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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCANATION
<br />I h6.by arm und6 p.nalty of pdjury rhar I d q.,npr fton rh. Conn do. Licru tiw for th. lollowins @n (Se.?o:l l.t
<br />A6in6s ud Prolission Cod.): A.y Cily or Counly shicn r.quir6 a p6tri to condruci alrd. inpro!., danolilh or t.p€r y
<br />itudun, piorio ils Lssudc., als rcqut* lh. @plic&l for s!.h p.mi( to iile a sistrcl s$rmd thal hc or shc n ticosd psuul.
<br />lo $. Fovtsio6 ol th. contnclor's Licosd Lsw (ClBpld 9, Codtftins wih Sdlion 7000 ofDivision I otlhc BuinN sd
<br />Pml6io.s Cod.) or rlut h. or sh€ b .rmpl thgcfron ed rh. bsb for lh. alLg.d €xmFioi. Any violaion olselio. 7031.5 by my
<br />applrant for ap.mn $bj6r!ln rppli.a.l lo acivil p.naltyol.ol mor.lh fivc hundrcd dol6 (St00).
<br />Vflir. ". o*o or,r," p,'p".y, or my cmplolc with *aB6 6 rh.ir $l..on,FNrion. will d! rh. wo* ed tE (f,rdE b mr
<br />i @d.d or ono.d for s.l. (sa.704!, Alsin6 ed Prcl6ioN Codc Thc Cont .ror's Lic.N tjw do6 nol aply lo u oMG ol
<br />rh€ rilDdry who bnildi or imptuvs th66n. ed who do6 suh srt hinaclr or h@ll or throo8h his or hs own employ.6.
<br />polid.d rh.t such imp.lwrs a. @t irqxrdl or orald for saL If, tow.E. thc hiildins or ioprovc16l i! eld within on. ,@
<br />of.omplaioq th. O*rd Buildd wi,l ha!. dr htrdc. oip.viig thd he or sh. did mi build or inFolc lnc !@paly for th. PtrpoE oa
<br />l. s om6 oartE Fopsty, m cxclusilcly contEti.s * ith licorsl cotu.croB b conshcl lh€ Foi6t (Sd. 704{, B6in6
<br />d ftDfsebn Cod.: Tn. Cont,acrofs Li.cose t,av do6 nor appl, io e ownd olproFrly who builds or dprovc rhdon.
<br />tud sho .onthcrs aor such pmjccls wirh a C.ntEclo(, licncd pu6@r ro lhe Co.rador's LiccM t2s).
<br />I @.xmDi ,nd6 S(rior
<br />,,," 1k)?o
<br />UOBrIBIU-COMT&NSAIION
<br />E&CI.ASAIION
<br />I h6cby amrn u.d{ F.aIy drFjlry on 6l$. aol,o*i68 dels.tioN:
<br />I have ,nd will mintain a Cglificatc ol Co6m to Sclal6dc for wort6 onrp€.s3lion. 6 Fovid.d lor by S..lion 1700 oflh.
<br />Lahor Code lor lhc pstbmucc of lhc ert fo. rvhich rh. pdmn b isNd
<br />I hav. dd will nai.tah wod(6 comp.Nation iGur.ncc, d r.quied by sd iod 1700 oath. L{bor Codc. fot the pslonnu.c ol
<br />thc mrt for shicb this !.flnil is i\ru.d My *ork6 codp.ns.lion i6urdc. ceid &d policy numbr ee:
<br />Cmi€r
<br />-
<br />dll eniryrhar inrhe pdfomd.c oarh. wort ro, whi.h rhis pmir is issued. I shlllnor dplo, a., pdson in m, ms.d
<br />$ db bdon subjet to th. $rrt6'.omp.Ntion lss ofcaliromin dd asr that ifl should baomc subjdl lo llE
<br />poltsl compoerion prov6ioN ofsdion 3700olrh. t b.r aodc I slull. aonhwith cohpry qnh iho* pblisirN.
<br />WARNINC: l:ailuc to suc w 6 .onpotsaion cov@g. i, unlawtul. md shall subjd a dployd lo oimital F.lti6 sd
<br />civil lin6 up h onc hun&.d thoued dolld (SlOO.0oo). i. 0dditioD to thc ssr of comp.Blion. ddag6 s Providol for fi. I
<br />SNUon 107i,orrh. Lak Cd( inlcrcsl dd
<br />Dr* zlctft " A
<br />!!e [ls!:uroNMcrcautct aalIor
<br />I ha€b, altum lndd p.elly olp€dury lhar I d licds.d undr p.ovi5ion of ch.pt6 I (commdcins vnh Sction 7000) oa Division l
<br />oi th. Bsin6 ud PDf6sioa Codc, ad b, li.@ G in arll aor.. ed .rd.
<br />COTiIBUqIION.I,EIDIIC.dCEICI
<br />I h.Eby aflird undd poally of pojory lh, rh@ i5 a onrruclion lodir8 aga€y foi lh. pahmd.. oflh. wo.k aor vlich this Fnil b
<br />isu.d (S€c. 1097. Civ. C.).
<br />AITUCANI.AES.dAAIIO!
<br />I @ afrn undd pqaI, of pdj!ry one of lhe fouowing del4alios:
<br />D.oolilio. P.mils-,{sb6tos Nolificalion F.dEol R.suldions (TilL 40, Pan6)
<br />Rcquir.d lntd of Noi6clr@n
<br />._ I .d! i6 rhd !h. f.d6d r.srhxoN Esrdrs sbdros rmwl e nor 4pl'.ablc !o rhB pmjd
<br />Nd-
<br />I [l cai& rhar I hav. .ad thb .pplicaliob Md sisl. thdt th. ahove infomarion is .orccl. I .grc lo @mply wit lll cily and cou y
<br />oft1in.n.6 ed Srare La$s Elnrin3 to blildins aurhortc r.prMt.liv6 of this Ciry ed Counlyto o16 upon rh.
<br />rbok hsriond prcpedy aor iNp€liofl
<br />AIIli.trnl or Ax tSigtrtrrtr.r
<br />L DaZS?t
<br />,.,. zfofto
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER ?--t ^ rt-o v.r lo\
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Ivleler Release 7,-lo-?o -E'*ta.;!E
<br />Rouqh a 9
<br />Service l\,4eter 4-ro-2)**1 lo,
<br />FINAL z-t6-zn fl€Lot
<br />Notes, Remarks, Etc
<br />Rev. 08'07-2015
<br />Sub-Panels
<br />Erpn6:
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<br />L'cc6. \unbd
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