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ELECTRICAL.INSPECTOR RECORD
<br />APPHOVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAXATTON
<br />I hcrcby ,fiim ,ndcr p(mlry 6r lrrjury lhd I m .xcnfl tbm rh. Conlr&lm Licc.se Lls ntr lllc follo*ing rct$. (Scc ?0l l 5
<br />Busincss ,nd P6f.sion Codc)r tuy Cily or County ehich rcquiEs a Fanril lo con{ocr, 3lr$, i.npiov.. dcmlhh or rcpon lny
<br />{Mruc, Firr to ils t.u!m, els rcquircs lh€ slplicant for such pcmir lo filc , sigmd rlalcmnr lhd h. or she is licensd purua
<br />io rhc Forisi.ns ot rrr ConrBctocs Liccns.d t]w (Ch!flf 9, conmncins uith Seclio.7000 of Dilisaon I ollhc Busincss ud
<br />PmlcsionsCode)orlturlrcorshcncrcmprrhcrcrmmandrhclsshforrhcalks.d.x.npr,on.AnyviohlionofScclionT0ll5tyany
<br />rantrl48nr ror a Fmrr.unc(N 'hc
<br />apll'.anr ro a.,vrlpcmk, ',lnu, mF rhu fivc hundrcd dolles r 15U0,,,t I
<br />{.7LV* ""*,.r,* p-p.ny. o, my cnlplnye\ wirt waasx os rhct slc .ompcnrrti.n. will do rhc wok ud rnc srrErft is mr
<br />inrcnd.n oroftren lor sk (S< 70,14, Bliimssand Prcfc$io.s C.dd Thc Conraclor's Liccnst w do.s nor q,!1, h an duer or
<br />rhc pmFny wh6 hiUi or i.{'mws th.mn. dd *ho dos suh m* hinsclf or h€rcli or lheush hh or hr own .nploy..s.
<br />pmvidcd rhli $ch imprcEmnrs e ml inrcnd.t orollcEi lor slc ll ln*cver rlE hlildins or irpbrcftd is $d sithin one }!a
<br />ol @nlplction. thc Ovmr Buildcr willn w $c bonlcn.fpovins rha' hc or shc did ft lnih or idrftk rhe pdFny ror rtE pu{n* or
<br />L owhcr otrhc pfl'prdr, rncx.luivcly.o.trcrinS Rirh liccnsd .onhclon lo onsrdcr rh. rrojc.r (S.c.7(),l]l. Busrmss
<br />ond Pnnirsion Codc: Thc Contretor s Licensc t-!w des n l ..'ply h an o*ncr o r Fop.ny who builds o. irntrclcs lhcrstr.
<br />and sho conrracrs for $.h piojdh wnh rConh.bd9 lkun*d ru(unt brhc Q,nrocbis Ltensc b$)
<br />uii(,cb
<br />I hcEhy nlinnr undcr lnnrlrr.l |xrJrryodd ofrh. fdk)*trrA
<br />-l
<br />havc and willruinrrinaCenifEarcolcon\cnlro Sclf lnrurc,.r so,kos .on9.nqrion, prcvidcd for bySdion:1700 orrhc
<br />tihor tuc. lor thc ,crfonuncc oI rh. *o* lo. *hth lhc pc.nir t isncd
<br />_lh3E and willnrlinrrin korkcii .o'npcnsdn nNUrnn.c. n\ rcqunL{ hy Sccr iM l?0O ol lhc lih.r C,d.. ntr rhc ncrror rMd.c ol
<br />ihc sok l{trshichrhi\ p.nnir i\ nskd MyworkcN .o lp..lrrn nNuran.ccanicrmdf,licynumtcr0c
<br />4iifi;;:;inrhct rlornErccolthe work hr qhichlhis pcirni h isslcd,I xhaU .or .4tloy any lc^on inlnyfl@mr
<br />suhlcr !) rh. qorkrr\ corpcdiinr Ls\,,1( rlii)nnJ. rnd.!(c rh rl I \houli 6c.nr e,hFcr ft, rhc
<br />WARNING rrilurc u $crc uork n conrEnsnlion .ovcnrsc is nnla*tu|- ud s,x'll \ub..r rn cnrlloycr lo riminrl Fnalrics nnd
<br />itr .ddirtun r{, rhc .on .t.o'nF.sarion. drm8cs
<br />\_{
<br />I h.Eby drtr,n u.dcr pcMlty of p.rjury lnal I an liccn{t u trorisin,olCh prn9r$'nrtcrcin!wirhScdion?U)0)otl)ivnio0 l
<br />.I rhc Busircs ,nd Pmicssions Codc-.nd my licensc is in tull r'ore and clttcr
<br />tr.n". Nutrftc'
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<br />coNlirf,lgrcll.ENDA$lclNLr
<br />I h.rcby irltn under pc rhyorpcrluiy rhd rh.rc k d.on{fl.rhtr lcndirs lgcncy for lhc pcrformJncc orrh. sork r.r which ihh Frmi n
<br />i\{cd (Sc. .llre7.( iv (')
<br />AIPIICANfDICIASAIIO!
<br />I tlni,y afian uMcr lxnali, of Frjury onc ofrhc folk,*ins dccloralions:
<br />D.mnnion P.nnns Asb.ios Norilic.rion F.alcnl Rcauloriotrs (Tnb 40. I'!n6)
<br />Rcquncd 11rror of Nurifi .dDn
<br />I.c irylhrrthc ltdcra I rceulo I ions rusrdins 6b.slos rcnohlrrc noratpli.dhlc tu rhn Dr,it
<br />M'*r,*l ( lhN rrxd rhi\ rlpl'cnnn nid nrrc rhxr isconccl l0sre ro@mnl, rirh rllCiry,nd C.unry
<br />Sr lc L!wsrclaling lobuiltliis
<br />ft.vc nEn'nmd F)!cn, t,r ins|ccrion purlx rc\
<br />Appli..nl or Aa€nl Si8mlum
<br />t ltP.mrilee nanF(Irn ):
<br />:,:';J[.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq i UFER
<br />Translormers
<br />Torqueing
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service Meter
<br />FINAL (; -aa-(t Jr), { ri -z.rQ )
<br />Notes, Remarks, Etc.
<br />Sub-Panels
<br />Air Conditioners
<br />qo*cn onDcns"rion pmliin,nsofSc.rim llu]o,rhc ljhtr C-odc,I sh.ll. hnhsirhc.mply sirh rho{ prori\n,ns..
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