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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DFJI,CARATION
<br />I hcrcb, rllirm umtcr pcnrliy (,r p.lury rhar I m crcDpr from rhc C'(,in'.n,n Li.cnsc bs li). rh. followinS lcahn (S.c.7011.5
<br />Brsi'1.ss rid Pof.si,,n C.'d.): An, Ciry or Courry *hi.h ..quhr r rrmn b conslrucl. 0lln. itrrrrovc. &m,li\h nr Er^rn rny
<br />{ .!mr. prior h ir\ isurfrc, trl\o rcqun.srhr lppli.dr for ru.h Fnn[ ro filc. siBtrd {alcm lnal h.orshc h liccnsd punu r
<br />t' rhc pn,virions.f rhc Cotrrrocr{tr \ t.iccn\cd Itrw (Ch{rcr c. Con,mcfrina Nirh scdn,n 7fln .f Dirir n I of rhc ausin.* rnd
<br />Pr.fcsn^ Cdd. ) or rh hcorshcis.r.mprrhcicli. and rh. hasn frtr rhc ulk8.{ crmprion AnyviolorionofSc.rhn70.115hyany
<br />ap0licrnr fnr o pcnrir nrbrc.F rh. {rplicant ro !.ivilncn!llroin.t mrcrhrn llvc hundrcddoll6 (55(x))
<br />l. ds owtrcr or rh. loFny. .r my cnDloler f,ilh w{8cs,s lh.n v,k$ryrn$tiotr. will do ltE $ork ml llr deroE n nn
<br />inlcnncd or olttrcd lor slc ( Sc 7On. Bu\ims\ and ti,fcsions Cndc: l'tc O'ntucnr'\ Licdn* Ir* &a n.r rptly o an osmr .l
<br />rhrpmFiy eh,hrikhori pii,hsrhtN[, ti wh. d,{s \urh k,rt hinr{lf or h.hcll r rhmu^h hN or hcr o*n en[lcyccs.
<br />Iroridcd lhlr iu.h inDmvcnrnk @ rtn inlc xld .! oitr.{ tl! {lc l( k,wrvci rh( huildinA or ir4,or. . r is v,ld wirhh .nc }qtr
<br />ol corohrhn. rh. Owftr auiUur w,ll hrrc ltr hualo of |,ovnS thi hc or shc dil ml hild or nvorc rtu poFny a{tr itr puqxM of
<br />-1.asoBncrolrhcFrp.ny.amcxclurirclyronrrrclnrswithliccnsedconr,crosros,n{rucrrhcpn+c'(Scc7or.4,3u\inr\\r*r r1.f6\iD Co.lc:'lh. Conksrktr s l-irrn\.1-,*do.\ frn rlplrt, ano*..rofF)Ir. rsh(Jhurldsorimftovc\rhcron.dnd who .u La.* n" \u.h pn)jr.rs wnh { C.nh'.t,n n lf,cnscd ,Drunr h rnc Gnrra.roi s l-iccnse La*)
<br />I rn'.(rtrr Ln,lrr S.crntr
<br />Dat€: O*n.r:
<br />]taa(!8llrr.lllfjNtaMN
<br />DICI,ATIUON
<br />I hcrcbyafftn,undcrFndtyof Frjuryo.colrhctulk,wlngdcclrrrri,,ns
<br />_l hlvc lRl willrun in aCcriilErrcotO,n\.nrh scll ln\urc rrr *orkrB con1p..\ari.n. d( r.vid.d tur bySccrion:l7u)olthc
<br />L1h.r Al(lc.,hr rhc pcrfoinunc. ofthc so rbr which thc pcnnir i\ n\ucd
<br />I h \c rnd *illnui'rrin *orkdrr .omFiurn'i in\urri.c. r\ quncd bySc.ri(n 17(ll.lthc tih.r Codc. ior rhc perli)rrronce ot
<br />rho work ntrshth rhi\Iirmn i\ i\sL\i My workcrs.. rFn\rri{ iNufun.ccldrr Md policynumhcrnrc
<br />{"rt-l-.r,,C-oh J-Yts
<br />?.\.\,?5
<br />I..dilythrrinrhc Nnanrun.cofthc wor& lrlr ahEhIhi{ p.irn is r$ucd.I \hrll nor cnrpl,)yrnyFAon in rtrynr0ftr
<br />v, rs t, h(conr \uhFr ro rhc sorkrr' conpcd\dn,n hw\ of Caliturnrr lnd r8rcc rhd ,f I should h.Eom runj(i ro rtE
<br />*orkcri.unpttr\rri(,nphvisi,,n\ofSccii.n.lTmofrhclihtrC(xlc,l\hdll.f.nhwith.oDplywirhthorpmvnions
<br />lVAltNlN(; Ir lur. t) {rur sorkch' .o rli.tr\.ri'rr $\$rgc i\ utrh*lul nl \hrll {'t1c.r xn .n,rl,rycr ki lnniBl F-ruhf,\ md
<br />('v,l fir! uI n, otu hundrcd rhou\rnd dolld\ ($l(X).lxx)). n rdJiriotr k) rhcco{ oi .onrpcnsrri,n,. dlnugc\ J\ pi(N Cd lnrrh(
<br />:::iTil:R
<br />,i;',I"I
<br />0t8 "J:::' "'
<br />ucEdSELColtrtAtr9B
<br />DECIdSAIION
<br />I hcEhy uflirn unncr pcnahroircrjury rhd I !m liltnql trndcr ptr)ltioh orCh3prd 9 (.ollmking *ilh Scclhn ?fi,) ofDivision l
<br />of thc Busin.s rnd Pro6shns Codc. and my liccnsc h in tullfore 0 cllccr.
<br />n 1 2019
<br />catsrf,rJcuQNLliNDlxli-acEtcr
<br />I h.rcby afitm u.dcr Fndry orprjuryrhd rh.rc k r co.ndcri,n lcnding recncy for
<br />'h. !.Yfonroncc oflhc qork lor which rhis lrmn is
<br />nsucd(56 11097. Civ. C ).
<br />8.TIIIIANIIECLABAIIA
<br />I hcr6y a,tlrtrr utrdcr !.mhy ol lelury onc ol th. tollosrnS dcclorarionr
<br />D.'nrlirn,n Pcrmir\ A\h.io\ Norific rhi FcdcrxlRcSuhh.ns (Tirlc.10, Pd6)
<br />Rcqtrr.d lxnrr of Nor'li.&oi
<br />-l
<br />cenilyrhal I hc fcdc.al re8nldr ions rcBarding rslf,do\rcnbrDl c nor aDli.nhlc !o rhis pol..r
<br />L*-trry rrrur r rravc rcaa rrrr rtplf,ar.onalt (.rcth rhc bvc inrorrortun rc.necr I.Ererocomprywirhallc'ry'tulcounry
<br />drlirir .csntul srit llvsrlnri0e k,burltl u nrarnc\ o,lhi\ Cir!_ rtrd C.ufryro rtrrcr u|xrn rh.
<br />r,,;;,' , :/ 20ld
<br />xh)!c nrnri,trrcd nii,F-ny f{tr i'N
<br />Applient or Aaetri SiIuluE'J>-.'.L\ 4,,r.-
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Slandards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / 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 />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough ar1,lc 5 \;rnl ',.fu-*l
<br />Service Meter
<br />5neFINAL 'kt 1.?f7l1 -etu *<
<br />Notes, Remarks, Etc.
<br />Communications Cable
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