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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG,COMMENTS OlINER BUILDER DELCARATION
<br />I hcrcby rliirm u.dcr r--nalry ot pcrJury rhlr I rr cxcm|n rior rh.G)nrrcd{,r Liccnsc l,o* f6r
<br />'hc
<br />lirllowi'18 r.r\on (S(.70]l s
<br />Bu\inc\s i Protc$n'n Codc) Any Ciry or A,unry $hich rcquircs ! pcldir t, .o {n,.r. ,lr.r. i'nr.vc. dcnmlnh or rcprt ,try
<br />nn,.rrc. prkrt' ik is\oatu{, Jlv, rcqun \ rh. {dicrnr ftr such lf,rnir k, lllu d si8md {arcm.l rh.t h. or shc h li.cn*d punuanl
<br />ro rhc pmvhions nfrtE Conmdois Licc"Ed Lrw (Chanrcr 9, Conrnrmin8 *irh Sccrion 7O(lO of Diltion .l or'hc Bu\inc\r rtul
<br />PmfcsioN Codc)o!rhur heorshc is crcnpr rhcrcfromand rhcborir forrhc lU.scd cx.Dfln,n Anyln,htionorsccthn703l5bytrtry
<br />applicrnr tu aldmn suhjcch rhc rttli.a.r b a.ivilpcoalryoln.r hor.ih,tr livc hundrcddouds($50o)
<br />-!.
<br />$ owncrof thc DmrEny. or y cnulolBs wilh woacs as rhcn $t compcnsllion. sill do rhc worl sd rhc (tu1ur n h
<br />inrenddl or ofcrcd for ssld (Se 70,1.,r, aurimss dld Prulissions G)dc: Tfic Contadofr Li.cnsc Lrw do.s nor ntlly ro an osnqof
<br />rhep@pcny who buil.ls or inpoks (hc6n. md sho diEs soch *orl hi'nsclfor hc*clfor rhn,ogh hh or h* owbcnDloyccs.
<br />prornh.l lhar su(h inllorcmnh m nor irrcndcd or offtrc! nr $b li howcrc. rhc l,uiBiry or iryrorcnrir h skl wirhi'r otrc ,tr
<br />ofonpLbn. rh. Owncr Auil,n will haR lh. burl.n of pmvirg rhnr tr o. shc dil mt hoild or inyrcrc thc pmpcny for thc l)UrlnE .f
<br />-1.
<br />mow.crollhcprcncnr, om.xclusilclyconr0crir8 wilh lic..\cdconlmcloNrocon(rucllh€ pr+cl(Scc 7014, Bu{ncs
<br />lJrr ADfc$ionCodc: Tnc Conracttr'\ Lturnsc t-n* docs nor uptly k, o$.dolproFnywhobuildsornnprcvcslncrcon.
<br />and who conrkh for su.h pnrj&1s sith o commdo(,lic.nsd pusuanr rorh.conrrrkn\ t,ie!{ t!q)
<br />lnmcxc.rt, uMcr Sccln r .B &l'C lnrr[isrcn\r
<br />DaIe O{ner
<br />WORKr{\' Cl),ltPEll.SATl()N
<br />DECLAMII!]N
<br />I hcrch! nffn uid$ !.n,lryorFrjuryonc olrhr foll.wi.! d(lantrionsl
<br />I havc and {ill nuinhin r Ceni6.rrc .r G)n*.r b s€laln\trrc ror sorkcra conpcns,riun..s providcd lo bySsri{in 3?00 orlhc
<br />litxn Co!c- aor rhc rcdommc oI rh. so,k for shich lhe n mir h irsucd
<br />I hrvc tulBillrntrirsorkcrfconrlctrsdnriNunn.c,rsrcqutcdnySccliotr:l7U).lrlrthorCodc.frrhcFrfonnMccof
<br />rhc wrk ro, "hrch,h6F:,frir is f{c]. MyMrkni oq{tr
<br />cm*,: - 9k^\e VW1|r
<br />{irior iD{r(n.. clricr rBltxni.ynumhcr r.:
<br />d1T.*TW\E )o\ Q\.>
<br />l.c ify rhrr h rlr Fr,ornDn.c .l rhc work f(tr $hi.h r hr lrrrnir t ssucd.I\l[llnor cmployrny ncr{)n inan} manicr
<br />$ 6rohccom suhrcd lo lhcwortc comp.nsaiionlassotC.lilhrnir and ogrc rhar ifI \lbuld b(. t{hjcdrorh.
<br />sorkcs' conrpcnsnrion nro vkionsols.criontlTrx)ofrhc tjih,codc I \hrlt nrnhsirhc.nr fl! sirhr]a)\.fn)visi(nrs
<br />\v.\Rr.'l\(; Fx'lur. r) {.urc trorkrh (o rfcr\rr ,trr .r1crr!.cnDlritrr lo simi'rl FMh*s d
<br />.'rll lnirs ut n, o c htr drrd rhotr\r0d d.llnr\ l\l(X).UX)r, rtr rnB8r\ rs l,n)vid&t ntr rhc
<br />DIr( t r\R,\t tt)N
<br />I hcrcbyliirm undcr rEDolly ol pcrjury rhrr I anr li.rnsd undcr nnrisin ofCh+rcr 9 (e,n'
<br />of rhc Eusincs d.d Profc$ionsCodc. ond nryli.cnse t in hlllore {nd.ffccr
<br />\nh S..ri.n 7(xxrioll)ivision l
<br />-h 6 bot .>
<br />N,-lt \t 6
<br />qONSIA!CUONIENIII!{;Iq!!I:I
<br />I hcmhy,ffii,nundor Fnalty of pcrury lhit lhsc n r conslruclhn lcnditrg.Bcmy lor lhc Frfumne oarhc *ork lor phich lnn pcrnil is
<br />issucd (Scc :1097, Ci! C.).
<br />AIfITCANLDECIAEflA!
<br />I h.dryafmnnd.r Fn,lry olFrjuryonc olrhc lollowing d8l nrns:
<br />Dcnolirn,o Pcrmirs A\tEdosNorific ion F.d.ml Rcgxlrrions (Tirlcrto. Pd6)
<br />-Rcqutcd
<br />Lc(cr of Norificdri,n
<br />I..nify rhnr rhc lcd.ral rcpuldrion\ n $h.{os rcnx)ul irc nor ontliclhlc lo lhi\ F6rccr
<br />-l(nirrhrl
<br />I harc rci(l rhi\ rpdicr h conrdv +'irh.llCiryrtu Counry
<br />s oflhis Ci(! rnd Counry lo cnr{ uFr r,r
<br />{ Gir:c t
<br />orJi'ucc\ rnd Srarc trws re
<br />!t[rc nEtrlioncd ln'pcny h
<br />Appli.arl or Aeenl SlBnriu
<br />l!€rn'ilce nfl nE (pnnt):a 30#g
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety i Low Voltaqe
<br />Fire Alarm / Dam pers
<br />Building
<br />Under Slab / Floor
<br />Bondino i Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Rool Top Equipment
<br />F actory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilinos (T-Bar Rouoh)
<br />[/eter Release
<br />Rouqh
<br />Service lvleter
<br />FINAL 6/i/l'6 ,;.t\kq
<br />Notes, Remarks, Etc.
<br />Communications Cable
<br />Air Conditioners
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