2736 - Y LOT NO.
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VIMA
� FOR ELECTRICAL PERMIT
4 ¢d3' Y 5 I9Y'f TY OF CUPLRTINO (J�
0o Hbt� t 195_ Permit No.
l�f Fee ti
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<m Application is hereby made to the City of Cupertino for a permit to install electrical
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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
a City of Cuperti/no/ all other I applicab h eto.
z_j Use of Premi: �/� .,,/
3 F Owner e� // Address -rl'or '4/'�/ylz- DA
N
W W By _ Address
O / CONTRACTOR, AGENT A roved C
—L) Phone: 'F0— � PP ELECTRICAL INSTECM
n State License. `
NEW RPL FEES
Size Service Conduit.----_------------Number�O�utlet s-----------------. -- ....... ....
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--------------�
Motors...-.-------.---- HP------------------- Phase_._...---_._-- HP Charge----------------L..-...-----
TOTAL FEES
RECORD OF INSPECTION APPROVALS
Rough Wiring------..._----- -------- --- Fixtures - .
01T[ IMSP[CTOR AT !P[CTOR
Finish Wiring .....----------I-. --- Motors -------- - --- -A----------------
DET[ IN![[CTOR �!T SPECTOR
Final ....... ...... -------� --.....
O [ INSPECTOR