2632 / h0. STREET LOT NO.
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r o APPLICATION FOR ELECTRICAL PERMIT
WL a 7D ` ratOFCUPERTINO
r. 0 Date 195— Permit No.
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a Fee S
< Ap li�Ta 1 n 1J'5L ter t16I�e� [Ity of Cupertino-for a permit to install electrical
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W i wirin�j�Q orVtu1�bn�rnc reverse side hereof, and agrees to install said
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wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
5 0 City of Cupertino,` and all other laws applicable
thereto.
Use of Premises L4
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3a Owner 4566 Boy4 'i.n Address �� �> C���h�• l�• S`
W w By Rre/M l C,ref _ Address . 1YOCAY,-414f- 1"w
02 CONTRACTOR, AGENT p roved
<U Phone: 'Yo /
o —//p/� pp ELECTRICAL WSPErlC1
p State License:
NEW RPL FEES
Size Service Conduit._...................Number of Outlets.... @.._ �•.0
v
Size Service Wires..........................Number of Switches.___�. ---... .v_. ----------
Size Service Switch----------------------Number of Receptacles-------.-- --------- --------- -------------
Size Sub Feed Conduit..................Number of Fixtures..-...1(7- --------- --------- .�r.C!...�
Size Sub Feed Wires.----.---------..Ranges................ KW.............. ------ --- ---------- -------.-.-
Number of Circuits-------------_--- Oven ------------- KW----...----- ------- --------- -------_---
Number of Meters..._...................Signs--/..... Transformers-------- ---------- --------- --------.-/0
Misc.-------------------------------------Dryers---------------------------------- --------- ------ --------------
Motors------------------- HP-------------------- Phase-------------------- Permit Fee $1.00
Motors----------------- HP----------------- Phase----------------
Motors.................... HP----------------- Phase........------- H P Charge................ ---- ----
TOTAL FEES 1 - -
3 30
RECORD OF INSPECTION APPROVALS
Rough Wiring ------------------------- Fixtures ............_------- ---- ---..............
DATE INSPECTOR DATE INSPECTOR
Finish Wiring ........ ------�------------------ Motors ------------- -----Ij- �....._
ATL INSP[CTOR y;
- Final J�.^.t�T[/
..... . --------------------
DATE INSP[CTOII