2805NO. STREET LOT NO.
W Z Q
rt OR ELECTRICAL PERMIT
3 `
&f)J.0 N 1964 of cuPLxTlrao
10
F
'o ~ Da� T�Nn ,1¢5— Permit No.
o Fee 5�
< w Application is hereby made to the City of Cupertino for a permit to install electrical
w I wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
0 0 Miring and/or fixtures in accordance with the provisigns of the Electrical Code of e
> City of Cupertino, arld all other lases applicable ereto: /
z Use of Premises ,f//J 'J' N it 't ! t t
J Z
O
3 ` Owne % Address
''�_
W � I By — _ Address
CONTRACTOR, AGENT /
Phone: S�cf J6 V APProved
�/ �j /� !ELECTRICAL INSfEC70t�
ELECTRICAL License: /�� 7/ —�'�t
NEW RPL FEES
Size Service Conduit ......................Number of Outlets ------------------ I- ___ ..._I._.- ----
Size Service Wires__......................Number-of. Switches_ ---........
Size Service Switch------------------------ Number of Receptacles .........._ .._._..- ..._._..
Size Sub Feed Conduit ----- ------------ Number of Fixtures....... r ...... .......... ...-._...
Size Sub Feed Wires -------------------- Ranges ................ KW....------ _-------- ----------
Numher of Cirmits_-__------------ Oven -------- ----- KW-------- - ------------- ----------
M
1I
�
Number of Meters
------------------------
Signs-. _.
Tra formers........
-
Misc.--------------------------
--------------Dryers.----_
-------
------5V
Motors ..-.-------------
HP --------------------
Phase --------------------
Permit
Fee $1.00
Motors -------- --------
HP .---------------
Phase ----------
Motors-------------------- -------------------
HP -----
........ Phase -----------
..... H P Charge........------
--- --------
TOTAL FEESD
RECORD OF INSPECTION APPROVALS
RoughWiring ----------------
............................
Fixtures ----------------------
-------
OATE
INSPECTOR
GATE
INSRLCTOR
FinishWiring ................
...-------------------
Motors ------------_----...�..--------`---...........
OATS
INSPECTOR
OATS
INSPECTOR
Final--- ----------I.......-......
GATE
INSPECTOR