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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS O\INER AUILDCR DELCARATION <br />I hcrcby.ftrrn u cr pcnalry (,f pcrrury rhrr I m.kempr fnn rh. G)nrr"ci{tra l,iccnsc tjw Ln rhe folbwing r.N,n (Scc7oll5 <br />Brsi',rss und Prol'c$bn Codc) Any Cily o, Counly rhi.h rcquiEs qrrmn lo construd, lltcr. improvc. dcnolish nr rcnln . ry <br />nfl.rur., trirr ro irs isxa.c.. lko rcltuncs rhc uprltlnr lor suct rErmir ro filca sirncd ddcmnr rhar hc.r sh. k li.Mscd pu*uanr <br />tr Ih€ povtions ol rhc Conhctols Lic.nsd Llw (Ch.plcr 9. Conrnr.cing sirh Scclion 7uD o, Divniotr 3 oflhc Busincs ond <br />Protc$ion\Code)orlharhcorshehcrcmflltcrcfiomaldrhchaskrbrrhcallcecdcxcnrfliotr.AnyviolarionolSccrhaTO.ll5hyrny <br />,lfli.drrorrremn\lbjsl!rhcerlicanrroacivilncnaltyolnornbrclhonlivchundrcndollaislS500) <br />.-1. 0s owNr ol rhc pmfIny. {r my cmflor..s rirh wager rhct v,k ofrF.sdn,n. wiu do rh. *ork and rhc (duc i( h <br />nn. lcd oroncrcdrorslc(Sc1!44.Busincssotrdltolassiotrsc.\tTncContacttr!Ltcnscti*do*nolrrplyroon.*ncroI <br />rhc l]loncny who builds or imrmrcs rlTK)n. und *h. dds \o.h sorl hims.lfor h.n.lfor rhbugh hk or h.r oen.nrpk'rN\. <br />providcd rhar skh inlrokmnk m nor inrcRli or ofErn nn sb. tt how$rr. ltE trilliry or irrlrowm hsklwirhinonc}!d <br />ofcoEl,Lrion, llT O*ncr Bliklcr pillh,tr thc bu cnoapmvinS rh h.orshc dd mt build or pn)rc rhc lm)psly for th€ Nrpo* of <br />l. rr o*kr or rhc Frrrny. anrcich\ivclyconlrucrin8wilh liccnscdco mcknslocotr(tucl lh€ pml.cl (S(.7orl, Bu\inr* <br />lnd h.fc$ion Codc ThcConrra.lofsl-iccnscLawd.csnorsptlyklr.osn.r.lpn,p. ywhobuildsoiinprovcrrhcrc n. <br />rnd {ho d,nrncls for such porcts $irh ! C.nr6ck'ns) liccnscd l)usuanr to rhc C.nrracrol\ l-iccnr ljw) <br />I rmc{cf,Ji un{lcr Sc.ri,, <br />l)olr: O*n$: <br />IVOiKERS' COIIPEN|SAT(JN <br />DECI/3A.UO! <br />I h.r.bt nflimuidcr l.nalrt.frrjrryon. ofrhc folkr*irs dccli,rrions: <br />I hav. and willtuinrrinaCdnilicxrcofC.n\cnrio Sclf lnsurc for $orkqa conrpcnqn,n. as pn,vilcdlnr$ySdri,'n:l7fX)ofrh. <br />txtxn G'dc. n, rtu llcrl'onBncc orrhc sort lb! which lhc pcrnit is hsrcd. <br />-lhilc <br />ond willrainrai. work.rj cotrrpc.sariun insunn.c, rs rulrircd by Sc.r n,. l7O0 of lhc bhd C.dc, for Ihc Frlbnmncc ol <br />lhc work for whi.h tht p.rnit is issNd Mysor*.s .o'nl..sarion in\xkrR..dicrd pdkl trumb.rrr <br />lrnicyNuNhcr-Exptcr <br />I..nify rh3r ir rhc pcrr'onuncc {)frlE $ork lhr shich thi( Nflnll t hsEn.I \hrllNlcmlloy arry Frvn, in rtry uincr <br />{) Nk,hccontc slbjccr t,rhc so {A c.nrr.nsrrion lrs\ ot Crlilnnir. a rgr.c rhxril I \k,rld h(nr subicd r.rtr <br />sorkcn comNtrviion F,i\i.tu ofScch.n.lT(n ofrhc lrhr C{xl..l nHll. f(dh*irh conlPly $ irh rho$ pmvi\nJn\ <br />W RNINC liriltrrc ro {cu.c sorken compcrsnri.n cr)vcrr8c rs u rlrstul. r \lEll \!hr.r rn cnrnl.ycr tu crimi' l pcmlrics rtd <br />civil nncs tr,, b oru hunircd rhousrnd dollafi (Sl(xr.(Xx)). ir iddirion ro rhc co( ol conrp.nruion. daftr-ses !\ pmrided nn th. <br />I hcrcbyrtfinnu d !.nixror|frjury rhar I rm li..n*\r u.dcr prnvi\ion DrChapi& 9 (.onrnrftin! wrh serion Tux)) olDirisnr ] <br />or rhc Busies\and Pruac\\n,n\ C.dc. "nd nry liccnsc n n' tullfor.c nl efc., <br />I hcEby aflirm undcr IE lly of pedury rfilr th.E is a mnsltuclhn lcndinB lgcncy ior lhc pcrfornEncc oirh. so.k forwhichlhn pcrhir is <br />issu.d (Se. 3097. Civ. C.). <br />A.T8J.IIAILDLCI,/IAAIIAN <br />I h.n$y rmnn undcr r.n,xy orp.luiy onc orrhc tollowina dKlnllrn,ns <br />Drn$lirion Pcrnirs Ashc\ros Noriticrrion Fcdcral Rqularions (lirlc4l). Pan6) <br />Rcqutud Ir(cr of Nonliuri(tri <br />-l <br />ccnilrrhat lhe lcdcr.lrcElhrio$ rcg{dir8 asticslos rcnn'vil m not qrdErhL b ihr l]ro)ccl <br />-l.cnify <br />rhll I h.\c rcod tht apflicdion a.d natc lhd rhc,hv. nrlornurion h.orc.t. I i 8re ro conr/y wnh oll Cnyutrd (tutrly <br />ordinanc.\ ond Sl0rc l-aws rcloliry to scnl{rivcs oflhn Cirynnd Counry nr cntcr uln'n rhc <br />rbovc nEnli.tren pmNny f.r <br />Applicanl or Agrnl Si8mtu <br />to\+ <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />S igns (monument) <br />!!!e Salety /Low Voltage <br />Fire Alarm / Dampers <br />Communicalions Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFEFI <br />Torqueinq <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Solfit Rouoh <br />Ceilings (T-Bar Rouoh) <br />Itlleter Release <br />Rough q 'Elt((t*t t<.*11 >9 -/Service [t/]eler us <br />FINAL lo/Zq*t*r</@ <br />Notes, Remarks, Etc l7 lll I <br />S.criirn .1O76 ofrhc l]hor Codc. inr.rc{ and alktrruy r tccs <br />ContrsLlor <br />L.trdci.AJ,lr($ <br />Site-Work <br />Transformers <br />Sub-Panels