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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCNRATION
<br />I herehy rrfirm lndcr lcnslry of pc,ju'] rhi I m excmrl fmm thc Conrtudo^ Lic..!. Liw lor rhc followinB rcast (Scc.7oll 5
<br />an*ine* rnd Por.ssion C.d.)r Any ciry or G.unry whi.h rcquios o Famil lo consldct. ollE. nryoq dcm,li\h or rcFt &y
<br />sh.rurc. Eior ro its issume, also (gutcs lhc applicant for su.h lrro l to lik a sistud d{cnEnr rhdr hc or shc il liccnscd IUNr.r
<br />iu rh. roriqioh..rrh. Conr&bcs l-iccnscd tlw (Chrrrf 9, cofr'Rncin8 qilh Seclion r0OO of Dilnion:l ot rhc Businc$ lnd
<br />Pmfcssiotrs Codc) or lhrr nc or shc n cxemlr thcrcfiom lnd thc hasis lor rh. allcscd dcFplio.. A.y violorioo oas.dionr0ll.5 by any
<br />Artrcrnrf.r oFrmil.ubjccrr'hc aml'r,a L, a$rlIlcnal) nl nd m,r rhJn lr. hund..J dullds'tr<00r
<br />l/l/\.,{"**, "' 't " 1*p.y.., my cnern}rcs w h srscs.srhcn mbconDcns.r,on. w,rd. rhe work und r. n tucism,' {nloir4 * .r"*o t"i *r. r sK ?r,44. Bdnm* ,nd [to,;$ionr codc: Thc coita.rors Li.cn{ tiw &rs nor ryply lo m o*ncr of
<br />rhc nm*ny !h6 hr'Uc o n{mhi th.mn, sid wtr d.s rkh Mlk hinsclfor hcrulf or rhmugh tis or hcr own enpldy..s.
<br />povidcd rhor such inDrovcmnrs N mr ilrcndcd oroffcr.n foreh ll horercL the tDiUinC o, imtrowmnr is sH wirhin ok )te
<br />ofconuhltun, thc Owmr Bui!:lq will n!rc 6c hldctr ofroviry
<br />'hlll
<br />lE or \hc dil hdild or impm{ rhc,nrrdy r.rih. Futr$or
<br />_1, a\nwncr.rrhc pop.ny. inrcrcluqivcly.ontr.ring wirh liccnsdd.onti.ros ro.on(ru.t llE prrccl lScc. ?(X4. Bt\irEs
<br />0M PmL\si{ Cotr. Thc cotrtrlctor's t-iccnsc L,w docs nol ,mly nr an owrcr of pnpcrty who bu ildr or nnprcvcs lhdcoi,
<br />rnd uho conrnchlor $ch pmjcckwirha G,nrracrorln licc
<br />"'u It
<br />I hcrcby nfinn unds,,.D.lryolp.rjuryonc olrhc lnl[,win8 dccl&lions:
<br />lhavcrdwrllnrNainaccnifi..tcolConsctrllosclf.lnsunlorEolkcrrcor.pcn\arnnr.arpmvidDd
<br />tf,txtr (i{lc.l{x rh. If,nnnnmcr ol rlt (ork nr*hi.h rhc pcrn,ir n n{k,l
<br />-l
<br />hrvc.nd willnrintoin qorkcr'compcnslrion insu.!rcc. !s rcquired ht Secrion]TrD orrh. trbor codc, ior lhc ncrtonnancc.l
<br />lhc srrk rbrwhirhthi( p.ir r is h\ucd M y sorkc6' conrp.n{rr io n iNUntt.afiicr md fx,licy trutr$firc
<br />P,r'.y \rniho _ F\t,i'c
<br />fI,1".,,*, .,*,.,.,nmtr!c, * rn,( htr shtr h,h,. fci,1 r r.trc,,. r.,rJ., 1,y.dl \h.r, r vblcr r, rhc ",rlc'. .. m|cn.ninn |Jtr.,{ (,li,r'aL. rn,l JHr,tr I
<br />*old',\n'nn,,i^1nnrnn,n.',rSc(Inn17ri,nrthcl.'h{Ifr.c.1\ltll l,'rhu'h.1
<br />.n,ploy rny pcno ind l rnMncr
<br />\hould hcom subJcd ro rhc
<br />ntly wirh rho{ fl)vnionr
<br />WARNIN(i Frilurc t, {.ur workcri.o r|.nsrridr..v.rns.i\ utrliElil. .n shrll subFlr an cmploy.r h crin,indl ,.nrhh\ and
<br />\'ff
<br />dollr (Sl(X).(XX)). in rd,lirnr r
<br />[{t0
<br />I lrrchyilijlrundcr |ttrrlty.lpc4urrlhal I Mr liccncd undcr
<br />ol rhc au\i'rcs\ rnd P(,fc*n[\Codc. J nry li.cDr ir irl lrll
<br />fr.r 9 (conu rn.nl8 qirhSr.rn
<br />l,i.cnscchss:- _- l.i..n\r Nutrthc'
<br />l)are Conldchr
<br />IANSIf,U!:UI.}XI,INDIUG.AGENI:,I
<br />I hcrehy amrd trndcr FnalryorFrjuryrhd rh.rc k a.on{d.ri(,n Lndin8 a8.Ry lor Ih€ pcrtbrmrcc otthc w. ror whi.h rhis pcnnil is
<br />issucd (sN 309?. civ c ).
<br />aITIICAII-DECI IIAIIO!
<br />I hsd,yaffimu c!,cnally ofpcrjury om of tlE follo*ine dc.l[llions
<br />Dtn.lnion P€rniir$Asbc{os Norificdion F.ncd R.Sxlariotrs (Tnb &, P!rl6)
<br />Rcqnibd kno of Norifi.arbn
<br />rh)vc i'nonn nr i\coflcd l rgrNrocomply*irh rll Ciryrid coutrt,
<br />irc\ olrhi\ CirtrtrJ cou ryk,
<br />ADpli(snl or Aarnt SiEnuluP
<br />P€m lNn ne(!rinl):
<br />>
<br />'l[-'"
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflil Bouqh
<br />Ceilings (T-Bar Rouoh)
<br />Ivleter Release
<br />Rough
<br />Service l\/eter
<br />FINAL /--/8-rB-U/#a pa
<br />Notes, Remarks, Etc
<br />{
<br />l."dr''. NJ \'
<br />trtrdc''. AJdrrs
<br />rcnovrlarc mr rynli.$lc h rhisl'oj..r
<br />a,
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