2806D LOT NO.
0
FOR ELECTRICAL PERMIT
JUN 19 196A OF CUPERTINO
Datd+I� AC !�I I�DTI��If1, I Permit No.
J( ��+ Fee 5 �C
Application is hereby made to the City of Cupertino' for a permit to install electrical
t..� wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
O wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
(J� City of Cupertino, and all other laws applicable thereto.
Use of Premiqpq
mac! GloG \ ✓
7 Owner Address
Address &
VCONTRACTOR, AGENT Approvedi U ��� ''
Phone ELECTRICAL INE►RC
Size Service Conduit ----------------------
Number of Outlets_......_.___.
utlets----------------
Size Service Wires ................_........Number
Size
Df -Switches -------- -------
Size Service Switch......---
Number of Receptacles............
Size Sub Feed Conduit ------------------
Number of Fixtures----.5.....-------
ixtures----5-----------
Size Sub Feed Wires ...................Ranges...............-
Size
---------------- KW --------------
Number of Circuits------------------
Oven -------------- KW --------------
Number of Meters ......................_Signs..........
Transformers --------
---- ----------------------------------------- ....... —.1 - ----------------------- -----------------I---------I-------
------------- --I--- ------I- -- - - - ------- ------
Motors -------------------- HP -------------------- Phase .------------------ Per -------------------- HP -------- ---------- Phase -------------------- Permit Fee $1.00
Motors -------------------- HP --- Phase ----------- -------- H P Charge.----...---- -- -- - ---------
/ TOTAL FEES—1.cilcll
(;ORD OF INSPECTION APPROVALS
��!e --- -------
RoughWi Vf-rd , --- Fixtures ---------------------- ------ - - - --- ---- ----
/ DATE (- INSPECTOR DATA INSPECTOR
FinishWiring ---------------- I --------------------- Motors ............. .......... ----------------------------
DATE INSPECTOR DATE INSPECTOR--
Final------------------------ ............................
I DATE INSPECTOR