2615 n 17
6 O
w a
�TA
- LOT NO.
IATIONFOR ELECTRICAL P
ERMIT
Yo a
CITY OF CUPERTINO0 ffll�rll
1964
3 V
oDatcCITV (1 (1iTH`DT•� 195LLII Permit No.
a Fee S a ��
N Application is hereby made to the City of Cupertinoifa permit to mdtall electrical
wiring and/or fixtures as listed on the reverse sidt hereof, and agrees to install said
LL wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
00
> N City of Cupertino, and all other !aws aicable thereto.
03 (\
oa r
a _j Use of Premises
3a Ownert4yyk0.(\ � S ""^{`Re' Address
- N ��JJ � ( l
w W By tai�,U, -1-tv K �AIJ (0—V3`i)._ Addressa Dhw.e—`t�
y CONTRACTOR, AGENT
a 0 L� c Q� _ Approved _
ELECTM,L INS�ECIO�
State License 9 '7 c lG
_ NEW RPL FEES
Size Service Conduit----------------------Number of Outlets----.....-------- -.-------. -.---7 ._.---. ----
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.
----.-----.-.
Misc.----...--rr-�----------------- ----Dryers-------------------------------- -........- ------.. ..----------
Motors-----Y----------- HP.--.----... Phase------------------- Permit Fee $1.00
Motors----------------- HP.........----..... Phase------------------ 00
Motors------------------- HP.........--.. ...... Phase...-------........ H P Charge------------- ... {--
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring................ .................'0--------- Fixtures --......------.-.....�------
eET[ IxsrmrR oerz ar[craR
FinishWiring ................ ........................ Motors ---------'_---_-...�.....-. . .--........-'--
G..r[ INSPECTOR Ory'- -- [CTOL
Final ...--'..�'-J----
OATL INSPECTOR