2764 NO. STREET LOT NO.
E o �T FOR ELECTRICAL PERMIT
o ® '�M OF CUPERTINO
LLMAY 2129000
° Datc195— Pemtit No.
0 F
° ` CITY OF CUPERTNO Fee
a Application is hereby made to the City of Cupertino for a permit to install electrical
w i wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
j LL wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
00
F 3 City of Cupertino, and all other lavas applicable thereto.
z J Use of Premises—�
J0
O
3 a Owner C;—/ D Address
Z
By HEATH ELECTRIC Address
w
o L�bRk[66(4xAL1Gt`y h1A Approved _
AIM
—0 Phonc: /7�J� �. �� ✓ice
State License; /v'T� Phone ELgato 6.4422
l _ �
NEW RPL FEES
Size Service Conduit.... .!......C .�......Numher of 'Outlets.................. .. _ - -------- _ ..
--- ----
Size Service Wire-/.. :-----Number of Switches-----...-------- .._:J.. .......... ... ..........
Size Service Switch--Z --I'5?-Number of Receptacles.
Sub Feed Conduit..................Number of Fixtures..............._. -_-.....-
Size Sub Feed Wires--------------------Ranges---------------. KW.............. ------ ------- ---- ------
Number of Circuits Oven /- KW
- i
--------------
-
...... -.. .. .------ ---------.-
Number of eters...................Signs.......... Transformers-------- ---------- ----------
Mist-- GDryers / ------- - -- -------
-
- - ---------
Motors -- Phase------ - /d-
S
'
Motors-------------------- HP---------------- -- Phase Permit Fee $1.00
Motors------------ ------- HP------ ---------- Phase ------------------- H P Charge._.. -------- -/Q C)
TOTAL FEES
C.?
_ OF INSPECTION APPR VA •S
Rough Wirin .�..---- Su' --- Fixtures ..... ......... .._..
l �` .. 1 t - --�. ....................---
g -- --o-r[- L..�---InsrmroR---- ......
oxT[ L.'----IxsrmroR
Finish Winn .I..................... Motors - - �--
.AT[ Ix SR[CTOS x ''yyII��// LIxSR[CTOR
Final -------- ------ k..I.A\ ------
DATE IMSR[CTOR