1609 NO. STREET LOT NO.
MW, FOR ELECTRICAL PERMIT
ti r A Q � OF CUPERTINO
3 '# f
Date ryv�/ Y , 1 J-y Permit No. b � I r,�J v
QT -r CQPERTINQ Fee
t i Is here y made to t e 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.
v Use of Premi=P=
Own(e�//��✓�-y ` /- Address
By 5�.. � �, tv "`��"� Address
CONTRACTOR, AGENty�
i 7/-
Approved ��'�
Phone: 7 Y �—i`� '+ C/ ELECTRICAL INSPECTM
i
NEW APL FEES
Size Service Conduit----------------------Number of Outlets---------__..... ....-_--- -
-----I- - .......
Size Service Wires.......................... - - - -------- --.. -
Number of Switches----__.------ - Y �-- -- - ..----
Size Service Switch------------------------Number of Receptacles_---------- ---- /p
------- --------------
Size Sub Feed Conduit------------------Number of Fixtures..... -�------ ---------- -6�Zr
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.........------- HP Charge------------ --
--- 0 a
TOTAL FEES S"
CO SPECTION APPROVALS
Rough Wiring.. . .71r.
� - -- - ...... Fixtures -------------------- ----------------------
OA INSPECTOR .ATE INSPECTOR
Finish Wiring -------- ..... ........................ Motors -VAT
�--------- - .............
DATE INSPECTOR Final . INSPECTOR