2529 1007'V 5. *9
NO. STREET' LOT NO.
• ICA IU tloylf
ELECTRICAL PERMIT
CI CUPERTINO q
Datel bI ILSk Permit No.
CITY. 'UV UUNtK I L.�u 1-ee S 3.e0
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
m wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
�- City-of Cupertino, and all other lams applicable thereto.
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v Use of Premi�P� eo-MM0/- ,A l C)<�MOdS /�✓S�c CeN1PrJ
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a Owner a�v�. CA9ArLA- Address l0y95 F,&tv- ✓iS
By WL" Address U 5. dt q9
h CONTRACTOR, AGENT
Approved
Phone 252-(000 ECTRICAL INSPEC7M
NEW RPL FEES .
Size Service Conduit----------------------Number of Outlets._.-------------- ......
Size Service Wires-------------------------- 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----I..... Transformers-_L--- ---1--- ---------- --2_00.
Misc-----------------------------------------.Dryers.............--' --- -------I------- -------------
Motors------------------- HP------------------ Phase....................
Motors-------------------_ HP-------------------- Phase------------....... Permit Fee $1.00
Motors-------------------- HP----------------- Phase---------------- H P Charge.---------------
_ #k00-
TOTAL FEES I
RECORD OF INSPECTION APPROVALS
Rough Wiring................ --- Fixtures ------------ ---
DATE INSPECTOR -ATE SIICTOR
Finish Wiring --------`-------�-- . . . ... Motou�-- - --...--�' '- ...............
G -.
DATE INSPECTOR �I ECTOR
Final '-'---'-------- - '-
--�- ----- - ..-.. --.....
-.1. 4
A L INSPECTOR