2687O��U CTI L-, i -u o
NO. STSTREEU LOT NO.
w
s?J'Q?'AtF0R ELECTRICAL PERMIT
oYU
PR 15 1964y of cuPEerlrao
Date
R 1 �i` 19ff Permit No.
IIUW Fee S J�20
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, and all other laws applicable thereto.
Use of Premises
rC�t 2So.J
Owner A
By S4 cd ✓C 6[ec l _ A
CONTRACTOR, AGENT A
Phone:C
State License: I?Py—%6 0
Rough Wiring ................
DATE
Finish Wiring ----------------
DATE
----------------
INSPECTOR A
INSPECTOR
Fixtures ._----....-----L----- DA - I ;-EC-T-OR
"I
Motors ----- ---- - ------ ------
L4 INSPECTOR
Final--------------------- . . ....... .
DATE INSPECTOR
NEW
RPL FEES
Size Service Conduit_ - - ---------
Numbr, of
O',itlets ---- _// ---- ----- -- -
-- -------
-- I- -,---
Size Service Wires---- -- ..;-9 .............Number
of
Switches J/ -------- -- --- ---
-------- .
/ 10
..... 7 -------
Size Service Switch ------ .........Number
of
Receptacles..----- - ----- ----
-------- -
----- I . ?o ----
0 0
Size Sub Feed Conduit -----------------
Number of
Fixtures......//.....- ----------
--------
----- =-
Size Sub Feed Wires --------------------
Ranges ----------------
KW.....---.-- - ------
----.---
---- -
------- * ------
rn
Nuber of Circuits----------------
Oven ..............
KW------------ ----------
-------- -
--------------
Number of Meters -----------------------
Signs ----------
Transformers..........-..---
-------- -
--------------
Misc------- ----------------------------------
--- Dryers ----------------
-------- -------------- ---
----------
--------------
Motors .... --- ----------- HP --------------------
Phase --------------------
Permit
Fee
$t.00
Motors----------------- -- HP --------------------
Phase --------------------
Motors ----------------- _ HP ----------------
... Phase.. ---------
-------- H P Charge._ .._..
...........
------.i''----'
TOTAL FEES_
T.
Rough Wiring ................
DATE
Finish Wiring ----------------
DATE
----------------
INSPECTOR A
INSPECTOR
Fixtures ._----....-----L----- DA - I ;-EC-T-OR
"I
Motors ----- ---- - ------ ------
L4 INSPECTOR
Final--------------------- . . ....... .
DATE INSPECTOR