|
ELECTRICAL-INSPECTOR BECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDEN DELCARATION
<br />I hcrcby allinn under penah, oa pcrjury rhar I am cicmpl frorn rhc C{,itad.6 Li.cn* tjw ro. rhc lollowin8 relsn (Scc 7011.5
<br />Busnrss and Pmf.ssbn Codc): Any Ciry or Counry whi.h rcquircs r frmt io mnslruct. ohci inlnovc- .kmlhh .t epair ey
<br />srrudurc. rior to irs issurrcc. at{o rcquncs Ihe srplicanr for wch pcrm ro nlc a sismd (arcftnr rhar h. or sh. ir li.cnsd pursmr
<br />ro rhc F,vi\t,n3 orrtt Comocror's Li.ens.d tlw (ChaIrcr 9, Commmine wnh Scclion 7{D0 of Division :l ot rh. B!sin.* 0M
<br />Pmfcsaon! Cod.)orrhd h.orshc i( cxcnDl lhcrcfrcmrnd rh.h.sis tbr lhcalkScdcrcmolion Atryridalio.orSccri{,n70ll.5hy.ny
<br />tr#ffi ;;-ffi #,*ffi;ffiil;il:r";'ff**", ",lhc potiyly *ho build\ or n{,or$ lhcm[ !n sk' dGs su.h wlk hinscllo! hcMllor lM,ugh tis orhd.wn cnnloyccs.
<br />providcd Ihar such inrrrorcnrnts e mt inrcadcd or ortr]n for s c Ii ho*cKr. thc lDildiry or impmtmnl n $U sirhin oi. ,te
<br />ofconpktion. th. Owncr BuikLr will hrw rh burdcn of fhvinC rhd hc or shc dil tror build or iDpr.r thc pmFny lor lhc pu4rc ot
<br />l. iso*ncrorrhcthp.ny. a nr crclusirc l, co.lmct ins $irh li.cnsd corrrr.lorsl.on{rucr rhe nn,rcr (Sec 7044. Bu\i,rc\\
<br />{d h.fcsion Co{lc:1hc Conrracrors Licen\. t-sw docs oorarplr ro $6oicr ortturcdy uh. builds or inrFovcs lhcreon.
<br />ud who $nln.8ror such pmjccrs wirh 0 Cotrtrocro(, li.ctr*d punuMr h rnc Glnrracrois l,ic.n\c l-aw,
<br />I hcrcby illirflundcr pcnllr, olr^-rturyom olrhc following
<br />_l hrve (i will tuinr,in r C.difi.arc ot Conenr ro scll hsurc rd work(J .onpcn\alion, 3s providcd for bySccrioi lTlD ofrhc
<br />libor Codc. lor thc Frfom,ce ol rhc $ort ror which rh. pcrmit ii hslcd
<br />I hrvc rnd will mni, ain* rlcrs corpcnsrtir insuruncc. a\ rcquncdhySccti.n:l7u)olrhcuhor(i c. fd rhc P.rfoanrmc of
<br />rhcworkforNhichihkF.rnilisnsucdMyvortcncomr^_nsalioninsuroncccrtricrlndF,licynuhb.td.
<br />n,y,ny Fson in,ny mnn.cr
<br />WARNIN(: |riluc b {.ur. trorlcn mn,mr\rri{nr cov.i'!c i\hwful. Md shrll \ubJcd rtr cmlloler ro rinrinil licnahics nod
<br />rlru\rnd dflh.\ rt1(x)l11x)r i'l n)n, daauscs !\ providcd for rhc;'j+1
<br />I hcNhy,rrnrundn pcn lryor|xrjry rh.r I nn lNnsd nnd.r vkion ol Chol)rq 9 (coDmmins sir
<br />oa rhc Iluri',c$ rtrd Pn,li\lnnN Cod.. md n,y licdn\c i\ n, fill turc. $l cllc.r.
<br />Liccnse Nlntqi
<br />CoNEI8ICIT]NIENPUCICENCI
<br />I h.rcht uratrn und.. Fn,lry of p.qury fi.! lh.rc is a co.slddir. lcndinS ascncy rbr rhc l,.rfomt oi rh. work lor which lhh p.nnir i
<br />hsued (S*,:1097. Ci! C )
<br />a,eg.llaNlD[cLd8AflrN
<br />I th.lry anim undor pcnahy ol r.rjury oN oflft followins ddlmrions
<br />tlcnrriri{'o Peflnih Asbcnos Norili.rrtrn F.dcml R.grlmiofi (Tirl.4}, Pan6)
<br />Rcquncd krrf of Norifi.arhn
<br />\rcnn,vrlxrc ror tpLiuhlc t, rhi\!n,I:.r
<br />rooryly wnh allCiry anJ Counry
<br />nbovc mnrioncd lropcny for inrFdnrn purrxcs
<br />,\Dplir nl o.Asul Sis lure
<br />"'"),'-[';u16;
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Air Conditioners
<br />Rool Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service lvleter ll
<br />FINAL "1L61l,,
<br />'(d eq
<br />Notes, Remarks, Etc :
<br />Sub-Panels
<br />I
<br />rhd nr rhc lcrfornftnc! olthc work lor shich rhh pcirnit is h\ucd. I shall
<br />tE.otrr \uhF.r i, rh. sorkd( roittr \rri,r lw\ofCtrlinr i.r Jn!rccrhir
<br />.omNnrrrionpiovisionsofSccrionl?(Xlolth.Ijt rCodc.I shrll. lonhwirh
<br />krdcir Addr$.
<br />-
<br />rIr
<br />--------T------
|