2656 NO. STREET LOT NO.
Z op ( 1
Yo FOR ELECTRICAL PERMIT
0 g Cl OF CUPERTINO
o J L<tUTAD 00 A CA
LL Date 2 K 19kZ Permit No.
F pf11T INO Fce S � —
<N 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
00
wiring and/or fixtures in accordance with the provisions of the Electrical Cade of the
5 m City of Cupertino, and, all other.laws applicable thereto..
z°J Use of Premises
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n
3 a Owner _ - -/ ��'""'-- Address +'r //l
N
w w By - L , . da - l ,.� �c _ 'Address
i o cox coqq, A0E Approved _
—V Phone: ��� /y ELECfRICA NSPECTOZ
State License: - ' CL
NEW RFL 'FEIS
Size Service Conduit------e7l............Number of Outlets....._....__._ _/_7-... ......__
Size Service Wires.........�z 0
----------Number of Switches......._._.... 0
Size Service Switch__..,,-Z.619-Number of Receptacles.........._ -/_7--- --- - -
Size Sub Feed Conduit------------------Number of Fixtures...._........__ L-/. ...._---- -
Size Sub Feed Wires--------------------Ranges---------------- KW---------- ---------- ---------- --------------
Nurnber 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—_31 �L0
RJ�COV5
�.Y ,40F INSPECTION APPROVAL
Rough Wiring ..ke......... ....... Fixtures ------------ ----- ------ - --- ----- ......
3�.,y- INSPECTOR Adbk DATE NSP
CTOR
Finish Wiring ............... I-------- Motors ------ ----
DATE IN31ECTOR Fi ------- - -U�._
..............
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