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ELECTRICAL-INSPECTOR RECORD
<br />OWNER AUILDER DDI,CARATION
<br />I herby aifinn undcr penalry orFrjury rhar I m cre,nfl fon rhe Conhd.k,E Lirtr* hw lot thc followir8 rcrv,n lscc 1J:11.5
<br />Busin.ss Md Prcrcssio. c{xic) Any Ciry or Coutrry shah rnuncs r llq$ir lo osrrud.:rlrcr. iarprorc, dcfr,li\n or rrJtr rny
<br />{ructurc. prior kr ils issulncc. lle rcqunes rhe apllicant lor such pcn rto filc, \i3ncd ddrm rhar hcor shc Ls liccnscd pnnumr
<br />h
<br />'hc ln)visi.ns or r Conkr.rois Li..nscd Lnw (chafl.r 9. C.nnn.n.in8 wih Scction ?Ou) of Divinofl .1 of rhc Busine$ rnd
<br />Profcssions Codc)orlhat hco.she hcxcmDl lherctroDand lhc hosn forrhc rllcecd qcnrrriotr Anyli.larionols(rion70ll5by..y
<br />applidanr aor rrrmil slhjsls rhe lprrlicanrro!civilpcnllryoli.rturcrhxnlivchx.drcdduurs($500)
<br />-1.
<br />as owmr oflh. poFny. or mycnlloyrcs wnn wagcs $ rhcn $b N.D.nsalnrn. silldo rhc work.nd rh. idun is Rn
<br />inrcnd.d or olttrcd fin {1. ( Sd 7(}ll4 Bu\inc$ aid Pmicsii{,ns Cdlc Th. Conrrhr's Liccnsc t*w des not oDDly lo an o*nc, oi
<br />rhc nmrcny who hilds or nn0oB ltrN,. ad who des sEh wort hiosclf or h.rrlf or rhmosh hn tr,Er o*n.nphryccs,
<br />!tuvidcd rhd skh inlrovcm.lsft nor im.r.lcd orofierc{ f(trslc.ll hoqcvc. th. buildi4 or in{n.\rmnt is s,ld wilhhorc )r!r
<br />.f coryhri,n. rl* O{rcr lltriBcr will hlw rh. hdrdc. of pmviry rhnr lr or shc dil , buiH o. intmh rlE Intdy for r nurpo$ot
<br />_1. r\own.rol rhc nolr.ny. arcrclusiklyconrra.rin! $irI li.cn\od.ontdr\ ro.un{rucr rhc Fr.,..r rScc.70,{.l. hxtrrc$
<br />rRI tlrL$irD Codc ThcCoftri.i(trkl-i.cnscl-rrdocsn.rrfl,lyrornoqncroinmpcn}*hobuild\o!tnp(rrr\rh.r(n,.
<br />rfd sho conrmchfor\uch pmjccr\ wirh r ContrtS r ) lircnsrJ Il^uMr t'rhcQ)nt..rtr s l-i.cnsc Lrs)
<br />I ai,dcn,pi uodrr Sccrnr
<br />y!JAK!BES}!IENIiAfI!]X
<br />DI.CI,ISAUAN
<br />I hcrchy afllm uMcr pcnihtofpctury otrc olrhc followr8 dcclimrions
<br />I hr\. rklwill trntrin a Ccnifi.d. of Cons.d i, S.lf ln\un fitr *nkcr l comDctr\dirm. ns pmvidcd l'orh] Sccii,'f,17(x).lrh.
<br />l-rl,or Cqlc. forlhc ncrr'ornunce ol'rhe work lor *hich rhc pcrmir n t\tcd
<br />I hrrc rnd will mainrlin work.rJ..mpcn\ilio. insurincc, x! r.quncd byScclion]TOOol thc Ltrhor Gtc- lll.rh. prfontu..c or
<br />thc work hr whi.h rhis tlcnnit is ksucd My qorkn{ omp.Ndiotr iosuDrcc catricr 0d policy numtcr c
<br />I.ciiiryrlrtrr inlhc p.!lonnaRrorrhc work rd wIi.h rhi\ |Eirnil is is nor cDdoyrny P.non i'i rtry n'rfftr
<br />if I slnJuld h$onE $ijc.r ro rh.{, x\ t, bc.rnE ruhE.t ti rhc*orltcn compctrsrrio hssofCrlii,mil,
<br />lh..nrply !irI lh.{ nD\isi N
<br />WAkNlNo: Foilurc lo surc sorkcN ompcnsalion covcrase
<br />(trrl finc' un ro om hundrcd rhousnd dollar\ {!lt.,.ooui. in
<br />Scclion 30?6 ollfie t:tnr Codc, i'rlcresl lnd dtorrcy\ lacs
<br />J,l,)lrr r, dir fnlNnnlrN rftl
<br />iirnrn. drnqca as pmvidcd for rhc
<br />I h.rcby0rrD u.d.r l[n ry.fp.rjurrrhor I in liccnq.d undci ChnDrcr 9l.on,nrncin! sirh Sccriu,7000) orDirnn l
<br />of rh.llulncr\itrJ Pn,lcssi{nn Co c, rl r,I'cc \c N nr rullln(
<br />o",., 6- lQ ' l P -',
<br />""",,,",.,
<br />I hcrcby iflinn uMcr Fnrltyoft{dury'har thcrc n r consi{d qcncy for rhc prrumn c.rrhc work for which tht lEnnit is
<br />is.ed (Ss.3097. Civ, C.),
<br />L.ds'rNam:-
<br />AIIIICANIDLCLAf, TX
<br />I lLnby r,tun undcr Fnalty ol pcrjury onc oftlE loln,wnr8 dcclarilionsl
<br />IJcnnlir (tr, P.nnir A\EL{o\ Nrriri.rrnn)
<br />R.quncJ l.trcrof N.rifi.ar0r
<br />-l
<br />ccniiyriar rh.Itdcr rcsularion\nor Jlpl'c lc t) rhi\ frclcd.
<br />il.dirtrh r I h,c rMd rhis rrfli.ari.n
<br />ordi.a"..s .nd srdi. uws ebrin8 ro buildi
<br />rh,!. rnrtrrr,l fn)Brr)" tu' r\lal
<br />APPROVALS DATE COMMENTS
<br />Site-Work
<br />Underground
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Salety /Low Vollaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding i Grounding / UFER
<br />Transformers
<br />Torqueing
<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 />Rough /A.
<br />Service Ir/eter 7-3t-l r
<br />FINAL -z- \-/I fit7rtr' ^,t n-t)
<br />Notes, Remarks, Etc U I-7--r -l
<br />l
<br />lrernrilee trhnrc (prinll:
<br />ion t cotr.cr I lgr ro oq,l, wirh all Cn, ind counry
<br />" - * -' - r -'
<br />:,,',.' il;;i;-
<br />ID/SIG.
<br />Pole Bases
<br />Meter Release
<br />sort.r\ .o,Nnsrrn t()!i\i.Dsof Sccri(,r :17(X)of rtu l-alitr Ci c,
<br />trnd..s AJ.lrc$:
<br />Applic,nl or AH ISi!nrlr,rt
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