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ELECTRICAL.INSPECTOR RECORD I <br />APPROVALS DATE ID/SIG COMMENTS ()wNItR It)lt,t)lrR t)til,c^RA't'l( )N <br />sttucturc. pri()r k) ils issuilicc, nlso rcquircs lhc rpplicxnl li)r such Jrrnril lo lilc ri sitlnc(l slnl('nrnl lhnl hc or shc i\ liacn\cd pursuanl <br />lo thc provisidrs ol-thc C(,ntrrck)r's Liccnscd law (Chnplcr 9. Crrrrrncing wilh Sc(lion 7(XX) ol Divi\ion.] ol lhc l]usincss snd <br />ill,plicanllbr{pcrnlilsuhjcclsthe xlplicilnllodcivilfcilrllyolnolilxrrelhnnllvchuftltc(l(krlhr\(35(X)). <br />_l.asowncrol thcprolErly.orrilycilrpl()yccswithlvrgcsu\tlNir\olccornpcnsxliofl.qillrkrthc$rrkrrrrltlEstrl(turui\rxi <br />snlc ). <br />_1. as owncr ol thc propcfly. am crclusivcly contractirtl wilh liccnscd cotrlrilclors lo colslrucl lhL proiccl (Scc. 7(Il.l. Ilu\incss <br />arxl ProlcsshnCodc:ThcCootrnctor'sLiccnscLawdocrn(,lnpplykrrnowncrofprolrcrlywhohuiLlsrrrinrprorcstlrcrcon. <br />a[d who contracts li,r such projccls wilh a Corilraclor(s) liccilscd puNuanl k) lhc C(nilrilck)r's l.iccosc liw). <br />_l anr excnrpt undcr l|. & l'.( li,t lhi\ ter\0fl. <br />r,,r" -? 12'6l t? <br />l hcrchy al'l'irrr unrlcr l)cnillly ol'pcrjrry onc ol lhc li)lL)wirl (ltclrrrlions: <br />bhrr Codc. lirr thc pcrfornuncc ofthc sork for which lhc Jrcrilril is issucd. <br />thc urrk for which thir;rcrrrrit is issucd. My workcrs coilrlreilsati()r insurancc can'icr arxl lxrlicy rrurrlrr rrc: <br />l'olicy <br />Scclion .l(176 ol thc l-rlxr (ixlc. inlcrc\l ilnd illkrncy \ ltc\ <br />o,u",1lZloll-l . nrr,,*,ffi <br />----ixfmJ! rtaN- <br />ol' thc Burincs\ nnd lhrl'cs(i{itr\ (ixlc. rntl nry liccnsc i\ in lull li,rcc xil(l cllt'cl. <br />l,iccr\c t-i."rr."ttrnrt*r: ?lZ-f ?2- <br />"*", 11', e ll:? <br />issucd (Scc..1097. Civ. Cl.). <br />[-cndcr's Nilnrc: <br />AfIIJSANI.IIEI;I.A8AIION <br />I hcrcby afiirm undcr pcnalty of pcrjury oE of thc folkrwing dcclaralins: <br />[xrmlilion Pcrmils-Ashcsk)s Notilicothn Fcdcral Rcguhtk]ns ('litlc 40. Pa[(r) <br />_Rcquircd l-cllcr ol- Nolilicolkill <br />-l <br />ccilily lhnl lhc lc(lcrnl rcgulilti(nrs rcgarilirrg asltslos rcnn)vill ilc nol ilpl)li.ill)lc tr) llri\ pr(,iccl <br />rhovc nrnti)ne(l pron(fly li)r ilsfrcati(!tr purloscs. <br />Appli(0n! or Agenl <br />l'rrnrilce nnnle lprinl):A Dou*- <br />u*" JfZto(tl <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Lile Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Elegr- <br />Bondino / droundlrs / UFER /1- /y. lg lLczrt <br />TransformErr- <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />ltleter Release <br />Rouqh 1l-3-t at [-.cz') <br />Service Meter l/tr- /9 rllc d <br />FINAL 6 2/-2o Lal1 ^)€-r'47, -AV <br />Notes, Remarks, Etc. <br />, <br />L-. <br />t <br />Lrndcr's Addrcss: <br />-