2165 cq-w/' sf ° Nwy rF 4
_ NO. STREET LOT NO.
TIA 'Q
Pl.tCdT16 '-7F`OR ELECTRICAL PERMIT
10 963 �`� OF CUPERTINO
JUL 1 /
Date o Y4$ Permit No.
CITY F C "'t Fee s 3
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
m
wiring and/or fixtures in accordance wi provisio e ctncal Code of the
City of Cupertino, other - ' able t er
n
a Use of Premi,P= C onmere tgL
c
a Owner 8�✓� °F /�MerieFl Address STVeMSCIree�-BLVD,
By rilio E/eczllc. INC, Address Olaoi r'w
CONTRACTOR, AGENT
If Approved
Phone: '25;2-166c) ELECTRICAL IMPECIOM
• -• N PV RPL FEES
Size Service Conduit..........:...........Number of Outlets..._............- ---------- ----------L..-------
._.
Size Service Wires.......................... umber 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--------I--------- ---------- --------------
Misc..rPIp---P°-"'-er---Pa/2......---Dryers---------------------------------- -------- ---------- ..I_.00.
Motors-------------------- HP----------------- Phase----------...----
Motors.................... HP------------------- Phase-.-----.-------. Permit Fee $1.00
Motors.................... HP-------------------- Phase----------------- H P Charge------------- I ------------
TOTAL FEES 60
RECORD OF INSPECTION APPROVALS
Rough Wiring ------------------------ Fixtures --------------------- ---------- ----------
OAT[ INSPECTOR............ ATE
'
'
Finish Wiring .....I"...... ... Motors .. ......._.- --- �------
DAT[ INSPECTOR
Final .. l..l. .k .. "-
D [ IRSP[CTOR