2847 NO. STREET LOT NO.
U Q
r o AP AI ATt - N FOR ELECTRICAL PERMIT
0 a JOF CUPERTINO
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IVOCT 191964
4 F Date 195_ Permit Na
° < �[ p�pT n�� FeeS �
a m AajT io,0Re)W' PE@tb�fIiP.City of Cupertino for a permit to fh. a'1 electrical
w wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
a wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
00
> 0 City of Cupertino, and all other laws applicable thereto.
2J
Use of Premises —
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3 °
< Owner Ad�d'resjs� q
W w By /.�it,c_n,,F-c Z„n
R n NTRACTOR, dENT
—
i o ApprovedNnt r tnaT n nr�rrs,v-�1
— 0 Phone: 6, 4 ELECTRICAL INS►ECTM
State License: 170215-1
FEW. —RPL FEES
Size Service Conduit......................Number of Outlets............._... ....._.-- -- ------- - ------ ----
Size Service Wires--------------------------Number of Switches.---....---..._ ---------- ----- -----------
Size Service Switch------------------------Number of Receptacles......----- ------ --- ---------- - ------------
C, . 0
Size Sub Feed Conduit--------- -------Number of Fixtures._--------------- -!? --- ------- -- .2 Y
-----------
Size Sub Feed Wires...................Ranges...------------------------- KW-------------- ---------- ---------- ---
Number of Circuits---------------. Oven -------------- KW----------- ------ --- ---------- --------------
Number of Meters------------------------Signs---------- Transformers...-.- ---------- ---------- --------------
Misc------ -----------------------------------------Dryers---------------------------------------- ------ - - ------ --------------
Motors.................._ HP......... -------- - Phase...--............_ Permit Fee $1.00
Motors........ ---------- HP................. .. Phase....................
Motors----------......... HP.................... Phase........... . .... H P Charge--------------- ---------
----
0
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring---------------- ........................ .. Fixtures ----......__......-1-----------------....-----
AT
Finish Wiring ------D- -I..... ........I-N-S1-IC-T N- - ...?Motors ..........D N-ATI......... ........I..SP T
.K-C--0.I-------
bATK INSPECTOR DATE INSPECTOR
Final -------------------------- ............................
DATE INSPECTOR