2780 ,20 6
NO.
STREET LOT NO.
E o D a FOR ELECTRICAL PERMIT
3 < MAY 26 1964cI OF CUPERTINO
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LLw Date S� Z �— +"^�}f19T!� Permit No.
6F Fee 5 6f-0
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a Application is hereby made to the City of Cupertino for a permit to install electrical
r wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
li
00 wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
S W City of Cupertino, and all other lases applicable thereto.
z_j Use of Premises
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3 <
Owner � Address
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W W By Address =4 S'V.
Q O fr.Ft.$A 4ACT R, AGENT Approved
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—U phone. A X (, r� JQ - ELECTRICAL INSPECT=
t) State License: 1- /X
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-----.6o... .... .......... . 6- Y
'------- ------------ O
Size Sub Feed Wires--------------------Ranges---------------- KW------------ ------- ------- -------....
Number of Circuits------------------ Oven .............. KW-------------- ----- - -------- --------------
Number of Meters----.--..............Signs.--------- Transformers.....-- --.-----
Misc..............---------------------------Dryers.._---------------------------- -- ------- --------- --------------
MotorsMotors..........------ HP------------------ Phase---------------
Motors...............--- HP--------------- Phase........ --......... Permit Fee $1.00
Motors------------------ HP---------------- Phase-------- ------- H P Charge.........- ----- --------.----
TOTAL FEES 7 r0
RECORD OF INSPECTION APPROVALS
Rough Wiring - ---------------------- Fixtures ..---------------
OAT[ INSPECTOR DATE INSPECTOR
Finish WiringOATL .....wI--NSPECTOI------- .... Motors ---.....-OATF- -._------
IXSP[CTDq
Final ---------- ------..................
OAT[ INSPECTOR