2164 NO. STREET LOT.NO.
AP.R IC-ATION�FOR ELECTRICAL PERMIT
CI �' OE CUPERTINOt O*
JUL,6 1868
Date �y— 7 ._....,19a Permit No.
V
CITY UI LUFLK I ,1' ..� Fee ti
Application is hereby made to the City of Cupertino for a permit to install electrical' '
O wiring and/or fixtures as listed on the reverse side hereof, and agrees to instalP said f'
lLd wiring and/or fixtures in accordance withthe provisions of the Electrical Code,of the.
City,tof, Cupertino, and all other laws applicable thereto.
f "Use of Premi r
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NEW RPL PERS
Size Service Conduit----------------------Number of Outlets----------.--- ---------- ---------- -----------.
Size Service Wires-------------------------Number of Switches....----------- ---------- --------- ----.--------
Size Service Switch..........--..........Number of Receptacles------------ ---------- --------- -------------
I 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---------------------- ---------------- --------- -------- --------------
Motors.................... HP------------------- Phase-------------------- Permit Fee $1.00
Motors..----------------- HP...:................ Phase.................... -
Motors.................... HP------------------- Phase.................... H P Charge................ ......--------
TOTAL
FEES
RECORD OF INSPECTION APPROVALS
RoughWiring................ .---------............. Fixtures ................:..... .......... ------------.----
OAT[ I[[.[CTOR OATc NF CTOR
Finish Wiring ....:.........
..�- .....-._... Motors ........................�... ....
OAT[ ueeccroR 1oAyt, i TOR
Final ... .-�L�---J-
1 OAT[ INSPECTOR