2674 NO. STREET T NO.
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PR,9QA FOR ELECTRICAL PERMIT
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CI F CUPERTINO
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PR 8 1964
' 0 Date 195— Permit No.
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° < ff ��// ((���� //�a pp Fee
a) A)�liTa6on45iherGOPERTING—ity of Cupertino for a permit to install electrical
r wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
�. wiring and/or fixtur{s in accordanre with the provisions of the Electrical Code of the
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5 0 City of Cupertin , and all other laws applic #e thereetto..
z J Use of Premise
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Address
? By� '�-�� /I� Address
2ONTRACTOR, AGEN
AELECMTRICAL411SPIECrMIX—Uo jAa Phony. PProved
State License:
_ NEW APL FEES
Size Service Conduit----------------------Number of Outlets-...-------------- .
Size Service Wires.................._...._Number of Switches................ L�--- ---------- . .-
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--------._--- __ Perini[ Fee $1.00
Motors..-..------------ HP-------------'--- Phase----------------
Motors--------`----- HP----------------- Phase-------------- H P Charge..... .......... .....
TOTAL FEES f
RECORD OF INSPECTION APPR ALS
Rough Wiring------------- ----------------------- Fixtures ----i---------------�------ -----...........
DATE INSPECTOR DATc ITECTOR
Finish Wiring .---....__.... ---------------------.-. Motors ..... .................
DATE INSPECTOR A�T \/ -- S ECT
Final .-----.. ..........�._f-i ----------
DATE INSPECTOR