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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DELCARATION
<br />I hcrcby iifirm undcr pcnalry of pc.jury rhd I tun.xcmfl tmm rlE Codrrtn Lt{n* tlw tir rhc rolbsirg r.nsn (scc.70ll.5
<br />Busirruss Md P.('resion Co{e) Ahy Ciry or Counry wnich rcquiE\ i rrimil ro onnrud. ahq. ifllprovc- dcmli{n or rcrat rny
<br />srtucrurc. priorro its hsuoncc, oho rcauircs rh. applicatrr lor su.hFnnil l. filc0 sisncd slo'cmnr ihal hcornK is lia.scn lusunr
<br />lo lhc lovhions oath. Cotrlraclols Li.cn*d bq (Ch,fl.r 9. Conmcn in! wnh sccrion 70fiJ or Divisior.l ol rhc Busim$ and
<br />Proiclsions Codc) or lnat hc m shc is crern lncrrfron0nd rh. b,$s for lhc dlcS.d crcmprion A.yviohrbnotScclion70lll5l,yany
<br />lpplicur tu ! pcrnril subFch th€ {pliclnl lo a civil pcnnhy of trol
<br />'norc
<br />lhM fivc hundEd dollatr (S5(x)).
<br />-1.
<br />as owror ol rhc ,roNny. (, nry ctrDloyccs wirh srgcs .\ rhct v,k conip.n\ar i{ . sill do rh. w.rk and rh. {tu1m is mt
<br />i.rcndcd or odcred lor elc {Se.704n- Busirc$ 0nd ProrassdN c.d. 'rhc C.nrrc'or's Licctrr kR docs trot {nfly ro m owner of
<br />lhc pn)lcry who hild\ or i'q,rov* rheErn. &*l *lm dms B-.h *oir niaNclior her*lfor lhn,usn his or n.r o$n cq)loyccs.
<br />lmv cd rhlt such improvcnE s@norir cndcd.r oll.Nd n v'lc.Il la)$cv.r.rlf buildin8 or nnpruvcnrm is sld wirhhonc,ldr
<br />olcomplcrion.lhcOqRrBuild.rwillharcrh.hordooftn,lingrh.ihcorshcdidfr huild or inpmlr rh. pn,ldy for rtr pu$)c of
<br />-l-rsowrcrofrhcrolcny.r,ncrclusivcl)conlr.crn'8wnhliccr*d.otr.rorsr..otrsfl.r'h.[orc.'lScc.?044.Ausmrsrnd Pr'oftrsbn Code: Thc Conirrroi\ Licenrc l,Dq docs nor oDplyln ano{ncrofrrrorcrrywho huildsor improvd rhcrcon-
<br />lnd who m mcls for such tmFts wirn a Qr Ecro(, li.cnqd pxnuanr b rh. Co h.n sLi..nscL0w).
<br />-l
<br />amcicrnpt undcr Scdion-. B. & P.C. lu lht rcnson
<br />Osm.
<br />]IA.BTE&T:TOIIIENSAIIAN
<br />!Eg.aa4u!!N
<br />I h.rcbyrindrndcrpcmlrynf p€rjrryoncorrhctullo*irsdechr ions
<br />I hxv. ud willroin[i. a Ccnificar. o{Con* to Sclf-lnsuE for "nkrl conEnsarion. as pmvid.n [tr hy Sarion:]700 olrlr
<br />Llbor Codc. Ior thc Flfoir:mcc oI thc so for rhich fic lcmil h i\su.d.
<br />lhrrc ann*illmainlinr worterl .onrpctrsalio insuromc.,s mquncdbySdn,nlT00ollhcLiborCodc.lorlhclrcrlolnEnccoi
<br />'|rc
<br />qu.lli,rrhi(hrhnDsn i\t\unl M\ "urku^ lonnc
<br />tfl t{vaf /.ot I ->n).
<br />icr oBl rxnicy numhcr ffc:
<br />!r-t co 1
<br />I ccdifylh.r hrh. p.rloi,nrm.ofrh. qork fnwhi.h rhi\ pcrmir hi\sord I \hrllnor.mpbyrny pcAon inany $nDcr
<br />s $ronront subJcd lo r hc trorkcm' co nllcnsor io n laesofc,lirdnri( rM ncn.rhd irlshould $€onrc srb]ccr rorhc
<br />workcn' comncnr.l ion porniotrs ol Satio l7u) ol rlr tihor codc. I srtrll. lonhwirh .nmdy wirh lh.r Imvisions
<br />,r.r"t4
<br />s1trkrr\ .nnfctr\arotr ..vcrr!c n trf[sli,i. rnd slr]l \uhi..r rn ca,t,l{,)u t) cntri"rl Ix h$ rtul
<br />rhru\rtrJ tlollrr\ (1l0O.1Xxr). in rn,liri,i, b rh. .o{ ol ron'Ixn\ario,. Jrtrrg.\ r\ nnrnlcJ lnr rlk
<br />0.t%
<br />irr.rcsl rtrd orlomy\ f.cs
<br />AppliGnl:
<br />, PECI.AAAIIT'!
<br />I h.rb, amrn undcr Forhyolp€rjurr rhd I an liccn*j uodq pmvnion olChapro 9 tcon'ncicins wir[ Sccrion 7000).lDivkion.]
<br />of rhe Busim\\ and Pmfcsions Codc, 0 my licetrs is in full roN and cfid.
<br />-Liftnsc
<br />Nun$er lOaQ ?x,
<br />k,*-'r--.c. /?
<br />CONSTRUCN(TN LENNINC A(;I'NCI
<br />I h.rch, amnn undcr Fuh, ol p€rrury rhnr rherc h ! sa(rudi.n Lndins aEcrcy lir lhe pq,hrunce otrh. worl lo. whi.h Ut pcdir is
<br />i$ucd (S( -1097. Civ. C ).
<br />APILICANLIECI/IMIgN
<br />I rmly alllm undc' rcnalty or Derjury onc ofrhc foln,winadcclualn,ns:
<br />Dcmlilion Pcrmik.Asbcsros Nolification F.dcral Rcgnl.lions (Tirlc ilo. Pan6)
<br />-Rcquncd
<br />t.llcr of NorifEolion
<br />I ccnifythri rhc fcdcral rcgdnri)nr rgrdirE r\bcsr$ rcnrvllure nor +plicable t, rhk pmjccr
<br />.f;*nri ,n, , t* .,0 U,* {rlicdion sln sisrc rhd rhc lbvc intunn,rion h .otrrcr I a8rm to omply wir h all Cny ond Counry
<br />nrlirktrr.r xtrd Srnr. t-r\\ tulnritrA b htrildug.oi{fl.ri(,,.ilcs ofrhi\ Cny d Couhryroc crulr)nih.
<br />ili)vc r i, cdpft, n!ln' i\txcri(mtD'Ir
<br />Applionl or ABenl Signaiur:
<br />Pemil.e mnE lprint):Dra w o.6.p
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondin g/Grounding/UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soffit Bouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleler Release
<br />Rough 1/n/ls 5b#A
<br />Service lvleter
<br />FINAL ldl?/t6 i)66
<br />Notes Remarks, Etc
<br />q
<br />lxr.d ' \l,n! \.
<br />Pole Bases
<br />Under Slab / Floor
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