96821 (2) 1132 Derby Shire
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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A v/ - 19 ... Perrni# No....q.6 .� .-------------...----
The-undersigned herab makes lie on.10 the EIct�4"cal for of the Ci}y of San Jose
for a permit io ins+all ct ' a r ir1 s } n e reverse side.
Exemption from re r Sf { rni or o actor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ ,�// ��yy [
Undersigned at'es4s that his State lifoml'{]Con4ra i �s Li�fC66�te 23 7✓""/
is in full force and effect and ro r /horizer,/Ilyjs �pf—/J
San Jose Ciiy Business. Li e # „ + —�/ 5(/J
1 certify that in the performance of the worl for which This permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER Lr , ZF -C//�vTZ a
ADDRESS 'P!
USE OF BUILDING
FIRM
FORM 290`10 (10/67) IOM //f
ITEMIZE THE FOLLOWING New Old
Outlets Panels, Cabinets Size Service Conduit
Switches Switchboards Size Service Wires Z
Receptacles Panelboards Size Service Switch �A
Fixtures Festoon Lamps Size Sub Feed Conduit
Mercury Lamps Dryers _/ KW�pp
D Size Sub Feed Wires
Ranges KW Heaters KW Numberof Circuits
Signs Transformers Motors Number of Meters _
HP Phase Ampere Loads Lighting Power
Miscellaneous
Rough Inspection p By
Final Inspection J —�U '6/ B ' �, m.,_�
Remarks: y