2835 &t4
NO. ^� STREET LOT NO..*
D ^TO"""GA N FOR ELECTRICAL PERMIT
CITY OF CUPERTINO
1 J70 -2UF(ERT
laoa
t� Date9 , 196W Permit No.
G1TYIIUI/ Fee S �
—�t\-pp reation is hereby made to the City of Cupertino for a permit to Install electrical
g 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
I„ City of Cupertino, and all all other laws applicable thereto.
Use of Premises
"
Owner ` Cl � /� Address
a
`:?' By
Address
225 �
0 CONTRACTOR, AGENT Appo e C
Phone: Yg- 707
E CTRIUL INSPEC101
NEW RPL FEES
o Size Service Conduit.....................Number of Outlets. "I ...."-------
Size Service Wires.........................Number of Switches.--------------- -------- ---------I....-------..-
Size Service Switch........................Number of Receptacles..---------- ---------- ------- - ------------
Size Sub Feed Conduit-----------------Number of Fixtures------------------ ---------- --------- ..-.-..-._...
Size Sub Feed Wires...---------------Ranges--------..... KW---------....-
..,..
...- .------.. -. -------- ----------.-_--
Number of Circuits................... Oven ....
rKW - ---- ------ --- ------- --------------
Number of Meters........................Signs l -. T �
ransm $d.-- 2Q6
Misr-...............'--------------------------Dryers---------------------------------... -------- `-- -- -----
Motors-------------------- HP-------------------- Phase----------------- Permit Fee $1.00
Motors-------------------- HP------------------. Phase
Motors HP..-...-.-------. Phase.............---_ HP Charge............... .------TOTAL FEES
RECORD OF INSPECTION APPROVALS
Rough Wiring --------- Fixtures ............._.. --L....----
-------------
OAT[ INSPECT OR
OATE SPECT.
Finish Wiring -------------. ............._.----.... Motors ------ -----_ ----�----- --- --------------
OAT[ INSPECTOR Final -Y... -- --- �.----
OAT[ IXSP[CTOR