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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS I hcrcby rfitm u crp.nalryofp.rjuryrharIanrexcmPrlmnrrhcCnnrr,.ror't-ic.nscIi*nnrhcrollo*ir8rcrbn(S.cro3l5
<br />ausi'rc\s add Pfl,fcsid Cdlc): Any Cirt or Counry whi.h rcqun \ r Fnnit r, .oNru.'. ,lrs. itrryovc. dcmlish or rcI,.n liy
<br />id.rurc, riff ro irs issu rcc. nko r.quncs rM aptlic. lor su.h Fnnir to fiL 0 si8.cd ( c'rcnr lhlt k or shc i\ li..n{d pu^udr
<br />fu rhc pn)lisn,ns oi rhc Conrscd i Licriscd Ijw (Chnprc. 9. Co@ncing *nh Sc.rio 7ft)0 of Dnkion I oa rhc Btsincs and
<br />Pmlcsstunscodc)orrharhcorshciscicarDtrhcrcli.mmdrhchn(isforthcallcEcdcxcm bn Anyvdarion.rSc.riDnT0rltby,ny
<br />unplicrtrrlornr.rmirsubjcctsrl.. apflicurxJ ! civil pcn!lryolnor nnn! rhd rivc hundr.d dollds ($50o).
<br />I. as ow*r ofihc pm,rrly. or.rycmplorrcs pillr wtr8cs 0s rhcn sb comFnslrion. *illdo thc $ok rnd rlt lerm ilrct
<br />intc cn oro,tircn ior Rrlc(5(.71|44- Busirc$ ond Pnr'csrions Codcr'Ihc Cootrcroas Liccnsc tjw d.cs nor {,ilyloanotrncrol
<br />rhr pft,pcn, who hrilds or itrqtrovesrhcd)n. &kt wh. dds suchao hins.lforhcr*lforrhrcu8hhisorhcrowncq,loyccr-
<br />trovidcd rhrr such inpmvcrEnts !E mr i cdcd or oficErd l.r slc. Il h.*cE. thc hiting or irymEnrd h eld wirhin onc F-
<br />.fco'pkrion. rhc Owkr Buih.r willlrw rh. bod.tr oflr.lnE rllJ h. or shc di] nor huik or imprcr rhc pmlidy lor lh. pu{x'r of
<br />l. as owi.r orrlr pmFny. mncrclusivclyconra.tins wilh liccnscd conlraclor lo consrE.r rlE rhi{ (s...704-4. Bu\itrs\
<br />lnd l,Innsion Code: 'rhc Conrracroas l-iccnsc l-aw docs.or apply ro !no{nd orl()rcdy who builds or inrptuv$ lhcreon.
<br />r.d wh.onrtrrsro!sEhpmj$k$irh.Co rero(9li.cnscd Dur$.nr ro rhcConrracroir Liccnsc L:w)
<br />-l
<br />aarcxempl ufldcr S$.'liu
<br />Ow.:
<br />UABKEBILI;!]IIPIXSAIIIJN
<br />D[CIlI&rIlO!
<br />I hcrchy ulnD undcr ncnrlryolrrsiuD- onc oirhc iollo*ins dlrbnriinN:
<br />-l
<br />hrvc a.duillminrain aCcnificarcolConsenr ro srlf lnslrc lor *orkds .!nrpcn\ i)n..s ptuvidcd for by Sccrion lT([oarhc
<br />Labo, Codc- fo! rlrc lErlormrcc Drlhc worl lor *hich rhc pe,nir h iss!.d
<br />Ihr!.rndrillnri' ai', $o c.1'co,pc \artri n,\urricr. r$cquncd bySccri( 17(r).1rhc Lrh.r (tdc. turrho p.'ntriutrr.cof
<br />'i[fl#'
<br />k!u.n. My workd{ .ompcnqri.n nNurnMc ceicr rn I'olicy numhcr 6ct Cc":h Y6.
<br />t.\. \a.,,,,,",",,,,,n", SNrJ W cot3tG€- ,,,n',"*,
<br />lccnifyrhar inrhc pcrfonMnccofrh. work br *hich rhis p.rhir n nrucd.l shall nor .mtloy ooy ,EBotr inonynuncr
<br />v) rr lo h.conr subj.{' lo lhc worlcs .omNnsltion hus ol Crlil rnin. ud urcc rtur ifl \hould b&omc subrLtl ro rhc
<br />eortcts co'n|xtrsl ion Frvnions oa Sccl ion 1700 ol lh! lihtr Codc. l stull. ronhsirh .o Ply wnh rh1rc Pmvrions..
<br />W]\RNIN(; Frilurc b {cure w(rkcr\ compcn\rrnr corcrrsr is uihslul. Mn :h!ll {l+cr m.n{i,)rr r. lrnniml |t alih! J
<br />:.;- r"tjb't, li' itti{il::::
<br />I hcrcby rfinm uMcr Fn0lly olpcrjury lhd I an liccnsil undcr t'mvnn,n ol'Chaprcr 9 (comtun.ing wirh sc.riotr 7ftx)) ofD
<br />of rh. Busincasnnd PofcsionsCodc, alrd nry liccnsc is in lullIoremdcliccrg Lug't1 "o1.
<br />,r",, f fC ft ?l]I Q c-,r*.,". ton*^t'.,
<br />A \lu - " --
<br />IONSIBI]CIONI.INDINIj.&{jDN(I
<br />Ihcrchyrllt,nunrlcr pcnllryolpcrluryrhd rh.ru isr con(ru.li{'n lcndin! rgcnry f(rrtulrrron ut.olrhc sorI li,r*hi.hrhnlcilnir is
<br />i\sucd (S... 1097, Cir a.)
<br />A.TILICANIDEgI.AIAIION
<br />I IEr$y 0]Inn u.d$ pcnahy of pcrjury onc ol thc follosins dc.luolions
<br />Drmolirbn P.rmir*Ash.sos Nolifi c.rion Fcdcrll RrBUl.rions Oirlc,1O. Pln6)
<br />R.quircd trlt.r olNoifE.lion
<br />o'din Ec\ rtulSrrc ljsl r.llriry n, hxiUnrg.onddcri,n,. rxl Ecscnrd,vcs oflhh Cily Md Countylo cnlcr upotr rhc
<br />abovc nrflrnnlcd pnrp.ny
<br />,\pDlicsnl or ,\*enl SiAnalu
<br />Prrn"A;
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />[/eter Release
<br />Rouoh {2ilv 5\6
<br />Service ltrleter
<br />FINAL 1/,t 4/t1,7\>6{
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Pole Bases
<br />tJnd.a! Addrcn.
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<br />-l
<br />ccrlilithlt rhc fcde rul rcs! lar ions rcs,rdins a\trnos rnolal uc .or drnli.ablc to rh^lmFcr.
<br />Llccnirrrilrlhn"crc"drhi*rpplicar natulnrrcrh rhcah,rc iniarnrdhn iscorccr lrsreloconIryw hallc ylndcirutrry
<br />XtLtCr11t ttt,,
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