2598 NO. STREET LOT NO.
x o ® 4 - A :1 1,FOR ELECTRICAL PERMIT
5 U FEB 2 0 1964 , of cvPExTlrao
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o Date195— Permit No.
CITY 0 C s ONS Fee 5 3 v
a m 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
4 wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
00
> City of Cupertino, and all oth r laws applic`ableetthherreto.
o-J- Use of Premises ,� /A
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3 Owner �CQ� Addresso�1;-G-1 41
— N
w w r By Address
OCONTRACTOR, AGENT PP A roved
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hPhonc: �— .5':!P /Q '�1,G ELECIAtUi IMPEC70i/
y \State License:/a-5—S'F/
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NEW RPL FEES
Size Service Conduit......................Number of Outlets..:............... ..
Size Service Wires.----.----------.---.-Number 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.......... Transformers4. .......... .......... .x•..00
Misc
- ------------------------------------------- .............. -- - -- ---- ---------- /-57/
----- ---
HP------------- -. Phase---.-.------- Permit Fee $1.00
Motors-------------------- HP.---------------- Phase----------------
Motors-------------------- HP---------------- Phase----------------- H P Charge................
f�
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring---------..... ----_-------------------- Fixtures --------- -----------------
DATE INSPECTOR DAT IX [CTOR
Finish Wiring ................ - --------- Moto rs ... ..... ... .......�......
--- .. . ...........
DAT[ INSPECTOR •yT ! R
Final
O.1 IXSP[LTOR