2562 LOT
NO. R ELECTRICAL NO.
DAE
,,,AN 2 01964C F CUPERTINO
� ��� �s6
Date rnlT 16 G. IDCDTIOIfi�� Permit No.
lV��� �� �� W, u oe v'i
Fee
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
t\� City of Cupertino, and all other laws applicable thereto.
Use of Premi 0" ✓�lWY
c I
Owner
✓ Address dJ,
By - " �45n� Address �J
CONTAACiOA, AGENT
Approv
Phone: CELECTHIUL INf}HCIOR
NEW RPL FEES
Size Service Conduit----------------------Number of Outlets-..------------ -- -----
Size Service Wires.............----------Number of Switches---------------- ------- ----- -.- -00
Size Service Switch........................Number of Receptacles............ 5--- - ---- _ -------------
Size Sub Feed Conduit..............._.Number of Fixtures..---------------- ---/ -Co
i
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.................... H P Charge------------ -----------
TOTAL FEES 13'
RECORD OF INSPECTION APPROVALS
RoughWiring................ --------------------------- Fixtures ---------------------- ----------------------
DATE INSPECTORDATE SRECTOR
Finish Wiring ----- - - . . Motors ............. - .........
DATE u3recroR % P�oA,xE_,f SrECTOR
Finalit ----- --------- -`.�.--�--� --'---...
DATE INSPECTOR