2504 NO. STREET LOT NO. -
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s M APPL-ICATIO FOR ELECTRICAL PERMIT
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Cpau CUPERTINOU'.o Date DCV S 1963 ,1195— Permit No. ��v
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< Fee
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z w Ap��c��on0Flier&�a�e�tatheibrCity 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
0 r wiring and/or fixtures in accordance with the provisions of tpe-?;lectrical Code of the
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5 w City of Cupertino, all%ther I applicable thereto.
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i_j Use o Premises
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3 `< Owner `
w w By .j"'�-'��� /'�,Gp��( ._ Address
a CONTRACTOR, AGENT
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n State Licenso.—
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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 Cryrcwts_.-....'-' Oven _ KW-.. --- - "- - ..... ......
Number J eters__---------_---------Signs.......... Transformers-3c- --__---- _- ----- --I_ .-
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Misc.------------------�- --- Dryers.....------�-��-----.-...-------------- --_--'-- ------' ----.-...".
Motors------------------ '---: -------- Phase--------------------
Motors-------------------- HP-------------------- Phase---------- --------- Permit Fee $1.00
Motors-------------------- HP........ -- .. Phase------------- ...... H P Charge.. .. ....I'
TOTAL FEES 1
RECORD OF INSPECTION APPROVALS
Rough Wiring................ . - --- Fixtures -....-----..-.... .. .-------.-.--
OAT[ INSPECTOR AT[ SRCTOR
Finish Wiring ---------------- - - --- Motors ---- - -- - --�- -- --------------
DATE INSPECTOR 6 TOR
Final ..... - .. ........�.-......I- -C'
GAT FSP[CTOR