2836 NO. STREET LOT NO.
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Y o PA OR ELECTRICAL PERMIT
3 a D' 7MOF CUPERTINO -
2 LL
,tAUG 3 9864 �3�
" 0 Date 195— Permit No.
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<� pl'I t' O� ZbUSn�t�TIf A Y P
Fee t
A Ica Ion 1 her o h d of Cupertino fora permit to install electrical
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w s wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
w wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
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5 a City of Cupertino, and all other laws applicable thereto.
o_j Use of Premises
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3 Own C Address 7
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a a By _ Address
Q O CONTRACTOR, AGENT Approved L < `
U hone: '-S 3 - �� ELECTRICAL INSPECrM
State License: —f
NEW RPL FEES
Size Service Conduit----------------------Number of Outlets.......-------.-- ---------- .
Size Service Wires--------------------------Number of Switches____------- .
Size Service Switch.....-------- -----------Number of Receptacles---.-------- ----------
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-----....----..L------- ----
TOT4 FEES
RECORD OF INSPECTIONAPE OVALS /
Rough Wiring---------------- --- Fixtures �. ........ ........
DATE INSPECTOR D/1T
M3R[CTOR
Finish Wiring ....._......... ........................ Motor y��(\... ..'..1(. -- -.... .--J'•'-^---'
DST[ INSPECTOR U �LI J SP[F CION
Final ---- ...-'--- ---.------
�----------------------------
DATE INSPECTOR