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ELECTRICAL.INSPECTOR RECORD
<br />DATE OWNER BTIII-DER DELCARAIION
<br />I hcrby rflir undcr prnalry ol Frjury lhlr I !m cxcmpr fn,n rhc c()nrrlod l-iccrsc bv tu rhc Iollowing reasn rss.70ll.5
<br />Dusincs and Proltsion Codr): An, Ciry or Cou y ,hich rcilltos d p.rnrn to conslrud. rllcr. implorc. dcmlnh o. rcprn dny
<br />drucrurc, r.irr ro irs i\suancc, rho rcquircs rhc apDlic0 lor*uch pcnnir io filc a sisncd srlrcmnr rhd lror sh. h lic.nscd Pu6utu
<br />ro rhe rmvisions ot thc Conrrucroas l-iccnrd tiw (Chnnrer 9, Connrftin8 sirh S.clion ?OUr ol Divisnr I 6frhc Burnrss,nd
<br />Phf.sionr Codc) or rhd h. or shc h cx.nFr lhcr.ironr a.d rh. blsis tor rhc lllcgd cxcnprn,i A.y vi,hrn'norSc.lion?03,5 hy rny
<br />applic l for r pcnnil subJccts lhc arrli.ont lo acivilpcnlllyoinor 'ftndrh,n fivc hundrcd dollrs 1$500,.
<br />I.n\ owmrofrhcJrot y.ornrycnrtlolBswilh$!Scs,sthci!slcconrpcnsdi,n.witldorh.wdrt drtEsMurcisnol
<br />inlcr.lc{ oroiicrcd |or slc (Ss 7014. Blsinc$!.d t\ofesio.\ Codd Thc Conr d(tr s Liccnsc L.wdocsnolapplyt,,nowieror
<br />rhc pmFny who builds or i.pror$ rlEBn. orl eho do( qch w(' hi scll or hcrcll or rhsrEh hh or hcr own cn{lor*s.
<br />prolidcd lhlt such imtmErE mer ihroiicJ or olitrcd tir {'k. ll howcki rhr t{ildin8 or inr0mrctunr tsH*irhinum rer
<br />orc.,nrLri.n. th. Own.r auitln will hrvc lhc hurd.n ofrovinB th,l ncor xhc dii mr hild or ihlh,vc lhc pmFny for lhc purlDs ol
<br />l. trs o$icr ofrhr !r,ptny, a'hcxclusivcly.otua.rnrS snh li.ctrtcd co.rri.Fl. condrucr rhc prcF{r (S...7(}14. Busrcss
<br />ri Piorissiotr Cod. ThcConlrucror's Liccn\c t-aw docs nor 0rplyh strosncrorpn,p.dywho huil{sor imDrover rhcrcon-
<br />and who conrmc( for roch pR,jc.h wi'h n a,nrnd,(n ltcn\cd flrsudnrbrhcCo.trlckn s l,iccn{c h*)
<br />I rmc*c'ntr !nd.r St.rn,n ,B.&PC ldrhirrc{\nr
<br />DEr?
<br />uoaf,[8rt:(auf[ltAtt0N
<br />DICLASAIIIIN
<br />I hcr.by rliinn u.d$ lcndlry oiFrjuryonc otrhc rolhunrg dcclarlionc:
<br />LEv. ..d will tuinrrin a C.nift r ofc.nsctrr ro Sclf.lnsurc lor workcri smp.n\lrion.,r f.vidcd for ht Scction.Umof rh.
<br />hbor Adc-.tor r& p.rfomn.. ofth. sof* lor shich thc p.m hisu.d
<br />I hrvc rnd will nrinrain wolkcrs compcnsnrion inrmrcc. rr Btutcd by Scrr ion .17(X) nf rhc L$or Ade. fot rhc ncrtonurcc ol
<br />j}$J.h,.n..t s s.ucJ ,M] {q[ss' \on,ncl..,trn, in\u'Jn(r, ' r]F,li] umh., oc
<br />f avr lc'l ( a'rt" lll
<br />.,n',"., (o /" /trt/r - jJt'ril17 - t1 - Lt' a
<br />I ccnifythrr in rh.p.rr.r.Dnc.ofrltr work li,r whi.h rhi! l,cnnir i\ n\ucd.l \holl nor .nui,y enl F&n itr rnyDnmt
<br />so r! r. bcotrE suhjcct ro rhc \( cn compcnslrnn, Lw\olcalinntrii. mdu!rc hd ill shouldh$.m s!$jd ft,rlf
<br />workcm $nUMslri.tr [ovhions oi Sc.ti{,. :]TlD of r hc tihn G c, l slull. fdhairh conlply *'ilh rhr{ PDti\iotr{..
<br />rilrc lo \c.urc workcr coNp.trlrrn,n .orc g. n rnh\ful, atrd slrll {rh}i.r u.trDn,ycr ro ri ti rlFtulrt\ nM
<br />r. o.c hund..d rhonsand dollG
<br />trhcrlitnrO e i.trrc{ Jnd Jn,
<br />t? llt n,,,
<br />lll1O.rX{)i nr JLldinn I r ofconlEnsrrbn. dams.! ar povacd for th.
<br />!,,"I",1I
<br />I h.'ch!rllnmun{lult rlrtolNrjrr rhir Idtrr lrctrrlundcr D isi(n1olChrIi.r 9rro tr,rMrtr! qirh Sccri.n 7(XX)) ofl)ivi\ion.l
<br />" ct6 Sltgor
<br />:4zlix
<br />I turcby rrfirnridci p.nrlry.rpcrjrr rlht lhcrc ir r cotr(rucriur n(lirgrg.ncy li,r ltu pcrnr rr.c rl rhcN.rk tbrwhi.hrhi\ F-'nnir i\
<br />ls{(i (Sc. .rlrr7. Civ ( ,
<br />l.cnil-vrhdr rhc lcdcr rcsUhlnnN rc8U{lirg !{h({o\ r.nnrvrl rrc iol3t)tluhL n,lhN nol..r
<br />-l
<br />cenify rhar I hlvc .cad rhh npplk,rn,. axl slnlc lhm tn. ,h.\c nrionmlion h cord I as.e l. $n ly wnh all Cny and Counry
<br />urdLEnccs rtrJ Shrc L!trrrc1.'ri,'c i{
<br />rho\c nE trrcLl nn,Fny f,tr r\h
<br />n rr,,.rr, .. na"", ,nr","OL ]
<br />P"^,* ,-^" tt;"rrt/G
<br />smdi.,L and lrrchy sulhoriz. EpE$nlalivcs of lhi, Cny and Counly lo .nl( upon lhc
<br />4r- \- ^,, t[nl,I
<br />.nci UJTLL ,.
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduil)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Sollit Rouqh
<br />Ceilinos (T-Bar Rouoh)
<br />lvleter Release SN ('X
<br />Rouqh
<br />Service lt/eter lr
<br />FINAL 9 7o tq .,4111(11)
<br />Notes, Remarks, Etc
<br />APPROVALS tD/stG.COMMENTS
<br />Sub-Panels
<br />of Ihc Bu\inclsrnd Pnncsn r\C.ilc. rnd ryliccn* is ir fulllorcc.xlcll(r
<br />APPLICANT DFCI ARAIION
<br />I ho$y afllm rndcr pcnalry.rpcrjury orc ofrh.lollowinB d(l0r0lions:
<br />D€molirion Pemirs Ashc os N6lii.ario. rcdcfll R.8uhnJ (Tirh 40. Pon6l
<br />-Rcqtrirod
<br />l-cncr of Nolifttrrkrn
<br />I
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