582 cocoo
NO. ..$IREET � LOT NO.
L` AELECTRICAL PERMIT
AN 19b�IT 1i' CUPERTINO
5
Date ` ^ — Permit No.
U
f III I r� l=ee
Application is hereby made to the City of Cupertino for a permit to install electrical
(y� 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 Premiqpq
Owner s/—,�+ 2AV ! t/9. Address
g By Address
CONTRACTOR, AGENT
Phone: 4/ 2 /"V Approve
ELECTRICAL, INs►ecrot
NEW RPL FEES
Size Service Conduit.. . Number of Outlets.................. .......... _--------
L----
.....----
n
Size Service Wires..1.....:CIG........Number of Switches........_...... ---------- ..........L.............
Size Service Switcve�r,6 ------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........ .......... .......... ..............
Misc----------------------------------------------..Dryers..... ------------ -------- -------- -----.....----
Motors-------------------- HP-------------------- Phase---------.........
Motors.................... HP.................... Phase-------------------- Permit Fee $1.00
Motors.................... HP---------------- Phase--------- .......... H P Charge................ ..............
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring....----------I............................ Fixtures ---------------------- -------
DATE INSPECTOR DATE INSPECTOR
Finish Wiring ............."--�-----------.........:... Motors -- --------------
DAre. IRSPEcrDR E f/ Rsj�cTD�R
Final / fl! �!?_.d!� :
y INSPECTOR 1