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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.O1VNET BIIILDER DELCARATION
<br />I hcaby imm xndcr t nrliy of pc,jury th.t I !m ercmll irom lhc Conto.roN Lien\. tlw for lhc aollowinC rclsn (Scc.70ll.5
<br />Busi.c$ und Proicssn,n Codc), Any Cny .r Coudy shi.h rtquir.s . JUnlil ro onstrucr. olrcr inrpro{c- dddolish ur nNn my
<br />rtudur. prior ro irs i$u.mc. sls rcquics ihc appliconl lor such ,emir to nb a risncd ndcn..r rhar lE or shc is liensd FuNanr .
<br />r. rhe rmviions ofrh. Co.r.rctr\ Li..nscd ttrw (Ch,flcr 9. Orm,rutrcing qilh Scclion 70{n ol Divnion I or thc Busirrcss nnd .
<br />Polcsions Codc) or rh.r h. o. sh. is crcnul lhcrcliomond rhc b.st lor lhe alhscd crcmprio. Atry riol0lion of Ssrhn 7011.5 bya.,
<br />aftlicld lM a p.nnn subjcck lhc applicln oncivilpcnrhyolnor modrhon fivc hundrcd dollosi$5ur).
<br />l. N oED$ ol rhc prcIrny- or ,try cmploree! N ilh w.rcs !\ rhcn sol. coml(nnf n,n. qill d. ih. ao* .ft1 thc {trruto n Rn
<br />i cndcd oroftrcd r'or solc (S.c7(I,l.l. Bu\incs od hoia\strn{ Cod.r TltCotrr oi\ Liccns Law docs nor {'rly ro ni owncr o,
<br />rhcp!,Fn) $ho builds or in{n,vcs illfrn. url who d&r uch $od hnDrfor hcrcll orlhn,dshhi\n hfowtrcnplo]ccs-
<br />pn)lidcd rh.r such inninvcnrnrs !E or iNcndL\l o! olTcr\l lo ylc ll txrwrcr, rh. huil i'B or nl1t)tuvcn*d n v,kl * i rh om )mr
<br />olcon1,l.ri.i.rhc()N.rAr' d willhrvc rhc larld olpn'vtB llxtr hc or shc dtltror ttrild o! improk thc rn,Ixry ht rhc t'uqrsc ol
<br />I. * owncrol rhc t6r.dy, amcx.lnsivclycoMacrins wnh liccnscd conrrdo^ ro.on{ru.r lh. Frulcd lscc. ?044- Bu\incs
<br />utrd Proisshn Codc Tht Conrrcroi s Liceo{ l.aw do.s nor rpply ro $ o*trc. ol prolcny tr ho bu ilds or inpnn.s rhcron.
<br />rtul who onth.is for such projars wilh a conimcn'(n ltcnscd lursuMr tJ rhc orntaclofs Liccnsc ljw).
<br />I rhrrc l, rtrd.r Sc.!rl
<br />Dor.: OBDe.:
<br />IVORKERS' C-OIUPFN.AT(IN
<br />IJ&CLA8AII()TI
<br />I hcrc$y rrtnil u dc. pcmlryoaErrur, onc olrte tollowinp declarrion\:
<br />I hdvc arxl will '!rid0in Nccnili.rtcolCo.sc ro S.la Insurc 6r wortqr $mpctrqri.i. as pmvidcd rb! hy Sccrnr .171() of thc
<br />LlEr Codc- ttrthcFrfomnc.of thc r.r* for which rhc tdnil i\ isnrcd.
<br />I hrvc rM nillnri rir worlcra conDc$riiotr in\oflncc. r\ rcqun.dh!Scdn,nl7lx)oirheltrho!Codc,f{trrhclf,rfonunrcof
<br />thc wort forrhichrhn n€irnir i\ tsucd Nly*orkc^ compei$rnn, in\ur cccdnicr a txlicynunrfi.rart:F*zt = iar*'FLAoa 73 i7 ao
<br />Iccnilyrhrtirth.D.ni)nnanccolrhc$orkforwhicIrhi\ft' rir is i($cd. I sl[ll tror cnrPloy !ny Pcnon in dn, trrMmr
<br />$ tr\ r) tEcotrr hjccr t, rhc ror*cn .ornl'cnernnr h*ro,Colir'.rni!. and xgr.rhar itl lhould h.tom \uh].crbrhc
<br />$orkd\ .onf.n\aii.nl'rl)vhn'trsolSccrion.lTtx)olrhcLrhr(i)dc.l\lx'll.t'nhwirh.o lny wirh rlN* tro\ ision\
<br />WARNINc: F{ilurc ro sccurc sorkcr
<br />rivil lii.\ rp b onc hundrcd lhonsi
<br />\r!rr{ n'76,,rrhc F r4 L-oqf inrcrc{
<br />".,", Jy'z/r
<br />onrFnrari.n corcngc i\ unlDNlul. nM shnll
<br />dollnn (Slu)-000). in dirior ro lhc.osl of
<br />{,l)..r !, .trrd!]r.r 1o rDinrl r{DJlrr\ r ir
<br />!)$|niMr.n ,!xnnrr\ r\ p(n dcd r,tr rh(
<br />I h$chtrlln rutrdcrNn lryolpcrjryllr lam lic.trBlundcr pmvi\i 'olchnflcr9(irB sirh S(ri,n ?(xn) ofDNisior l
<br />ol rhc llusincssrxl Pn)fc\snnr Codc. r d lnylrcn* is ir lull ir.c inlcl'lccr
<br />Z\(-)a
<br />?Z
<br />(:ONSTRI](:TION I ENDIN(; (;ENCI
<br />Ihcrcbyrfinmundcrpcnrlry.r,crjuryrh lhs. iqr..nirucridr LtdirE isocy ror rh. I[rru'nM.. oi rh w.rk nt$hi.h r[i!,tdir i\
<br />i\{ucd (Scc 1097. Civ. C.)
<br />Ixndcrs Addrc.s
<br />-
<br />AITUIANLDICLA&IAN
<br />I hcEby afijnn und.r nenolry ofncriry oic ofrtu rolb$in! dNlnturi.n\l
<br />Dc.blirn Pcnnirs^sh.{os Notincrii,r Fcdcft! Rcguhb.\ l'l iilc 41),l'Jn6)
<br />Rcqutrcd ta crorNolili.{rion
<br />I ccnil}th3t lhclcd.ralrcsrllrn)n\ togardirA astr(o\ rcnx,vrl rrc nor.pfli.lhlc t' rhn prl}tr
<br />lcdifyrhar I hrvc r.rd (hisaptlkarionrnd( crhar rtu !in{ inlhnrorion h.otrcct l rBrN h
<br />ordiMn.cs ,rd sr.rc l-itrs mlarios ro buildins conndcrion- u.i hc.chyrorhrtc rfrcsunr ivcsofr
<br />rhovc mcnrinncd ptuI.nyfor tlspc.liotr pu4xxcs.
<br />comDly rnh all Cnyand Cor y
<br />,:"","':;zz;^\Ipli.rnr or Asrnl SiSnrrnrc m<221>
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Slandards
<br />Spas, Pool, Founlains
<br />Srgns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bouqh)
<br />Ceilinos (Hard & Solfit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service lVleter
<br />FINAL
<br />Notes, Remarks, Etc
<br />COMMENTS
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