2557 ,2oG4/ d-�omEfTfiaO
NO. ;T LOT NO.
I AC TIdN�D LECTRICAL PERMIT
jAN g QV �`PERTINO
Date /—My OF wm'Ti Permit No.
Fee
Application is hereby made to the City of Cupertino for 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 Premises S�/V:W_* /�dtGfii✓G ,CFSiOfNCE
;.a Owner WIr '"qddress 2Oe9l
By /� �LFt�C�/e Address
CONTRACTOR, AGENT
Approved
�Q(,�/ Phone: ELECTRICAL INSPECTM
NEW RPL FEES
Size Service Conduit----------.-----------Number of Outlets... ..........
Size Service Wires.........................Number of Switches_.._.. 90
y;o
Size Service Switch--------------........_Number of Receptacles._ �J.... ---------- ._....._ _.. ----
Size Sub Feed Conduit------------------Number of Fixtures_.__..... .......... _......._ ��....
Size Sub Feed Wires..........'-'-'....Ranges................ KW-------------- --------- --------- ------------
Number of Circuits------------------- Oven ........ KW......-------- -------- --------- ----------
Number of Meters...._..................Signs.......... Transformers........
Misc.......------- ------"-'----------1- -.Dryers---"---------- � - ---------- -------
Motors.....-.--/-------. HP--...... 3...... Phase......./�- Permit Fee $1.00
Motors-------------------- HP---------------- Phase.........-'-------
Motors-------------------- HP------------------ Phase... - - H P Charge--------------
TOTAL FEES 3 i elL
('. CO F INSPECTION APPROVALS
Rough Wiring I--- - -...... ..... ------------`---- Fixtures ......-'-------- ----- -
Nxrc INSPECT0R DATE ixsr[croR
Finish Wiring .... . ---- Motors ... .. .... ....
........
••DATE INSPECTOR qAj�` , x3r[CTO11
Finalx'..� --- -----------
- INSPECTOR