95395 1143 Hollyhead Lane
' Building Permit Confirmed ❑
.Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT .7-�
w� — c.
Date----------- =------?-/�--------------- 19-6 Permit No..- 5 �`-. --------------------
The undersigned hereby makes application to # k le ' I Inspector of the City of San Jose
for a permit to install el0 r r I d on the reverse side.
Exemption from requ. S a al o nia or Contractor's License is hereby claimed
by undersigned: s owner tyy�-�� statement filed ❑
Undersigned atfes#s that his State of jL_ ajlf Cc c c
is in full force and effect and properly a n his n.
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so\as to vi
o
latehe workmen com pensatio flaws of California.
OWNER W,'/
ADDRESS
USE OF BI III
FIRM SIGNED �-
FORM 280-10 (5/68) IOM
A v cr„i T aA,cc R T.a na Donahue
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Switches Switchboards Size Service Wires Z
Receptacles Panelboards Size Service Switch cy
Fixtures Festoon Lamps——Size Sub Feed Conduit
Mercury Lamps Dryers __ KW=J'Size Sub Feed Wires
Ranges KW Heaters KW Number of Circuits
Signs Transformers Motors Number of Meters
HP Phase Ampere Loads Lighting Power
Miscellaneous
Rough Inspection By
Final Inspection By
Remarks:-?/1 ���J wla