1772ch
10 313 I E, Es�r7R s-D 2 t y.
NO. ST LOT NO. -
AfIl mil N O ECTRICAL PERMIT
N 0 O ERTINO
Date /u+�a�1 ��wl� Permit No.
Fee N�A)'L12'
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
wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
Use of
Owner . 124 -IQA"�' 5 S
By
Phone: AL 2-/"O O d
NEW RPL FEES
Size Service Conduit ----------------------
Number of Outlets ---------- 1.------
----------
--___.__--
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 -------------- KW --------------
----------
• --------
--------------
Number of Meters ------------------------
Signs ---------- Transformers ........
I----------
----------
_---____-___:_
Misc--------------•-•-•--•--------------------------Dryers----------------------------------------
---------
----------
---------•----
Motors .................... HP --------------------
Phase ------------------- Permit Fee $1.00
Motors -------------------- HP --------------------
Phase --------------------
Motors -------------------- HP --
Phase -•------------------ H P Charge------------
TOTAL FEES i
Rough Wiring
DATE INS
Finish Wiring ________________I_______
DATE INSPECTOR
ON APPROVALS
Fixtures---------------------- ----------------------------
DATE MSPECTOR
Motors ------------- ------
TE
Final
.DATE INSPECTOR