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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER AUILDER DEI.CARATION
<br />I hcnbv iffifln u cr Nnrlry ()f p.riury lhlr , !flrc0npr lr nrl'cC nr^ruA't{ci{ ttrtr illh'c lonosr! rc6on (scc70:rl5
<br />Bu\i'r.s md Pnn'csion Cdc): Any Ciry or Counry {hi.h tuquncs I Fnnir lo c.n(ruct- alrcr. i'npnrvc. d.molish or tp.r ,try
<br />{ru.rurc. Drior ro irs hsumcc.oho rcqunes rhc !pp!ic!!r tor \uch Frmir b filc r signcd {arcm r rhd lEo, \hc is liccnscd Pui\urnr
<br />h rhc fn,vi$ons of rh. Cdrti.tois Liccn*d tiw (Ch.Incr 9. ao nEncing sirh Sc.rion ?(XI) of Dvisiotr ] oflnc lrusincs and
<br />Pn,r!$iotrsCodc) rrhrthcorshciscxcnDrlh.rchnn!n{llhcb!si\trrhcullcgcdcrcnuiotr.AtryvnnatirnofSarionT0.llSbyrny
<br />rl]plicanr li,, r pemil subjccrs rhc rrpli. n,dcililp. lrr or or 'nr. rhrn livc lundrcd doll$ (S5tx)).
<br />_1,!\owturorrhctn,Ilcdy.rnnycmrloyeswirhwa8csarlhcnsbconDenqrion.silldorltrwor*ddrhc{mruc'\,
<br />ir.ndcn or orcmd r.r sL (Se.7044. Ausimss und Pmfc$iom Codq l he Conta.ttr r Li.cnsc L.w docs not lmly lo !n osicr or
<br />rnc prorcny sho huild\ or ifiprolcs rh.tun. d wlb ilms \rh k)rt himscll or hcrsl{ or lhrcuah hh or hcr o*n cmfl,rytcs.
<br />[ortlcd rhd su.h imlmrcmnh .L- mr ir .'r].t or ollcGl lb. sh ll how.Fi rhc ttildins .r nlll)tuvcftN is sold wilhin nnc yc
<br />olcotqrLrion. th. owncr auirlcr will navc thc hurdcn ofpravins rhrr hc or shc da n.t t ikl or iq)tuvc ln. pnrdy for IIE pu4n* of
<br />-1.
<br />rs owncr ol rhc rlonen y. run cichsivcly conrracrinE wirh licci*d .ontr.t$ fu onnrud thc pmFl ( s.c 7044. Buems
<br />and fioliask C{xlc:Th.Cinractr'sLiccnscLnwdocsnor.tplrromowncrolpnr. y$h. buildsor inrProrcs Ihcron.
<br />itrd who conlruds l'or {uchpoFhsirhfl ConrEck,(n !.c0scd pursuunr lorhcCont.cktr sl,iccnsc hw).
<br />I r .icfrt, u .r Sccrl
<br />Olner
<br />IIQBrl:8!Lr:l]!I[IN$LUA!
<br />D&CIr'TBAIIOtr
<br />I h$chy drinn n dcr Nnrlr, or pcrjlry otrc oirhc folk,$in-! cch'rrion\
<br />lh.vcatnwilrmint0inrCcnificarcolConscnrroSclflnsurcn,worrc^.otrrp.trs{tion..strovidedfuhyS&iionlT0oolrhc
<br />ljb(, c.d.. br rhc p$rormancc of lhc wolt for $ich lhc nsmit h issucd
<br />-lhovcond
<br />willman anrworlcF comrrchsrrion insurancc. r\ r.quircd by Sc.iion lTlI) oithc l-uhot Codc, nn rhc p.rfonn0h_cof
<br />rhc wort for whichlhi\ pcrmir is issrdd Myuorkc^ .o'nPcn\rrbn i.surin c cnnicrurl poli'jy nun,h.. rc:
<br />I ccniryrhll inrhc p. nrn{nccoflheworkforwhichrhisr.rmiri\issucd.IshallNrcmPlo}rnyIEr$nin!!,m,nn.r
<br />w slohccom lu6jccr rorhc sorkc^ comFn\drion hw\ol Caliroari .,nd 4eihll ill sk)lld hcs,m $brcd rorrf,
<br />Rortcn.onwnsationprovisbnsolSccrn,nlT0OotrhctlhtrCodc.lshill.lbnhwirhcomply*irhlhosrrovisbn\.
<br />cnil rlN\ trp t, onc hundrcd rhou\nid dollar\ (Sl(x).(Xr0). ir rJd co\r nl.onl|*iurbn. dnnu8cs rs [ovidcd lor rhc
<br />Sc.rion :1076 ofrhc L:trr Gnlc
<br />"",",p 1</ /8
<br />i' crc{ r d {rirncy-\ l(\
<br />DECI.dBAIIQN
<br />I hcrby afiinn und.r lEnalty o! pcrjury rhar I am lic€nrn !n<lq provtion.rCnnpld 9(conrmncins wilh Scrt,n 70m) orDilision:l
<br />of rhc Busims {nd Pofdsbns Codc. dd nry licctrs is itr lull lhrce ond cffccr
<br />a",t*",.. (-
<br />IONEIXIJIIIONIENOINI;.&GDNCI
<br />I hcEhy sltnm undcr lcnalty ot Frjury ihd Ocft L1 , .onid.rlJ. lcndi.S !8cmy for thc p.Tl'olmmc or rh. work for whkh rhh Isnit is
<br />irsued(S* :109?. Cir C.).
<br />Lf,ndci. Ndorc
<br />-
<br />AEUCAXLDA:LASAIION
<br />I hodry,fio undc, Fnalty of Dcrjury om otthc folheins dccldolions
<br />Dcmlirion Pemits AstEst.* Noliric,rion FLtcml Rcgul{ions (Tirlc,lO, Pan6)
<br />-Rcqutcd
<br />Lcud ol Norifi@ri.n
<br />l.cnifyrhur rhcLdcr.lrcAulolions rcglrding rsb.{o\ rcnoval rrc nor dtPli. lclorhistnjccl
<br />-lccnilyrharlhrvcrcadrni\ryDlkdrionddnrrcrhdrrh.nt
<br />v. irhaulion tcotrccl I aare b Ll,mply wirh all Cil, .trd County
<br />. inonccsandSrarcL.wsrhrinsrobrildingcoNturion,r' hcrcby,urlntrizcrcprcscnlolivcsoilhhCiryMdCou.ry'ocnrnnr.nrh.
<br />I lh.!c irnrr c,r,,mn i) r.r ,PLfAppliclnl or A8.nt si8@ltrm
<br />>(.U t't l.a ,",., g1Jll8
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bouoh)
<br />Ceilinos (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Itleler Release
<br />Rough
<br />Service lvleter
<br />FINAL 7{L4rK br\t<6
<br />Notes, Remarks, Etc.
<br />tD/stG.
<br />Air Conditioners
<br />Csrhl
<br />-
<br />&13
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