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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DF]R DELC RATION
<br />I hcrchy aftrar undcr pcn{lry oi pcrjuy rhrr I !d .rc'nnr iro,n rhc Con(r..lor' Liccnsc Lnw fot rhc rollowing rca$n lsc..7oll 5
<br />tsusincsr ml Prot$n,i clldc) Ary c ! or County whkh mquncs o Fnnir lo urndtucr. nx.r, inlnJv., d.mlhh ,{ EIEn iny
<br />ntuchrc. I'ri, t, ir\ issurm..,ls. rcquiEs lhc ryflicd lor suchlrcrmir lo lilc a sisn.rl nrr.m r rhd hcor she is liccnsed I,dslrnr
<br />ro rhc pm!isions of rhc Contrackr's Liccnrcd bw (chaprcr 9. cunxncn.in8 !irh Scctn'n 7000 of l)ivi{ion :l ol rhc Ilusincss .nd
<br />Pn,rcssbnsqd.)orrh,lhorshciscxcmplrhcrchom0ndlhchosntulhcrllcseJcxc.Unr. nyviolnlionofSsrionT0-ll 5bynny
<br />rmli.a.r iorrpcann subjccrslhc aprlicanrtoacivilpcnalryofn.rfrtr rhxn fivc lrndr& dollan(5500)
<br />L rs owncr orrhc polfny. or m, cmtlorecs with strBcs rs rhcir $le conp.n\arbn, will do rhc woA,d rh. (nElE ir tur
<br />inlcMcn or ollcrcd for ele (Ss ?044, Business and Prnfc$ion\ Cinc: Tne c(,ntrd.M! Li.ctrsc L€w docs nol aptly r. rnowncr ol
<br />rhe pDpcn, sho huildr or iqrii,hr rhcbn. dd who &rs such wo hnnscliorhcisclforrhdughhhorhc..qncmployccs,
<br />nnrvid!{ rhor such irprcvcmnrs am nor inrcnd./ or ofi.(d {or srlc Ii howca. rfu huiliiry or in{rolenxn! ie $ld wilhio onc }qr
<br />or.omnhbn. ltu owrcr Buikc! will hrw Ih. ttrdco of lovins rhlr tr or df, dil mr hoiti or iq,Nt lhc Pmrny for rlf ,!qht or
<br />-1.
<br />u\osIcroirlrc pmpcny. ancrclu\ilcly..ntlcri'rg wirh lic.n\cd.oDnncroutr)con(rucrrhcF,jccr iSLt 7{X4. Busir'c$
<br />rnd lh,hs\i,nCodc: Thc Co.kd.ror's Li.ctrsc Lrv des ml rnnlylo inowncr ol p(,pc y who bu ild{ or imorcus ricrcoo.
<br />and who.otrtfrcrsiorsuchomrc.r\sirhaConrru.h(rli.fl{dpuN.trrt,rhcCotrl!!.roisl,tcn{tr*r
<br />I {nrcrcnor unds Selion B &Pc hrrhnrn\or
<br />Daler O*n.r
<br />wonxeRs coltH,'ltls,riiirN
<br />OEII.A8AIION
<br />Ih.rbydfirnund.rpcndryolp.rjuryoncollhcn bwirgdcrLtr0tions
<br />-lhrvca
<br />willmi lin a Ccrr iltlr. .a Con{nr b scliln\urc |or workc^ conDc.sarion- as rrnlidc! tor hys.crion l?(x)of rM
<br />trblri Cq!c. lor rh. tnfMMfte or th. work for *htch rhc pcrmil is hsodd
<br />I hrvd rnd willilrinr in sork.ri com|Etrsltiotr insurancc..s rcquircd bySccrion l?0Oorrhc Llb.r Cbdc.lb! thc P.rfonurccot
<br />rhe wo.k for which rhia p.i,nil is issucd. My *orlcrs mnU.nsll ioo insurancc c,tri.r aM Pli.y nu mbd trcl
<br />-l
<br />ccniiyrhor inrhcI'crrormfr.ofrhc work r.i shi.hrhis Frmil is issucd.l rhall not ctrfl,,y,nyl.nor in,trymurc!
<br />s as ro s-.o@ srbFr t, rh. slkd( o,np.nsarion la*s of Crliidnie. and ssr. hnr ir I drukl heom suhjd ro rtt
<br />workcr( comFn\arion florision\ .f s.cr ion ]lm of lhc tih.r (i'.1c. I shnll. n,nhq irh c. Dly w irh rhos novni.ns .
<br />WARNINC F,ilur. r. scurc workcs compcnslri,,n cokEsc is onln*rul. dnd shlll suhiccl !n cmpk'rlr h.rnnnml Fnillts and
<br />cilil fincs uD ro o.c hundrcd riou{ dolhs (Jl(n.fflo). in kldirn,n ki rhc c,cornn n\rrion, drmScs rs prolidcd l'o! lhc
<br />SNri.n:to76olrhc Lann (ixlc. inl.r.{ rndarttr'f,y \ tucs
<br />K
<br />DES.AAA.II!]N
<br />I h.6byarfirn ndnp€nrlryoftEjlryln l 0m lienEt under l,llision ot Ch,fl$ I (ammrcin8 with Sd b. 7000) or Diviliotr 3
<br />of the Busiress and Proression\ Cdd., 8nd nry lkc.s. k in tull iora dd cfisl
<br />4 26.14
<br />!:oNsralcu{rNrENDlN!-&aDNqr
<br />I hcrcby rtfii,nundcr p.nrlry orFrjxry thd ihcrc n r cotrsru.iion lcndins rAcncy r.r rhc p.,ntrnurcc olrhc work ror rhi.h rhi\ Fnnir N
<br />ksucri (Sc. 319'7- Civ. C )
<br />AIfLTANLDECI.ABAIION
<br />l,r,rhy sninnxnd.r pttr,hy ofpcrjuryonc ot lhc tollowinB dNl0rorions:
<br />Dcnmlirion Pcrmih Asbnos N ificrrb. Fcd6.l Rrguli! 6ni lTitlc .lo. Pin6)
<br />-RcquiEaj
<br />Lcrrc, ol Norifi.d'i0n
<br />-l
<br />arrilyrhar rtc rcddalrcFhriuns Eeardire.shcslosrcrnrrrlnrc mr apnlictrhL rorhis p$j(tt
<br />lccnirt rhar I hNr r.nd rhs I|]plic0lbn 0.d slilc lhallhc
<br />odi'[trt\ x&i Srnrr l-r$\rc].ritrS!, hLll,ll,g c.n(nrri,ni.
<br />xhr. n(r irnul pn,Nny tur inr
<br />A|,plicnnl or A*ent Sign,lom
<br />nnn ri,nr ^.,nr..l lilrN1o..Dd!*il,rlL(_ir\ ' L(,{tri\
<br />lx litr 7. 'rtreyahr r.\,n rhi\( iryrn(lCounr!n,. r., nl),{rrh.
<br />Dnre
<br />Site-Work
<br />Underqround
<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 />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Bouqh
<br />Ceilings (T-Bar Rouoh)
<br />Itrleler Release
<br />Rouqh
<br />Service Meter
<br />FINAL 7-l-te J)zJDt {vr)
<br />Notes, Remarks, Etc.
<br />Translormers
<br />rrore: 1 -6- rf
<br />^pDrkanr:
<br />Li.cn{ class
<br />-Licen*
<br />Nu,nbcr
<br />t ndcrs Addrcs'
<br />I
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