2592 .u� .
NO. STAE /' OT NO.
r o ® AP I.. N OR ELECTRICAL PERMIT
o a Cjqy OF CUPERTINO
W FEB 13 1964
n Date 195— Permit No. �� 9
�—
° a CITY OF CUPERT'���z Fee S S6r
a N 'Application is hereby made to the City of Cupertino for a permit to install electrical
w
r wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
.. wiring and/or fixtures in accordane-c with the provisions of the Electrical Code of the
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City of Cupertino, and 1 of ler laws applicable thereto.
z_j Use of Premises _
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3 m Owner / C� Address
W Z By Address - `� A'' hS: Y
ww -
QO CONTRACT AGENT `j rov �
_l) Phonc: Z-plc — / �� PF ELECnlc tN5}E
State License; —f
K."W RPL FEES
Size Service Conduit.-/--- .......Number of Outlets..-_5 -7baw-
Size Service Wires-_.W-Z.--.........Number of Switches_--..---_._- --_J---- ------------
Size Service Switch.../.A#._P�_ *_ Number of Receptacles__-------. - ---------- -
Size Sub Feed Conduit---_.............Number of Fixtures_-.-.----_._-.- 1-.S. .
_---------- ----------
Size Sub Feed Wires....................Ranges------/------- KW.------.----_ --------- ---------- --------
Number of Circuits.......7....... Oven --._I-..... KW.....--_-.--' ---------- ---------- -----114
-----------
Number of Meters......../........ --Signs---------- Transformers ------- -- -----**------
Misc:7Ln 4o _ Dyers- - - L --- - - I
. ...
Motors-- -A..........
HPa Phase-----/..._.-.._-
Permit Fee $1.00
Motors.................... HP ................. Phase--------------_ �I
Motors-------------------- HP.................... Phase.................._ H P Charge------------
TOTAL FEES 6i
,-RF,W F ENSPECTION APPROVALS
Rough Winn g.9.._-,.N
- :1.... .. ... . ......... Fixtures ---- - - ---------
DATE I.SPCIT.1 -- D.t TE
-ANSPECTOft
Finish Wiring ............... _ _ _ Motors _ Ie-`------------
-----
DATINIECTO. , -
Final --- -->c - ��
-- - ------
..........
DATE INSPECTOR
I, the undersigned do. hereby certify that
'I am the owner and occupant f the s ng le
famil;Y dwelling at /C� 2
forwhich I�m making applica on do
M� work as a homeowner.
I also certify t at I will not hire any
non-licensed/oe-Ar-;,&,i .. or contractor,
but will do this work myself.
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TELEPHONE7E NUMBER IG JRE
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