50275 (2) 7569 BOlhnger Rd. Building Permit Confirmed �lc
` Not Required ❑
CITY OF SAN JOSE _UM ING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date----- - ------//-)-------- 19--/'V Permit No. ---------
The undersigned her makes appli lion to he lee i Inspector of the City of San Jose
for a permit to ins}al ri I r r e on the reverse side.
Exemption fro r r o i ntrac+or's License is hereby claimed
by undersigned: as
owner ❑ statement filed"o572
Undersigned attests that.his State of California Contractor's License # /y y�jJ
t is in full force and effect and proper a izes +)I�' lif.7},o,,' Lj/�/ �G J� /
San Jose City Business License
I certify that in the perfor neo o a wor for w mh this perm' i1 sued I shall'.of employ
,,any parson in any manner so o violate the workmen's mpensaiion lows of California.
OWNER
ADDRESS — r FOd
USE OF B I ING
FIRM SIGNED
280 201n
I
i r-r�569 Bollinger ltd. f• ��' _ Hill
ITEMIZE THE FOLLOWING ��3 _ New Old
Outlets4A/ Panels, Cabinets
�c�-- Size Service Conduit
Switches _g2Switchboards Size Service Wires R
Receptacles!�Panelboards Size Service Switch 1
Fixtures Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers -,I/— KW Size Sub Feed Wires
Ranges KW Heaters KW Number of Circuits _
Signs Transformers ' Motors �_Number Meters
HP Phase Ampere Loadsf Lighting Power
Miscellaneous � / Powe
Rough Inspection B
Y
Final Inspection T— 3' "7 7 By -
Remarks: S�AA . �y� 4 `
280-201n