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ELECTRICAL-INSPECTOH RECOHD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER AUILDAR DELCARAIION
<br />I hcrcby drltn tr.df rcirty of !trjury thAt I fln cxcmtl riom rhc C.nrtucro* Li.cnsc trw rd rhc rbllowins .cu$n ( Slr ?01 1 5
<br />Businc$ otu Proicssion Codc): Any Cir, or Co! y which !equi6$ r r ni h Nnstruct. rltcr. inrrn,v.. d.'mlish or rcPait sny
<br />srrucxrc. prior to irs n\uancc, als. r.qnncsrhc !mli..d nr ru.htrir r k) lilc u siBocd srar.ftnr rhir h.or shc is liccned pur$lnr
<br />b lhc F)visionl orlhc aontrtrck s Licctrscd Lr* (Chlprcr 9. CoFftmine wnh Scdion TlIb of Divi\in.I orrh. Busincs and
<br />Polt$ionsCodc)o,th$hcorshciscrcnllrhcr.rr.,ndihttflsisrorlhc.llc8cicrcmPlion. nyliohriodolsccrhnT0ll5tyaiy
<br />arplicrnrrorancmirsuhj*Brhc.pplicrnltoa.irilFcnrhyolnolnmNrlunfilchu.drcddoll.rs($5u0.
<br />-l.aro*ncroalhcpmpcny-orny.npk)ytcswirhw{scsasrhcnsobconrPcnsrion.willd.rhcwoik0Mlhcsltrrurci\ftnimcnd.n or offcrd for el. (s(.x!4. Busircss ond Pmfcssbns Codc Thc Onrrcttr s Li.ctrt tjw docs nor lpplyio m owftr or
<br />rh. F,pcny sho boilds or improvrs rhcFn, and wno dcs \uch M,l him\.lror h.r$lfor rhrough his or hcr own cnfl.yccs.
<br />nrcvidci rhd such impovcrnh rc norinr.dlnl or.ltcdJ fiY eL.ll h}ctr. llE huilding or in{mltn.nr is $kl qirhin,{r Frr
<br />of.onlptrhn- lhc Ol ncr Buildcr will hnh rhe lturden of Imvi'rg rhd h. or \hu dil n.r ttrild or impr*t $c ,mFny for rhc farFc of
<br />-1.!sosrcrolrhcpropcny.r'n.r.lusilcly.ontr.iingwirhli.c.scdcoftld{slocois.rrhcfmj.cllSa7{}44-Businr$nd Phtu\bnCodc:ThcConl!0crolsl,icctrscl,!sdo.snorrpplyk,a.sncr.lptoFnywhohuild\orinpn'rcsrhcrcotr.
<br />lnd *ho coniEch ftr \nch tmje* wilh r Conhctorls) liccnscd pursu0nr ro rhc C. rlctr's Li.cnsc tjw)
<br />Dsrcr
<br />-
<br />Own.r:
<br />worKER$c(ttrjrPEN!^Ioii
<br />DEILAM.IION
<br />I tceh, al0rmLilcr pcdx, of tcjury om ol lh. followin8 dalaBrnrns
<br />lh.vc md will nEn rir a Ccnitudrc .f (i)tr{.r t, s.lf ltr\ur. ntr $orkc6 compcn\rri{in. r\ pn,ridrd fi, byScclior.lT(x)ol rhc
<br />Latff Cc{t, frrhctl.fonruh-^c o,lhc *ork fitr *hkh rhcFnnir is i\\urd
<br />I halc and $illnrainruin $d d^ compctrs.rion ir\um.c., as rcquiicd hySccrion lTmorrhc lihor codc. lor rhc Frrornrtuc ol
<br />A,J Frmir n i$u.d. Myworkcn o rtef{ri(lr iNurrNc.rnnr Nli.ynnmhcrmw4tcasL.TraJ
<br />{-l .f.
<br />l.cnil, thar in rhc lcrlormncc olrhc sort n, *hich rhk Frnn is isu.d.I shrll nor cmnloy lny r.rn,n in rny ntmmr
<br />$ si.lE@m sbjcd ro rhc wotr.r $mpcnerion h*s ofcolifomio. mi 4rcd rhd irl should ttr.nf, subjd h rtE
<br />workcn comFn\srion fiovici.nsofsc.rion ]70o o! thc L.nn Codc.I sh{ll. fonhsirhconltlly wilh lht pmvnionr
<br />WARNIN(;] F,ilur. ro *urc sorkcr' con{i.nsal ion covcrus. is rnh*rul, d nrli subrccr trtr ct{k,rtr n, ridmllcnrllics otrd
<br />.iv'l fincs ut lo oN hutrdrcd rhousand dolla^ ($lou.ooo), in addirn,n ro (hc..$ ol con[cn\.lion. dtrmgcs as Pruvidcd r'or rht
<br />Sc.rio. 10?6ol rhc Lnh.r Codc- inrcrcdond nnomc, s fcc\
<br />1.C.lr,,
<br />I hcrb, altfln und( Fnrhyolpcrjury lhll I r lietr\cd tr pr)risi.n olChnBd 9(comnrncing $irh Sccrioi TIXU ofDivi\lotr.l
<br />ol rh. Busi'r.\sr PmL\\nnh Coilc. n|d nrv liccra is n tullli)i* rRl.f,icr
<br />(?t .d2'tt$1
<br />61.c .l %Lr r4*r,r..
<br />COXSIBIJ(:II()NIINDINC.&CEN!:I
<br />I hdruby rfllrnundcr pcnrllt ofr.rjury rhut ihcrc is a con{rudioi hnding,Scrcy lnr
<br />'nc Pcdom'mc orrh. $Itrk ror shi.h lhi\ rrmi n
<br />ilsu.d iS.. 1097, Civ. C )
<br />AIPI.IIANIIIEII,AAAfION
<br />Ih. yrlfii,nund$ pcnrlly ollcrjury onc ollhc lollowin8 dcchrariois:
<br />Dcnrririn Pernirs sb.ior Nori6cilio ftdcBl Rc8ula! tnN 1l irl. .l0. Pan6)
<br />Rcquncd h crol Notilicnlion
<br />-l.clif)
<br />thrr rhc icdcral rcgdh,'nh rc8r'l'ng J.b.snr rnn!rl rrc n.r Jl.llEohk ro thtr F!..r
<br />!C(n,b rha, I h.a Eod
<br />'hN
<br />rrrl{arion dJxl srtrrc rh.rlh. ah)vc ini,,rorion h.orer. I r8t& ro comtly wirh all cn, lod counry
<br />or(lirrtrcc! tr{tSrrrclr'\srlxritrgt)hu l,lir!.onnru.rn .rtrdhcrcht n'cscnrdilc\ofrhiscirynndcoutrryrocnrcruE rhc
<br />.hr\r rmtrrnmd n0!.ny lor in\F{r
<br />Appli.ml or AA.nl Sian.lor€
<br />/L
<br />4.G.1bo
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Lite Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh 1/Al,t ,r\ 5x
<br />Service lVleter
<br />Ir)/L{! t t >agf{
<br />Notes, Remarks, Etc
<br />Site-Work
<br />FINAL
<br />-l
<br />cxempt undcr Scdi.r-. B &PC forlhhElson
<br />nr,.r"*,*, 6{rr,;u (-t3lo}
<br />-r:rprc\
<br />I
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