2049 /o�6 9
NO., STREET „ LOT NO.
Fr APPLICATIOW-FOR . ELECTRICAL PERMIT
CITY OF CUPERTINO
4 j'.4 I in
DategqlO rfi !� , 195— Permit No.
p+�J �1��'(II T•v� Fee $ 1:5
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
wiring and/or fixtures in accordance with the provisions f^ •lectrical Code of the
City of Cupertino, and all other law p lic le there
I
Use Pre
C
a Owne K• Address
Address
-� CONTRACTOR, AGENT
Approved
Phone: ELECTRICAL INSPECIOI , .
o NEW RPL FEES
Size Service Conduit......................Number of Outlets.................. .......... ..........
Size Service Wires....................... .. umber f. S 'tches---------------- ---------- ----------
Size Se ' Switch........------- ------N m 0 eptacles............ .......... .......... ------------
um
Si b F d Conduit--------- ------- r tures....----------- ---------- ---------- --------------
iie Meters------------------------Signs:.
Sb -eed Wir -- ------ ----?an ----------------- KW..---------- ---------- ---------- --------------
I V,
S-------............ ven -------------- KW............. ---------- ---------- --------------
_�*;4p, j
Nu of Meters------------------------Signs2�.: Transformers-------- ---------- ---------- --------------
Mi ------------------------------------------------Dryus---------------------------------------- ---------- ---------- --------------
otors.................... HP-------------.--. Phase.......-----------
Motors-------------------- HP.................... Phase-------------------- Permit Fee $IoOO
Motors-;----------.......... HP.:------------------ Phase........._......... HP Charge----------------I--.------
TOTAL
harge---------------- ---------TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring---------------- --------_----------------- Fixtures ---------------------- ----------------------------
DATE INSPECTOR
DATE INSPECTOR
Finish Wiring -TI..... --------IN5----0-....IMotors __- ..... .. -------- -- -
-------
DAP9CTR DATE INSPECTOR
Final ..........................
DATE INSPECTOR