2016 854 Lily Ave /
Building Permit Confirmed [�Not Required ❑
CITY OF SAN JOSE BUILDINGDE��+L-- ,
APPLICATIO FOR ELECTRICAL PERMIT 3
Date---------.........`----1=�'---/-----.. Ir/4LPermi# No.-----------------_.....----------------
The undersigned hereby akes application to the Electrical Inspector of the City of San Jose
for a permit to install electrical fixtures and/or wiring as listed on the reverse side.
t Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement Clod ❑
Undersigned attests that his State of California Contractor's License # 2ZC7�Z/:
is in full force and effect and properly authorizes this application
San Jose City Business License # �—
I certify that in the performance of the work for which this permit is issued I shall not employ i
" any person in any manner so as to violate the work m n's compensation laws of California.
OWNER ,
ADDRESS
USE OF.'BDI �G
SIGNED
2e0-10(10.69) '
854 Lily Anve Lifetime Pools /
ITEMIZE THE FOLLOWING l New Old
Outlets Panels, Cabinets Size Service Conduit
Switches Switchboards Size Service Wires !
Receptacles Panelboards Size Service Switch L(Av
Fixtures Festoon Lamps Size Sub Feed Conduit
Mercury. Lamps Dryers KW Size Sub Feed Wires
Ranges KW Heaters KW Number of Circuits
Signs Transformers Motors Number of Meters (' `
HP Phase Ampere Loads Lighting Powe
Miscellaneous
Rough Inspection -
i ,.
By
Final Inspection n W_ 7 J B'•,,
Remarks:
'4 � vw2 .Qrv � -�=7dd