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ELECTRICAL.INSPECTOR RECOBD
<br />APPHOVALS DATE COMMENTS OWNER BUILDER ONLCA RATI('N
<br />I hcftby trfli.m u.dd ,.mlry of p.rjury rh.r I atr.rcr+ rm.r lhc Cbnraclor' Lierr ti* lbr thc folloritrS Elsr (Ss.?0.11.5
<br />Ausinc$ ! Pl'oi.$ion Codc) Any City or County {hich rcqutcs r Fa'nil lo onrlrucl- !llr. inrpolc- &'tulth or EDat uy
<br />(rucrurc. Ilritrro irs is\uancc- also rcquncs rhc lpl,liconr tu \uchl.rn rro filca iisncd ddcftnr rh,r h.or rh. n li.cn!.d Nrsuanr
<br />ro rhc nm!,snnr\ of rtr Contract r Li..nscd t s (Chrprcr 9. Com'rcncin8 anh Sccrion 7O({, oi Divnion :] oa rtE Bu\iNS Dnd
<br />Poltsin!'C,dcrnrrh,rhcor \hc nocnfl rhcrclionrsnd lhc bdsn lor rhc all€scd crcmptiotr Any vblarknorsc.iion 70.115 by iny
<br />illliyrfn d ncrnl \uhFr\th. rmh.anrros,nill).mlr),lnorm crhrnr*rhundn''lJnllJ\ttrlrr,
<br />r1l. !. ntr rcr .r rhc pmFny. or rny cmnl.rrc( * hrnpcsaslhcnsEcomrcnsalion-$iU&rirwo unrhe nerEi\mr
<br />inrcfrlcd or oficrcd lor $lc (S.t ?o14. Businc\s d Profcst'n\ C{iJ. TIE Conks.lrtr s Lk.isc bw dk\ nor rplly ro rn osn$ ol
<br />rhc FqEny th. buius or inDms ttEmn. lri wh. d*s skh v.rt him{llor h.r*lfo. rhmuAh his or lrcr nsn cnployccs.
<br />pn,vid.n rhar su.h in,r(,vcftnhdd, inrc i.doroflcrrlnnqb ll. hr$.vci ih. bxiUing or in{roE.r.r h sld wirh,nom y!-
<br />oi corr|lion. thc Owmr Buills sill h.!r lhc nud.n oa lrolin8 lhd hc o, sh. did ml huiu o, i,l{ri! rlrc prrEry ror rrr purl[{ or
<br />I.r\owicrofrhcpfl,lf,nr.trfl.x.lu\iv.ly..ntn.ring*nhlion\cd..r.tsro.otr{ru.rrh.pmfd(Scc.7{!,1.Bunnc$
<br />{l l,Lts\in ( nlc l'hc(onrE.rr'\ l,i.cns. Lrs (kE\ trn rmlyk,
<br />!.d who conri.c Lr su.h proj.\h wfh a Contr&bdn lf,cDscd pu
<br />)I n,who brildsor imnrovcr rhcrcotr.
<br />Contrtor'\ I imn\c lrw)
<br />"YFr.
<br />X:.
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<br />J- riirn un,lor pdfr ry.rtdriLrror. olrl[ 1.1,'qi'r!
<br />_l hNc ur sill nu inrain 0 Gn ilEarc ol Cnn\cnr ro Scll tu 1,tr u{[.rr c!rp(n\rri,n,. x\ Frnlcd lnr by S..rii)n:]7{n) ofrh.
<br />t- rn Cod.. r, rhr t.'|,n rn...1 rhr sork ntr trhi.h rhc |*nnir A n\u.d
<br />)*haw afrl will nuirkin *orkc^ .onrp.n{li,n insurrh=c. tr\ requtcd hy sc.r i{'n r7m dt rlf, ljbor codc. fo. rhc ,crfonluh_c ol
<br />$ork fitr*hich rhi\pcnnir i\ isu.\l N1)$ork.^rft i',\ukn.c uri.rr F'l(i ru lhlrnrr
<br />E {.\" {'Jful <1 01 c .1
<br />-l
<br />cenily lhrr in th. p.rl.rnDfte ofrh. sork ior whtrh tht Frnrir N nsucd. I shrll n.r mln'y 3ny rER'n in any nrnmr
<br />v, as r, tf,arm lubj(cr t, rhl sorkcis .on,!.nurnnr h*s ofcalif(xnir. Md rgrc rhar rfl sh.uld hccom shjcd ro rhc
<br />sork${ .o f.nsrionnovnions of SNrn)n .l7U} of rh. trhr Cod.,I shaTl, ionh*irh comtly $ilh rlx'c prcvnio$
<br />WARNIN(;: k1turc ro s.uh qorkcr con{'.nslrion .ovcBSe s unh*ful \u6Jc.r xn cnrnk'ycr t, .rmi' l n nrlr'or rtul
<br />.ivil fin.s up ro om hundEd rhous.nd doll6 (SI00.UD). in addilion ion. dnnu8.\ r\ rmvid.d lar rh.
<br />X rI?Cod.. inrcrest and lnorfty s fcc(
<br />tx
<br />I hcchy!{fiirnund.r Fn.ltyolp.rjuryrhar I rm liccnEd under
<br />ol rhc Bu\ir*l\rnd Pn'fcs\tuns C.dc, dl nryli..n{ i\ i'r ful
<br />nol'ChrnicrQrconnmncin! rirhS.crio T(Xx)) oi D'vi(i( l
<br />Contre.tor
<br />I hcrby rflnm undcr Ix lry ol I,c ju,y rfior rlrr ir ( onsrrucrion
<br />hsu.n lse :t097. Cir C ).
<br />in! rgcncy nn rhc F.^rfrrnutu'o .'l rh. sork Ir'r which rhi\ pcnnir is
<br />AIELIIAILIEII.AXAIIO
<br />I hrf,try dlm und.r r.nilry uf lrrjury oft of rh, rolh*nrg dslurlionrl
<br />Dflhlirknr Pcrnik Asb.no. Notiflcari{ Fcd(al R4rhri,ns (Tirlc40. Pad6)
<br />Rcquird tr(cr of Norifr ion
<br />fci,ry'hd
<br />rhc rcdcirl rcsurnrnn{ rc8rdh8
<br />Zl(cnrr\ rhsr I tu\crcrd rhkannlKari,,nJJd nar
<br />vrl rrc mr rptlicahle ro rhh Imjc.r
<br />l.Lg'( k'(rnt,ly{iIr]l( ryrtrd (-,{n y
<br />.',1tr tr..\ rtr,lSrrrd l.rq\ Blxrin! h hui
<br />rri,rrl pmpcny lnr nr\p(lion
<br />\c*:r-\,r Il zC-
<br />-;"^rfrrt**
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rouqh
<br />Service lvleler I
<br />FINAL 0
<br />Notes, Remarks EtC
<br />ID/SIG.
<br />IK,t
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