2802 loll/ �o ,�liw•re, � y _
NO. STREET LOT NO. -
r /�GPPL'o ) RO OR ELECTRICAL PERMIT
3 < , JUN 101964 OF cuPExTlrao
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Da� — 191(--"Z Permit No. v ��
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i�' 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
LL wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
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5 City of Cupertino, and all other laws applicable th -
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z J Use of Premises
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3 � Own��e�rr77// /— Address
W W By �� ` _ JL
A�C' C ; /t�/C, Address 7m
QO CONTRACTOR, AGENT ApprOVed
u Phone: ELECTRICAL tNSiECTM
State License: Z 7- ! d'7'G/o
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--------------------
M-�e'r�/------ --------- HP---- --- Phase----------------.. H P Charge-- -------
TOTAL
---TOTAL FEES- 2,0a
RECORD INSPECTION APPROVALS
Rough Wiring......-------- ------------------------ Fixtures ---------------------- --- -----
OAT[ IXf R[CTOR OAT[ IX R.......
Finish Wiring .-.------------�- Motors ...._.....A- -------- ---- --- ------O--
DATE INSPECTOR
Final -----------------'----- ------------------------
DATE INSPECTOR