2199r
NO. STREET LOT NO.
�APPLICAON F I wLECTRICAL PERMIT
JUL 16 19
1 CITY63 H UPERTINO
1 ! Il��ll .�
Date 1�—' Permit No. I/ OI
Y OF CUPERYiI !0 Fee S
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
wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
Use of Premiq'q
c
a � rvL o
:a Owner Address
CONTRACTOR, AGENT Approved
�/ %U,fS pp
Phone: EL¢CCRICAL INi}EC701
i 9�
NEW RPL FEES
Size Service Conduit----------------------Number of Outlets---.-------------- ------ - ._-------
I-.._.--------
Size Service Wires.........................Number of Switches---------------- -------- -.........L--...-.------
Size Service Switch------------------------Number of Receptacles------------ ---------- _------- ---.-.--------
Size Sub Feed Conduit------------------Number of Fixtures------------------ ---------- ---------- ----------
SizeSub 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.................... H P Charge------------- -------------
TOTAL FEES
RECORD OF INSPECTION APPROVALS
Rough Wiring................ -'-"---------.._........ Fixtures --- ---�----- ------_....---
DATC INf[[CTOR .ATF IMSR[<TOR
FinishWiring ....:........... ........................ Motors ....---- -- ---- --- ---------------------
DAT[ IRS[CCTOR DA
Final J -I- INS[CCTOR -'
DAT[ � INS[[CTOR