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ELECTRICAL.INSPECTOH RECORD
<br />DATE ID/SIG.COMMENTS OWNER BUILDER DELCANATION
<br />I hcrcny lmirn undcr pcnalry.f Frjury rhar I dn eicmpr fiom rhc ConrrEron' Liccn{ l.rw for rhc rollowing rcdsn (5...70315
<br />Busin.rs anil Prorcrsion Codc): Any Cny or Counry which r.qun$ , Fm r ro con{fl.'. allcr. inl|mvc. dcmlhh or rcpar.any
<br />slfl.turc, r,itrlo it issurmc.0ho quncs lhc trppli.a rbr such rBnbil lo fit a si8ncn slolcmnt lhal h.ordrc n li.en{d l,trr$a.r
<br />b rhc povisions ofthc Ci,nrB.rols Li.cnscd ljw (Ch{rcr 9. Conmcking wirh Sc.rbn 7fix) of Division ] of thc Busincs lnd
<br />Ptr,nssions CodcJ or lhar hcorshc hexcnDt lhercfrommd thc b.st for lh. rllcscd cxenDlion Anyvi{'Urio.orSccrhn 70.115 byany
<br />lpplicanr for ! pcrlnit subjals rhc ryI,lico 16 !civilpcMhlolnor nnrc rhnn fivc hundrd dolldr (5500).
<br />-1.
<br />rs owm. of lhc pmltny. or m, cnfl,,Jtcs wilh uues as rhcir $L conp.n{r i('n. will d. rh. work sid rh. snEluE is trol
<br />inr.M.J o. .flcrcd fir €L l Sft.7{N4, Aurinc$ aM Pr.fcsion. CGlc Th. Contrd.rols Lkcns L1* 6iocs flot lpply lo 0n owncr oi
<br />rhc popcdy *ho huilds or iqarrci rn€@r a,n who drEs such M]* himsclfor hcscllor rhrou3n his or hcr own cnployccs,
<br />pmvidqt rhd such nnl,ornEnh m mr iNcd.rd .r oltuErd for eh. la lr,w.wr. rhc huiHinA .r nmovc'm h $ld *irhin om y!{
<br />oi conlhrion, rhc Owkr Buildcr will huv. lhc burdcD oi proviry thd h. or sh. di:j nor 6uiu o. nq,mr rhc pmlsry f.r ln. pury,{ ot
<br />-l
<br />x cxcr.plundrr Sccrion
<br />D"lr: OPn(.
<br />.]I9BKII&1]1;OIITENTAIIj)N
<br />DTILIaAI]ON
<br />I hcrchyrfliflnundern.nrlryof l[quryo colrtun)lbwlngtlc.l rxri{rn\:
<br />I htrk nDJ silltrDinrri', rCcnifi(trrcolCon\dii k' Sclf li\urr l{tr Norkr '.o rtrtrr.liotr.r! ln,vidcd Ior by Sccri,,n :17(x) ol rhc
<br />L'Ixtr Codc. nr lhc I,c ionnrnQ of rlrc *on( tur Nhich rhc p!(nir h i$!cd
<br />Ihr\arn,lwillnui'rrxi',*.rlcr!corp(n\rrimnnurrn.c.a\rqui'idnySc.riotr:17(X)olrhclrhor(odc.iorrhencrfonmtucof
<br />rlt Nork iq whirh I hi\ pcrmir i\ i\{'L{ Myso c .oqrcn\rrnr iNrn .d crricr dd poli.y nuDbcr trc
<br />-lccnif,thorirrh.Nnnnnirccolrhcworkf.rwhichrhhpci,nirshnrcd.Ishrllnorcq)l{,yanypcr{
<br />inriy rdncr
<br />v, rsb hcconE \uhjcct rothc*orkc co'ntrtr$rn,n h*sofCrlinntrin. md lEncrh3r ifl sh.uld hr.om subj.cl lorhc
<br />worlcr\ co'npcn\rrion !mrisi(,n\ ofSL\ri()n 17fi)of(hc Lnhx G)dc.l slu!1, fonhwfhc.nlly qilh rhos nolisn,ns
<br />WARNINC lJailurc r,, ecurc sorlc^ .onrFn\in,n.ovcn'gc is trDliwinl. anJ \hnll \ubtc.r ar c ploycr ro cri inllI.trohi\ rnn
<br />civil finrs up bonc hundrcd rhorsrtol dollin ($l(X),([n), i'r, lirion k, rhc c.q .l c.nltlc.sarnn, drnugcs !s povidcJ f(r rh.
<br />S.crn, .1076 of rlr l rhn C(dd. inrcr.( r d dnonry\ fc.\7e:&a
<br />IIECI,AAA.IIO!
<br />I hcrb, amfln und.r lcmlly of pcrJury rhal I ao liancd undcr lmvision otChaprer9 (Lrn@ncing sirh sc.ti,n 7{xx])ofOivnn]n l
<br />or thc Burifts\ anrl Pmtursi.n$ Codc. and my lkc.se is infulltur.c md.fccl
<br />,-,**" ar*, R /6r>., 7
<br />"",",7-26- /tr ,.",^"'",, &4/14- J1 C,,,',r7
<br />CANI'IAI]EUANIE DINC.AAEXCI
<br />I hcrcby rmrm undcr lEnahlotp.rjury rhnr rhcre k a connrcri'n lcndinE r8cn y rDr lhc |irforntsn.c ofrhc qork lnr trhich thi\ Filnir i\
<br />tsuLt lsc. 1097. Civ. C )
<br />I ccnifyrhd thc fc{tcrrl r.grLrnnn ftgdnr! r\}rnos rrnx)!rl arc norxtrl)li.ihlc r. rhis tn'a.l
<br />I ccnifyrhit I h!!c rcidrhhapplidliotrlnd sr0rclhdlhcahor inlornrlri.n nc.m.t losrek,.onlPlywirhdllCirrtndcourly
<br />ordimmcs atu shrc Ltrws Elnrirs to huildirB coNrucrion. a.d hcrcby0urhorizc !.prc\cnrurilc{ olihi Ciry Md counryro ctrrcr upon Ihc
<br />k,!c if, r'oicd nmpr y lnr i'r\turior
<br />,\pDli(nnl or,\frnl Si,tnirtr'.
<br />n-,a.',.^,"r1*t,u,,I?DPK GRI f f
<br />7-26-/8'
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)c;')
<br />Walls (Rough)?'ro,lt I 'fl.*a,,r-
<br />Ceilings (Hard & Sollit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service lvleter
<br />FINAL 9-L7.lB,J )t5*,.<9
<br />Notes, Remarks, Etc
<br />a(r r,
<br />o. /7
<br />APPROVALS
<br />-l.0so$ncrolrhc
<br />prolcrly. r.rcrclusivclyconlruclin8 wirh licenscd connadoNro.onddcr rhepojccl(Sec 7(!t1,8u\i,'c\r
<br />and Efts\inCnld"lhcCo.kr.tr'sLi.cnscLradocsnorrpplybrnotrndr.rtm,tcdy*hobuild!.rinDbvcsthcre.tr.
<br />and rho conlrucrs r'or such prcjccls *irh ! Conrructq G) ltcnscdNrsuatrr rorh.(bnrracror'sLi.cnsc Lrs)
<br />Poli.y N!:nhcr:-Expircs:
<br />-
<br />Ixndcr'{ Addc*.-
<br />AIPIICAII.IICI/BAIIOB
<br />I Lnn, rllEn undrr pcnllr y of pcrjuy onc or rhc r{rlowing derar r ionl
<br />Dcmolirion Pcrmih.Ashc(os Notification Fedcral Regularion\ (Tirlc 40, PM6)
<br />-Rcquircd
<br />t ucrof Noril_rc.rion
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