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ELECTRICAL-INSPECTOR BECORD
<br />APPROVALS DATE OWNER AUILDER DEI-CANATrcN
<br />I hrfthy rlrtrm utu].r p$alry or lrcrjury rh.r I m er.npr rmm rhc CnnlmctoF LiccnE L,* atn rlr r.llowing rclsn lscc.7ol I 5
<br />Blsin€$ ond Profc$ion Codc): Any Cirt or Colnr, whi.h rcqoiiN , Irrniir b onsrrucl. allcr, inPmle. dcmh\h u tNr di
<br />3rtu rud,Irirrb irs h!u,n.c. rho rcquircs lhctrpFlicam for suchFnnir ro file ! si-lned srorcmnr fiar lf, o. 3h. is liccnscd luNuint-
<br />lo thc plolisions ol thc Conrrackn s l-icen$d Lls (Chafls 9. Comeming wnh S.ction 70OO of Divtion I olrhc Busi.cs and
<br />Pmic$ions Code) or rhal hc or shc is ercnfl lheefrom and lhc b$t ntr !h. rll.8cd cxcmtlion. Any riolalion 6fSelion 70.t1.5 hy any
<br />q,plicanr ror aFmir subjdck rhc aptlicanr Io a.ivil p.n,lryornor rmr. ttun fivc hundrcd dollars ($500)
<br />V\"/ L ar owmr of lh. ptuFny. or my cnployces wnh *ages rs then $h .lmpc,slion, will do rh. wo* a,n tu nnl1m n mr
<br />irtcndcn oroEcrcd lor sle (Sa 7(x4, Busircs and Pmf.ssn,ns Codd: Thc conrncloas Liccns tjw dms not apnly b M owncror
<br />rhc ptur.n, wtx, huius m inpn,K fi.mn. dld *ho dc ssh rrrt himsclior hc.\clfo, rhmu8h hk or hcr o*n.mphyccs.
<br />providcd rhlr such imrrcrcrcnrs m mr imcnd orolibrcd 6rsah.ll ho$cw. rh.lrildin8 or impm(nE is sld wirhin.nc rra
<br />ofon{,lelion. thc Owncr BuitLr will hlvc ih. bxnlcn ot potis rhd hc o. rhc did mr huild or i $orc rhc pDpcny for rh. P rF€of
<br />-1.
<br />6 o*rcr ol rlr lnpcn y. rm cxclusirdly conrrrcring wirh liccn{d cdnta.bs to connrud lh. I}(id (Scc 7044, Bunncs
<br />.nd Pmf*sirCodc-th.Conrru.ror'sLiccnscLnwdocsnor.ptlyr.!no*ocrotprcpcnywhobuildroriftprurcsrhcrc.n.
<br />ud sho conrrrk lor roch F,jecrs eirh I Co.ta.k,ns) li.cn*d punud fu lhc Conr0doi\ Licctre ljs)
<br />"",.A/'11 l&.. -L
<br />I hcrcbytrrln'n!nd.rn n,lry.rF,uryotrcolrh.rollosingd..lnr ions
<br />-l
<br />hlvc andwil!maiorain Cdnili.arc.rco cnrroSclrlnsuichtrwork$rcomDcnn(io..is troridcd lorbyS.dnr l?(Xlolrhc
<br />t hor Crdc- for lhc perfornErcc ot rhc so* io. which rhc Frnir is h\ucd
<br />-l holc aM will mlinuin *orlcF co'npcnsrrn i.\urrtu., a ruqunM by scd nrn l?ur ol lhc L{hor C,dc. f{t rh. df.hMNc of
<br />lhc $ort In yhich I [is Frnrir i\ t\kl Myworkc* coht .sark,n iisrtrn.c crEicr .nd Policy.umhcr 6c
<br />Policy Numtler:-Expncs
<br />y! lc.n'ry rhr h rhc n rrontunlc ofrhc anrl ror whrh $is p.,mii n isucd.I shrllnor cmtloy ony pcrson iD 0ny nx'nncr
<br />$ as b h.rom rubj.\l to thc q er comFnstion luws oicrliaomia. and alrc hd ifI should h..om su$jd loltr
<br />u'orkc$ corupctrsdlinpmvisions ofSccri0 lrOOolrte tilitr A'dc.l rhtrll. Lnh*nh conply wir[ lhos rovnions
<br />TVARNINC: l;iihtrc ro ccurc $orkcr\ cotrpcnsdn,n corc gc i\ unh*lnl. rnd nrll \ubncr nrr cnUl.)cr lo riniiul!.Bhi\ rd
<br />S..r 'on lh,7a or r h€ I inr I{nc inlercn
<br />".,",.elqltA
<br />I hcreby rmrnr und.r Fnalry orncrjury rhal I un liccNn unJcr rmlision ofChlprcr I (.om,ncrnre sith
<br />of lnc Busircs and Prcfc$ions C.dc. and .ry lk.n* h in tull fd.. ltrd crier.
<br />Li.cnsc Cl,s:-Liccnsc Numhcr
<br />Dor. ( onlrrcror
<br />COISIAIJCII9N.LENDING.&AIMJI
<br />I hcmhr rin'n trndcr Fmhy.l !.rjury lhit lluc i\. orslru.riotr bndins ascmy ro' rfu pcrlonruku.rrhc work nn which lhis Pcn.ir i\
<br />tsucd (Scc 1097. Civ C )
<br />kndclsNanr
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<br />APPT,ICANT DECLARATION
<br />I hcr.n, afim utuk, pcndlr, oi ,.rjury .rc of lh. following dNldlrions:
<br />Dcmliion P.mits Ash€srox Norillc,'io. Fcdcrsl Rcgul,rion. ITirl. 40. Pd6)
<br />-Rcq!nd
<br />kllerotNnifi carirn
<br />_l .ea ily lhar rhc fcd.ld r.gultrtions rcgtrdir8 asb.slos rcnnvul rc not aprlicatk ro rhis Pn,j.tr
<br />U4Acnity rhd I hN. rcad rhh trl)nlic'rion ontl {atc rhar th. 0bvc inromEr ion ir corsr I astd ro con ly with ,ll ciry and counr,
<br />.di.mcs and srab krs rlarins ro 6uildi.s constructirn. ed h.rchy lurhni2c rcFc*nrarivcs ofrhis cilyand Counly ro cnrcr upon rhe
<br />rhi)r icniiotud lroltny tor msr..r
<br />^pplic.nr
<br />or Aseni slsMtue,]{
<br />r"-u"" ."." r r.ir, t, K VE rzoNt@-
<br />6l qltS
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / 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 (Rough)
<br />Ceilings (Hard & Sollit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rouqh
<br />Service lvleter
<br />FINAL lDh,//9 vn lqd/
<br />Notes, Remarks, Etc./u"
<br />-+
<br />rD/srG.COMMENTS
<br />Site-Work
<br />I cFdc''s Add'cs
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