2164 NO. STREET �" LOT,NO.
fjAPPLICATIONIrOR ELECTRICAL PERMIT
JUL V33C f OF CUPERTINO
` Datep /y--/ ...194U, Permit No.
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V 1 i Fye .::��:�.hf.Y Fee S `�• CJ l�
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 f
wiring and/or fixtures in accordance withthe provisions of the Electrical Code of the r4
City of Cupertino, and all other laws applicable thereto.
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ELEC17UU1 INS}ECI'Ol
NEW RPL FEES
' Size Service Conduit......................Number of Outlets..........-------- -------- ----- .... ...-----------
Size Service Wires-------------------------Number of Switches.--.....-------- ---------- --------- _-.--..----
f Size Service Switch....... Number of Receptacles------------ ---------- ---------- - ------------
Size Sub Feed Conduit------------------Number of Fixtures------------------ ---------- -
Size Sub Feed Wires.---..............Ranges.....------.... KW-------------- -------- ----...---
I ; Number of Circuits................... Oven .... ......... KW-------------- --------- ---.....-
Number of Meters------------------------Signs---------. Transformers--------L--------- ---------- --------------
Misc_ --
----------------------------------------------Dryers..--------------- ------------------- ------ --------- - ............
Motors-------------------- HP------------------- Phase- -- -----.---------- Permit Fee $1.00
• Motors. ---- --------- HP--- - -
------- --- --- Phase------------------
-
Motors-------------------- HP---------------- Phase----------------- H P Charge----------.----- -------------
{( TOTAL FEES
I RECORD OF INSPECTION APPROVALS
. ; Rough Wiring................I--------------------------- _ Fixtures ----:---------:....... -----------------.....---
DATE INSPECTOR DATE Mir CiOR
Finish Wiring -------`------- --------------------!... Motors -----......- ......... -.` -..-
F DATE INSPECTORDAA I TOR
Final 7. '...-
,� DATE INSPECTOR �