2665 /04/11 1 -
m No.
MINATI't LOT No.
o° /APR ELECTRICAL PERMIT
MAR 3 0 1964f cuPExrlNo
Z LL � T /7
° Dat C1 — SID t4tn r/
195— Permit No.
a Fee S
a Application is hereby made to the 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
j 4 wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
00
> City of Cupertino, and all -other laws applicable thereto.
o J Use of Premises
(J .
3 <
owner ��� � C q Address _
Address
QCONTRACTOR, ANT T A
—l) Phone: n PProt'
' ELEClAl J1L INL}E
State License:
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........ .......... ---- /,7__0
�tes�.f.--�------...----�---Dryers-------------------------.-------------- -------- -----...-' ---2,.-----..
Motors----------------- HP-----------------... Phase.------------------ Permit Fee $1.00
Motors-------------------- HP------------------ Phase...................
Motors------------------- HP------------------ Phase...-----........... H P Charge--------------- -------
TOTAL FEES 90
RECORD OF INSPECTION APPROVALS
Rough Wiring-------------- --- Fixtures ------------ --
-- ----- ----
DAT[ CTOR OAT. IMS[[
Finish Wiring ...._---------�- IR TT[ . ... Motors ---------- CTOR-- --...- �-
- -
---------
DAT. INSR[CTOR rT�[ M[[[CTOR
Final �. C.�`1..�. ...�. ------------
DAT[ INSPECTOR