAT INDTiCTON