|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG,COMMENTS OWNER BUILDER DITLCARATION
<br />I hcrcby,flrN undfi r.n,hy oa p.rjury th,t I m cxcdpr fFh rhc Coirdck,N l-iceo\c trw fttr th. r(nb*in! rcas.ls.croll.5
<br />Businc$ d Ptuicsiotr Codc): Any City or Comrt whi.h r.quiEs r Fi'ni' ro coned.r, Jtcr, inDrovc. dcrmlhh or E$n rtry
<br />slrudlrc. prio lo ns i\su0na. ilso icquncslhc opplic.hl lor such pcrmn ro nha si8rcd sr cnEtrr thal lIor shc h li.ensd nururnl
<br />ro rh. pmvisi.ns.fd. Conh0.roli Li..nscd tjw (Chaprcr 9, Onn r.ncing wnh Sc.rion 70(n or Divkion I oi rhc Burinc$.nd
<br />Pmtcsions Codc ) o! lhrl hcorshc iscxcnrlr lh.rcfrom dlhchashforrhcallc8cdcxcmplion AnyviolalionotScclhn7011.5nyony
<br />ap],licDnr aor a pcmit sut'jccc ihc rppli.anr ro rcivilpenollyofnot mrc lhln l_L!c hundrcd dollaG (5500)
<br />-1.NowncrofthcpRrtEny.ormycnlPhyes{irh*lscsd\rh.n$b.o.rpcrsdion.q,dolhewortandlhcslEruEhnninicd.n or oficrcd for slc (56 ?044, Br\n'cs\ a.d Prcia$ions Codq Thc Conrracrois Liccnsc b$ docs nor dplly k, xi o*n(or
<br />rhc Imr.ny *ho buill]s or inDmvcs lhcrer old Bts dfts su.h s& hnnsclfor h.rclfor thrcuEh his or hcr own cmployccc.
<br />pbvidcd rh,r srch impbwmnken inrdrlcd or oflcB! for elc li hos€1€i rhc hdihiig or iqmrcftnr is $ld sirhin .m F.
<br />oa Ls'npkrion. lhe Owm, lruiuq sill h!!. rtr hnrdcn of pmvil8 lhnl lr or shc dil ml t{ild or inqnorc lhc pmrEi, tr rrt plqss .r
<br />L aso*mrorrhc ln,ltny. rncxclusivrly.onrrcrirg wirh lillnsl conrlactE ro.oneocr rh. ptui.r (SN. 7rr44, BusE$
<br />and Pmlksion Cod.:'rhc Contactols Li.cnsc Law dms nor rrtlyro rnoen$.ftropcrlrwho builds.r imtro\es lhcrcon-
<br />and who onlncls lo! such roj.rls wirh ! Co.rn ro(s)liccn{d puisunnr ro rhc Conrra.rois Liccns L!w).
<br />I m,.r.mnr un lcr SNr
<br />[antr[Bl]gJufENsallllNDEqr$ IION
<br />I lt'rht llntr,unn.r p!Mlr!of Itrjoryo .of rhcfoil,,kin!,l..hrrri,n,\
<br />-l
<br />hrvc 0rxlvillronrroin !Cc iricare ofConrcd ro Sclilnsurc for qor*cn conwnsarion. $ pmvidcdfo,bySsrionl?00orrhc
<br />Labor Codc. ror lhc F.rfoflrDRc oi rhc woik for ehich rh. pcnnn ( issu.d
<br />Ihdtrndwillnui'ri"srtrkorrmn,p.n\di{,,i',\uBncc.3\r.quirednySccriotrlT(X)ofrhctrhorCo..forrhcltrlonnmcrf
<br />rlt qork nr *[i(h rlrntcnnir i\ i\{a] Mytrork.r{.onEtrs ri.n in\uno...rnicr a, fli.y u rr dc:
<br />. (la+ e F. ^"rL
<br />-lcniftrhrl
<br />iDrlcpcrfo mRc ul rhc work f(, whi.h rlri pcrnrir i{ issucd. l shall mr cnr oy rny p.rsr in rny manrcr
<br />v, s n, hcorE luhjcci t,,lhc *ortc^ conFr\a't,n l0$\ olC0lilorni!..nd asre ihar ir I sbuld tf,com suhFcr t, rh.
<br />workc's compcn\!lnnr rmvi\ion\ ofSccli,,n:17(x)ollhc tihor Conc.lshtr1l. iidh*iih conuly sirh Ih.s piovi\i.n(
<br />ll/lRNIN(; frilorc h rctrr. worlr^ ronlrcn\dnnr covc.rgr i\ unlnNful. rtrd s {ublc.r r cmtloycr b .rnninal trmlrts and
<br />civil lnr.\ Lt ro oN hundr.d rhousrtrd dollan ($l0o.Oxl). ni .rFNatior drmrscs trs providcd for lhc
<br />;:'-r"';/ji");;'
<br />^)
<br />I hercby lmrn undcr pcnlltyofpcrjury lhal I an liccned undcr pmvisionolChaptcr9 (ollwrcin8 {irh Sccrion 70(()) oroivisn{ l
<br />ol lh. Busi.css ond Pmicssions C.dc. od my liccnsc is in tull lom ad cltml
<br />A.Cqb
<br />elat f tk
<br />I lErchy atinmundcr I]cnlllyofpcrjlryriar rhcrc h a consrruct6. tndin8 lgcrc, l(,r rhc Frrornuncc otrhc *brk ror shhh rhis Fmril is
<br />hsucd(sc l0i)7. civ c ).
<br />dltl.tcAtfD[cl.Anall()x
<br />I hcErry alim undc. i'cnolty oIFrju,, om olrhc rbllo*in8 dal&n'io.s:
<br />Dcnnliri.n Pcnnirl^(bc os Nolilicotioo lrcdcrdl RcBUhrions lTnt 40. Pd6)
<br />-Rcquircd
<br />lxtr r of Nodltu4iotr
<br />-l
<br />ccrlify lhrl $. lcdcEl E8ubl ions EB,rdinB asbcstos rcmwl ee ml arplhablc to lhn pmjel.
<br />d:Sr&fliry ttar I h!'c rcad rhis sonlic.rion rrd srore rhar rtE atnv. 'nlotmrio. h core. I ssxc ro on r
<br />ordi'rr cc\ rnd Sirrc laws mlariig t,6xiUnrt r.nd r.Itrd*ni nG.frhi\ Cir
<br />atx,v. ,.trri,rEl protcrry ir i,rsF.rion
<br />ApDlicanl or Agenl SiInah!r.
<br />OSr'!?iLr\;#
<br />y trirh rll cn) .M cirtriy
<br />\ tr,,rc, d\ rn.rllr{rr- Kltr ltB
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dam pers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />To rquerng
<br />Sub-Panels
<br />Roof Top Equipment
<br />F actory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffil Rouqh
<br />Ceilings (T-Bar Rough)
<br />l\lleter Release
<br />Rough
<br />Service [\l]eter
<br />FINAL lolz/rx 5Dt5\5
<br />Notes, Remarks, Etc
<br />Communications Cable
<br />Translormers
<br />Air Conditioners
|