2295 joc� � �.�STEST�T�`SI�R;• -
NO. STREET LOS NO.
D / FOR ELECTRICAL PERMIT
TY OF CUPERTINO
AU 9 T3 /
Date , 19Y-3 Permit No.
CITY OF CUPERTINP, Fee �- od
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
Cityfof Cupertino, all 11 laws a(pl�cg let thereto.
v Use of Premises A vTo
/I-64 /�yyAID
Owner
SP/� LC- �/ Address /006<- L —S711rL��JQ
:a
ro By /9Z? ��Address T ��
22 Approved
^
Phone; e7 Z _l71"7 eTJUCAL tMVIEC[OR
NEW RPL FEES
............
Size Service Conduit.---------------------Number of Outlets..-.--.---._.---- ---------- ---_-..-.I-..----.......
Size
--------
I---------- --
Size Service Wires--------------------------Number of Switches-..--..-------.- ---------- --------- ._----..----
Size
- ---- ----
Size Service Switch------------------------Number of Receptacles......_..-. .. ....... --..----..I
Sub Feed Conduit------------------Number of Fixtures_..--._.-..----- . ...... .......... .
Size Sub Feed Wires...................Ranges........-------- KW-------------- ---------- ---------- --------------
Number of Circuits-_.------------- Oven .............. KW..--------- ---------- ---------- -...........
Number of Meters..---------------------Signs.......... Transformers--.----- ---------- ---------- --------------
Misc------------------------------------------------Dryers..........----------------------------- ---------- ---------- --------------
Motors--- ---------------- HP-------------------- Phase-------- ........
Motors...._.............. HP-------------------- Phase-------------------- Permit Fee $1.00
Motors.................... HP-------------------- Phase----------------- H P Charge---------------I--------------
TOTAL
harge---------------- --------------
TOTAL FEES 0 C)
RECORD OF INSPECTION APPROVALS
Rough Wiring---------------- ---------------------------- Fixtures ----------------
DATE INSPECTOR
DATE
Finish Wiring ---------------- --------------------- Motors ... - - ...
DATE INSPECTOR Final
/ t-
.......JAT-I........ ...