2767�o?4 Sf 4e ell�ow adzzr e �o
NO. STAE T - LOT NO.
D t. R ELECTRICAL PERMIT
'S t MAY 22 1964 �10F CUPERTINO
MAY 2p 19
Date 'htn 195_ Permit No.
Fee . / D
Application is hereby made to the City of Cupertino for a permit to install electrical
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
Use of Premises
Owner
By —
rn6kf FtNIA
Phone:
State License;,—Q�
Address
Address
Approved _.
ELECTRICAL INSPECIM
Phone ELgato 6.4422
NEW
RPL FEES
Size Service Conduit.'�.�.�.......Number of
Outlets..............__ _...:
vim/
_.. .
Size Service Wires- .._:Vo----------Number of
Switches---------- -------��...:........--
_............
Size Service Switch—! �. 1.09._Nurnber of
-Receptacles-. .......... .._z
......_.............._
Size Sub Feed Conduit ----------------- of
Fixtures_._......_..........._--
----------
_p��
Size Sub Feed Wires ----- --------------- Ranges --------/-----
KW.------------ ----------
----...--
-----'----
Number of Circuits------------------ Oven--./
------- KW._...------- -... ......
.
Number of Meters... � ................Signs..........
Transformers........----------
----------
d
/..._-
Misc---------------.........------ --------Dryers....
Motors ----I�--------. H _ Phase --------------------
..... .-------------- -------
----..._.
---�--`7s
Motors-------------------- HP .................... Phase ..
Permit Fee
$1.00
Motors ------------------- HP ....... ........ Phase ..................
4
H P Charge------------
TOTAL FEES
f d ECORD OF INSPECTION APPROVALS
''
/
Rough Wirin--r1--' -=1....................-------
Fixtures -----------------I-----
---
DA I- ` INSPECTOR
Finish Wiring ................1........................?Mto,Q......----
DATE
------ -I....
INSPECT.-
---'---"--------
DATE INSPECTOR
/ IATA.. I
Final------_.._.....
IMSN C.
....---
DATE
INSPECTOR