|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUII,DDR DNLCARATION
<br />I hcrcby lmrd under Fnrlry or pcrjury lhnr I d .xcnv'r ronr rlt cbnr0doF Liensc Law fttr lhc follosing ..rs, (sr.7011.5
<br />Busincss arrl Profc$ion Codc): Any City or Counry which rcquircs ! pcrmir !o .onsdcr, dlrcr. nntrovc. dcmlish o, rcptrk atry
<br />(tucrurc. lrior ro irs hsuunce- lko r.qLires {r rypli.anr tu soch pcinir tr lilc r siBrEd slslcnEnr llEl hcor shc i\ li.cned pusudtrt
<br />ro rhc fmvtions olthc Conrockr\ Lienscd liN (Chlprcr r. G,nnn.ncing wnh Scdion 7uJ0 of Divhion I ofrhc Bulinc$ a;d
<br />Pmf€$nnF Codc ) o' rhar hc oBh. is.x.npr ttErci.onr md rh. b$is ror rhcollcscdcxcm ion. An,liohrio.urs.clion70ll.5byatry
<br />aptli.inr ror n p.rnil subjN( rhc lmlicanl roacirilpcnaliyofnot mrclhan live hundrcddollar (S5m).
<br />-1.
<br />tr\ ownc. of rhc preF-n t- {n ny .mpk,y.c\ wirh ealcs a\ rhn q,h .onll'ttr$riun. $ill do lh. work ftl rllc {tuhtr. is Nn
<br />inrdnd.!oroff.rcdforslc(SN.r044.BusincsmdPmfcs\nrCodcThc(inruc(r'\I-ic.ns.Lawd.csnorlPplyro!nownc!of
<br />rlrlmpcny wlm build\ or nlll)n,vcs rtErsn. nnd w}[ docs sEh Mrk hnnsclt or hcrrlt or rhmueh hi\ or hfi.sn c nlorcs,
<br />plovilcd lh(r such inrF.vcnrnh rc nor inrcndql or uflcr.{ f{n slc. Il k,trcvct rlrc hllkling ot im|B,rcn.lr is v,ld sirhin , r'! yr:tr
<br />of.o,irLli.tr. thc Owncr Burkld sillhaE rhc burdfl olpn,viry Ihnl lE or shc did nor hild or i'npnrt thc fmFdy for rtu Puqx,t ol
<br />l. isorr*rorrhc prorcny. nnrcrclusivclyconlru.lirs wilh li.cnscd .nnrr!.b^ h.oniru.r llr nnrrd iscc. ?O14.llu\i.c$
<br />and h.lisshnCodc,lhcConta.ror'rLi.cnscl-awilnsnorrpplyror.owtrc!ofpropc(ywhohildsorimptuv.sthcr.otr.ond uho cnnrmcls aor such prcJcds lnh ! Conrrcrons) licenscd lu^lanr b rhc contuctofs Liens bw)
<br />1.trn.\cn i trndc' Sr.r'cn .n &PC ri''hi.'.1'{'
<br />Dnre: Ou.r:
<br />aa.Mli&rroME;!,sA1t!l!
<br />DElLAf,.trUO!
<br />I hcrcby in'nm undc, ncnlltyoipcrjury orc olrhc n,lk,wi',8 d(lmrnnr:
<br />I hivc ldwillmoiniritrsCcnificoreofConscnrroScltlnsurcforsork.f.onltlctrsolotr.!s pmvidcd iortySNlnn,.]70ootihd
<br />tihr C.d., ror lh. pcraonnrNc of r M work tu wnich lhc ,crmit is issucd
<br />Ih.vcstrduillmrn.inBorle.rcomp.n\alionin\uratrc.asrcilrncdbys&ri()nl70oolrlrcLaborCodc.ttrrhcpcrfonnr..or
<br />lh! *ork n, $hi.h rhhFrmil is is$.i Myworksi c.mptilar ion nruo{c .0nis md Flicy nuni}et m:
<br />lr',rSC'3
<br />'li_f %c.?c
<br />l.c ilyrhrri.(h.p.rloflMrc(nlhc*orklhrrhi.hrhi\tciinir i\ ksu.d. I \hill nor cnll]loy rrry pcron i0 !ny mrnncr
<br />v' !\ro hc.onr \ubl.d n,rh works\' .umr.nsnr i(n lr$of Cllildrnil rtrd ryElh ill shuld bccotu \uhtc.r kJ rhc
<br />w.de6 dnn|rnurn)n pmvnn, \ of S(riotr ]Tm ol rhc trtn C.dc. I stmll. l'onhsili conrply *irh rh)$ lm,vilids .
<br />lYARN[lc: Filn€ ro $cur *ortcm' .omp.nsolbn ovcroSc is unl!-lnl. flnd ihall subj.cr m cmplorlr to simiMl pcmhics and
<br />civil fincs uI lo.n. hundnd lhousand dollns ($lm,00o), in.ddiliotr k,lhc co\l ofconrpcnssrion. d0mB.s 0s lrovidcd for rhc
<br />secrn,n .1076 ofrh€ L1l.r C.dc. inrcrce n6d.lbrmy s ncs.
<br />o*.. o7.ZL - | X o*,,*,,Xr RAu-t,'r Sr,7
<br />L(EIL5IDJAIIAdCIAB
<br />DECI ARITION
<br />I hcrcbyamrnr undcr pcnollyofpcitr.r rh,r I sm li.in:{ undq prcvisio..rcl[Prs 9 (conrmncina silh Strrirn 7filo) orDilision l
<br />or rhc ausincs Md Pmfcsions Codc. and my licctrsc h in tull fod a.d c[.cr
<br />,'-^* rr^r, ' C --,Lt 17/ 7?z
<br />o^,,:-4-.)A,0 .*,-"* 11- (-ar^,J ;1*tril ,L4-
<br />coNsr.8ljElluNLDNulNli_a!-<l
<br />F
<br />iisrcd (S... :lO9?. Civ, C. ).
<br />Lcndci.llam
<br />-
<br />p.!".,**",.,
<br />wrW9'
<br />AISUIANLDA:LA8IIION
<br />ultinn u cr rcnalry olpcriu.y.nc olrhc lnlk,$ina deh.rrio.s
<br />idi Pcnnn*AdE(os Noriiicorion ltdcral Rceuhri rs (lirlc41), Pxn6)
<br />R.!uilc(l lrlrcr ol Mnili.rrin,
<br />-l
<br />ccn ify rhs hc rcd.'d I rc8u Lr ions EBirdinS ast{nos rcnsv0lorc nol alpliclhle ro rhii rrcFcr.
<br />fZJ(n,0 rhd I h,( rc!,r rhn urphcannn ,nd {urc r h, rhc !h,vc inr.mntrbn is .orccr I aErc ro otrrly wir h arl cir y rnd cdunry
<br />.ftl rncc\xnJSrlrcL1$srNritrsrohdrld'nscon.rrucr'n0,edtur€byarrlbri2eNprcsc.livcsollhhCityr"dCounryrocnr..uronrhc
<br />$.vc.rtrrn cd proFny for inspc.rion purp.scs
<br />apprion( o. aseni sismrure !!-Fr7t,,t ,'r-fn ,\
<br />-44"
<br />**, Aa:LL. t[
<br />(
<br />Site-Work
<br />Underground
<br />Liqht Slandards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER dttol,(rtyutt*-t7-
<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 />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rouqh t //0//,?erhp/a-.{2-
<br />Service IVleter I .'
<br />FINAL I /1b/tt bvlov-/d-
<br />Notes, Remarks, Etc
<br />xls(tg tru1@ Tl4/s aer*4 .ll.\ V^--l/ek"
<br />-L
<br />(aLa :
<br />4
<br />Pole Bases
<br />' r'>2 -r'
<br />I
|