2689 NO. STREET - LOT NO.
W Z Q
FOR ELECTRICAL PERMIT
3D APR 17 1964 l OF CUPERTINO
' o Date 19$1 Permit No. C::2v
O < CJ 111V Fee S Ca
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
00 wiring and/or fixtures in accordame with the provisions of the Electrical Code of, the
S W City of Cupertino, and all other laws applicable thereto.
o <
z J Use of Premises
J_ Z
O
a
Own— Address
Address
— m Ji. .1/ Address
W W 11y -
o Yjtti. N Acro AGENT Approved 04
—0 Phone: �7 "��C/U ELEeraruc rNsrxC�+mt
(1 State License:/gin
NEW RPL FEES
Size Service Conduit...._................Number of Outlets.-_--f...._.. ---------- - _---- - -------I
Size Service Wires--.......................Number of Switches. 1/0
......... ........ - --------- --- ----------
Size Service Switch........................Number of Receptacles._--------- ---------- -_------- --------------
---
Size Sub Feed Conduit-_--------------Number of Fixtures--
-7------- ---------- - -------- ---
Size Sub Feed Wires--------------------Ranges.....:---------- KW------------- ----- ------------
Number
--------
Number of Circuits...--------------- Oven -------------- KW----------- ---------- ---------- -- ...........
Number of Meters........................Signs--........ Transformers-------- ---------- ---------- --------------
Misc------------------------------------------------Dryers---------------------- ---_--------- ---------- -- ------ --------------
Motors------------- ------ HP-------------------- Phase-------------------- Permit Fee $1.00
Motors-.--------..._._. HP.--------------- Phase.................._ Permit
Motors-------------------- HP-------------------- Phase.. . .............. H P Charge-.---------- ..-- -------
TOTAL
lharge----------------
TOTAL FEES
RECORD OF INSPECTION APPROVALS
Rough Wiring---------------- ---------------------------- Fixtures
......................I---------...._---------
OAT[Finish Wiring ......--- ----- --------I-N-SPECTO_R___ jillk Motors ..... ...DATE ------.....-.-..--
Dere
----------
DATE IN'rECTO PECTOR
01 �44
TFinal/o-A - -------------------------
DATE INSPECTOR