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ELECTRICAL.INSPECTOR RECOHD
<br />DATE I 5lG.COMMENTS OI{NER BUILDER DNLCAR,{TION
<br />I h.rcby orrn undn ,...lry oi pcrjury rh l dn cxcn r rmm rhc cotrtr.rorc' Liccnsc tjw lbr lhc folloBin8 !c*,n (Ss 70.11!
<br />Bu\inc$ ard Proacssion Codc) Any Ciry or C.lnry *nicn rcquircs a,Flnrit lo cotsrocr. rlrcr. impmv.. dc'nolkh 'tr rclan trny
<br />structu(. Frior ro ns nsuancc. !l$ Equncs
<br />'hc,tpli.,nr
<br />tor ru.h tf nir ro iilc r sigftd nnrcmnt rh.l lEor shc is liccn*d puruanl
<br />r.lh. F,virions ofrh. Conricroas Liensd tls (Ch{rer 9. Comrcncins snh Scclidn 7OO0 ot Di!i{n,n l.r rhd ausinss..d
<br />PmLsions Cod.)o.lhd h.orsh( t.rcnrfl rhercrom dd rhrh\ir ror lh. alke.d ckmprion Any viol,lionoiSc.lion?011.5 byiny
<br />lpllicont lor a pcrnit sublccc lhc orplicani loa.ivilpctr.xyolml m.n rhan livc hundrcd dollars (5500).
<br />L rsownerolrhcponc'1t- saciclusivcly.onrr4rins wnh liccnrdconrrlcront,conndd rhc nrcjdcr (sN 7044. Bu\ins
<br />r Pilri{\ionCodcrThcCont,cror'sLi.cns.Lrqdocsnorlptlybsnopncriilrtup. ywho huilds or ir,trovc\ thcrcon,
<br />cnd wno.ontracknnsuchpn+chnirhaConlBcfudolkctrrdplNrmrlorhrConrrlcroisLiccnrtrw).
<br />-l
<br />rmcxcnrpl undd sc{r
<br />]loBf,l:Bltg)llfl;Nsa-IlaNulill aalro!
<br />I lrrcbyrll1' rutrd.r Ntrrlryorl.rjury.ncorrhclnllowir! dlylnr.riotrs
<br />-l
<br />hrvc rnd will mrinr.in . Ccnilt c of Conscnt b S.r-lnsurc for work r' onpcnsolmn. !s pmvidcd lor by Ssl ion :1700 ol lhc
<br />htxr Codc. tor !fic perf.r@.. of rh. worl fd whkh thc pqnir ir issued
<br />df hNcind *rllnDmhm worlch lonrcn\.rnn Nrsmc..s rcquircd nySdior l7{xj olthc Libor Codc. for thc pcrron!&cc.f-tht trnrl ror shrch rhNtxrm[ rs h.ud My s orkcr' ompcn..r on rn\urrrc!am.r lnd F'lEyrumhc, rc'
<br />o />a lttol1
<br />I c.drfylh.r in rh. Itnartu cofrhcworkn,whichrhi\pcnnirist\ucd.I\hrllnorcrnlloyrnypc^oninanyflranncr
<br />so $ro t{conr {rbl.d ro rl.. worlcn ..npctrs ion la*s .ac,lironria. Md lBB rh.l iil snould b.ronrc s$rcl lolhc
<br />workcis omrcnsaliotr f'mricions.fScciio.17(x)ofrh. titsr C(x1.,I shJI. rorrhwithconlny eilh lhr$ I'I)visions..
<br />::::';i':ry:'ry^^;Ur*,)4 Z t'<-'
<br />ll( I.,\st,t) ( {)N rr \( l(}I
<br />T)ECLARAfi(TN
<br />I h.mbynftrnundcr p.nahy or pcrjury th,r I m li.enul xndd pn'vhion orCharrd 9lcommncing wirh Seliotr ?fi,) ofDilhion.1
<br />oi lhc Blsincs ind hofesionr Cod.. (d my liccnrc is h firll I'ore and ctfccr.
<br />,?2 ZZ (,r-<)
<br />*{ rl 1{ *"^*",y.
<br />llr.NilBl(l!1)ll,IlDl}ii:!1il!.ll
<br />I hcrcby,rinh undcr p.ialry or ncrJury rhd rhdc h r sn(ru.rion bndi.g dgcn.y for rhe pcrfrnuncc ollhc eoll io! whth rhh rrnrir k
<br />isslcd (Scc.309?. Civ C.)
<br />APILICANLDECIJM.IIIJN
<br />I tdtby lilim !nder pen!lly olpcrjury onc orrhc lolloqins {islanrions:
<br />Dcmlirion P.rmils'Asb.slos Notincalion ff dcral RCEUl.tions (TirL,t0. Pon6)
<br />-Rcquncd
<br />blc. olN.iift rltun
<br />Ic.nifyrhrrhcfcncrslrc8rl ion\ dgddinl r\hcdos rn ulurc nor rnrlic3hl.r. rhi* nmj.cr.
<br />N-
<br />-Lhlccnriyrhrlrlrctulrhi\dnnlicahn d{Jrcrhrrhc$orcinror.rridriscitrccllr-qierocomplywirhallCirysRlCounryqrJ'norcc! and Shrc tiws rchuns ro huildins cnn{Ecr'on. md hcrchyrurh.rizc r$rcscnralive\ ofrhn Cny and Counrr ro cnrcr rF,n rhc
<br />,t{vc ircnrioncd pmp.ny lor irspcdionNrlrs
<br />/.4<<-,\I,Dli.anl or A,l$1 Siannl urr
<br />*"-,u*.,n,",nnn,,, {D'r14A 4ba.,.,.,t{..4.f
<br />Site-Work ,
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />l!!q Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundino / UFER
<br />Transformers
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilin gs (T-Bar Rough)
<br />lvleler Release
<br />Rough
<br />Service Meter
<br />FINAL
<br />Notes, Bemarks, Etc.
<br />:-n
<br />APPROVALS
<br />l. !\ owncror'hc pn,Fnr. or mycnuloBs wirh Br8cs a\ rhcir slc.onDcn\ain,n. *illd{, ihc wo.* 'Jri rh. s'tuiuc n
<br />i cfrhd or offcr.d lor srlc (S( 704:1. Btrsims Md Profcsion\ C.dcr'rh. Contn rofs t-iccnsc ljv docs.or apnlyro an owncrof
<br />rhc pmFny *1x, builds or in{,mvcs themn. d wk) d{r\ such w)rk hin,scll or hcr\.lr oi rhRr8h hii .r hlr own cnfloycc\.
<br />prolidcd rhar such i'npmEmnt m mr inrcndcd or oftrn f.r elc I t hos$cr. rhc hildi',g or inlm*cnrnr k $kl wirhir
<br />'
<br />trrc I r
<br />or connhrion. rlrc owncr Auitlq sill hor lhc hudcn of lJrovirlB lh hcorshcdid nor buildor impror rhe pm!,en, turh.I qx,col
<br />Under Slab / Floor
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