2527 NO. STREET LOT NO.
r o PLIGAT I FOR ELECTRICAL PERMIT
3 FU€C ll 7 1963c1T of CUPERTINO
' o Date 7' lv y,� ,196-a Permit No. '�` �J _
0a L� L tl\ I ._,�:� Fee 5 2s.
a m 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
4 wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
o 0
> City of Cupertino, and all other laws applicable thereto.
z_j Use of Premises Tib'/ FL,LEC
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J Q
< Owner rLCM /- 1,1 4M l Address
N
W W By f7G/7/Z � rr_L /5-e.. Address / 6 e ry c ' /7WC
OCONTRACTOR, AGENT A roved b
! —U Phone: 1' L S 5—(�� PP ELECTRICAL INSPECTOR
State License: �d�3 / n e- /G
'- NFW RPL FEES
Size Service Conduit.. . -.,Number of Outlets. ---------------- .y5... .......... ......... ....
b L
Size Service Wires----. `.%............Number of Switches.._..:......... .-- _-- --------------
Size
-`--:-.«'Size Service Switch-2" --------Number of Receptacles------------ ��.-(�.- --.._---- --- c/G
' v
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---...I....-- ------------ ------ -------- ---....71..
Motors.---._--------. HP.----�'--=------- Phase--�- -------
Motors-----.----.---- HP------------------ Phase-----------.--
--- Permit Fee $1.00
Motors------------------- HP.................... Phase.................... H P Charge------------ ---
I---
L —
TOTAL FEES 2J,S S
REDO F INSPECTION APPROVALS
Rough Wirin VV . . ----------- Fixtures ...................... ----.---
DATE INSPECTOR DATE j INS..CTOR
Finish Wiring .... ----------------------- Motor2--- ----- - �------I--'--C---.........
---DATE INSPECTOR ^` �yDA / I- -C- .
Final`._ 4 ... ...�.
------- -----------------------
ATE INSPECTOR