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ELECTRICAL-INSPECTOR RECORD
<br />COMMENTSAPPROVALSDATEtD/slG.
<br />Site-Work
<br />Pole Bases
<br />L ht Standards
<br />Pool, FountainsSs
<br />Si ns monument
<br />Fire Alarm / Dam ers
<br />Communications Cable
<br />Buildin
<br />Under Slab / Floor
<br />Bondin / UFER/ Groundin
<br />Transformers
<br />Sub-Panels
<br />Air Conditioners
<br />UIRoof To entE
<br />Facto Wired Unit
<br />Walls Rou h
<br />Ceilin hHard & Soflit Rou
<br />lVleter Release
<br />Rou h
<br />Service lvleter
<br />FINAL )
<br />Notes Remarks Etc.
<br />()r! \t R tit .t)t.tt tlt.,t ( ,\11\ I lrr\
<br />I icrchy aflirfr undcr pcnally ol N,ury lhal I m cietrll,r rdn dc Conlrlcion t-kcns tiu fot rh. rollo*ins rcsen (SN'7oil'5
<br />Bxrinuss ,nd Pn'icssnri Codc) Any Cily o, Counly whi.h rcqunes ! rcflnir to consrrucr, llrtt inprovc. d.mlish or rc|ot onv
<br />(ruclulc, prior b iG issuarce. aho Equt r rhc .rplicanr for such Frmi o lilc ! \ised {nrcmnl thal t Dr sh' k lircnsd po^uanr
<br />lo rhc Eovisions ofrh. Conkr.lols Lifti\cd tjw (chlPlcr r. G,mmn.in3 with Sccrion 7fiD o, Division I ol lhc B0sincs\ und
<br />Penssionr Cod.) or Ihor heorshc it.xcnrDt thcref.omand rhcbrsis ror thcallclcd.rcmdion AnvvtdionolS€dhnToll'5hvanv
<br />arpli.anr forapemit \!hjd3 rhe omlicinr ro acivilp.nalryofnol nFrc rhan fitc hlndrcd doll*( ($5fir)
<br />-l,
<br />a\ o-e' .fihc lollny. o, ny €nDloltcs pirh Pasc! as I hcir \,L $mPcnsar ion. sill do llE *d drl (rE utrlm ir tur
<br />inrcidcn or.fi.rcd fm sk (S(.7o44. Busincss ond Pn,fcssnnrs Codc:1hc Contru.ror's Liccnsc lrw docs nol oIPl, b un owncr oI
<br />rhc pDpcny who t{ild\ or ny{m$s rtcd,n. aM who des suh sork him|lfo. hc.slfor rhouBh hn., hc, o*n cnplovccr'
<br />p",!id.d rh,r such innevc'rnh m mr inlcndcn or otlcrcd for std. Il h.wcsr. rh. hildins or imPrcvcmnr is sold Nirhin 'ic ,car
<br />;furn{ftrhn, rlEOwmr Buit+r uillhrlc rtr buds ofpnrli'r8 rhar tE ot shc dd m! toi[ irlFrc lhc pmFnv lorrlE purlF{'f
<br />I.0sosncrofrhcForrny. onciclusiv.ly..nra.rins wirh liccnrcd contlclos lo coNrru.i rhc roJc.l (S( 7044. Businc$
<br />oftl Pn,,isi,n Cod.: Thc Conltackr's Liccnsc Law doe\ nor aPply to {nosnct ornnirnv whn huilds or i'nprovcs ltcr"n'
<br />rnd who onrnd\nn\uch |x)irls *irhac \) liccnsed pu(hir i, rhc C.nrrdor's Lic.tr* Lrwl
<br />;',"'ry#alt
<br />DIiTLjI].IIA\
<br />I hcrcbyrllirnrn .rpcmltrofpct}tryoncolrhcft,lk,sii8dcchririons
<br />-thalc&xlwillminllin!ccdil]c0l.ofconsenths.lflnsurclolworlcn'.omlctrsdion.aslftvid.niorbyseiionlTlx]oriheLabo, Codr. ror lh. pcrftrIlec of rhc wort tor wtich thc p.mn is nsucd
<br />I h,vc snl will dai.rain worl(cri cotr\Er3arion insunmc, {s rcquircd hy S€crion l7O0 or rhc tjt'or Codc, ror lhc ,rrfoM'c ol
<br />rh. work for wfiich lhis p.mir is nsued. M, workcn coq).nslion insrhncc caEicr dd Flicv numher dc:
<br />Policy Numhcr
<br />-Eipitorl
<br />-l(nifyrhrlirrhc!.rio
<br />unc..flhcwo.k itr$hi.h rhn!c nil i\i\sucd ldrallmr cmPkrviiyp.r\on in xny tutrncr
<br />so .s k) li(onc shj.d ro rhc wortcra comfns n{ hws ot Crlif.rnir' rnd aAEc rhrr ifl sh.uld ll.tonf, {brcd torlE
<br />sorkcs compcn\rrirn Ircvilions olSccri.n lTur ollhc tih.r C.{t.I shrll Innh*irh strPl, wirh rh']* lmvntnB'
<br />WARNINC: Frihrd k, ecurc wotker( .o r8ns.rion cov..!gc is unln$tu|. and \hall subF_r m c'n,lortr ro riminll pdrxi$ 'ndcivil fincs !p r. onc hundrcd rho,sand:::+ffiw'
<br />n ..ntFtr\trinr. drnilcs ur pmvidL{ ffl lhc
<br />lhccbysmn,uodcrlcnellyolp.tjutyrhal,amlicci$drnd.rpmvhionorchl'rs9lconmncir8wirhSccri{rn7{xlo)orDivisinnll
<br />ol rhc B$in $ and Pmfcsiors Codc. !d my liccnse is an ltll rore and cltccr.
<br />CANIIBJ]EU9XTENDUG.trGDNCI
<br />I hcEh, !,Irn un.Lr Fnllly o{ rt4ury rhal lh.rc h a co.nd.ri,n lcndi,E lscn.v ro. thc lcdom@ oi lh. mrk ror Rhich rhis If,mI n
<br />i\sucJ (se. 3(I)7, Civ C.)
<br />APPLICANT DIiCI A[A]I(IN
<br />I trrhy df,irm ufrlcr p.mhy ol pcrjury om of rhc f(rlornrE dlrlarxrii,ns
<br />llcmolirnnl PcrnrirlAsbcdos Norificrrion Folcrul Rcgulrriotr$ (Tirlc J0. PM6)
<br />RcqunL{ trrrcr.l Norillcrrirr
<br />l.cnilyrhal |hc tcd*nl rc8!l ion\ ngardine asbcsros tcrB,vnlrtu tror r|t'licablc ro rhis Pml$r
<br />-l
<br />ccniry rh,r I hdvc rcad rhi\,tdi.ario. ad sr{. rhd Ihc ,h.vc infondbd is coFai I aEr€ ro conrlly wnh s cirv nni Cotnrv
<br />o inrn.r\n d slrl. t;rr\ rchr yaurhorizcrcDrcscnrari!c\ofrhisCiryaod(i ntylocnrc!ulxnirltr
<br />atnrc Nnrn,ncd !n)p.ny lo! in
<br />]\ptliunl or A*enl Sienot ^,",2/l/ztt
<br />Underqround
<br />Torqueinq
<br />Walls (Conduit)
<br />Ceilinqs (T-Bar Rouoh)
<br />'tlnt *, "/'cn)
<br />t) \\' \--..-
<br />Lln.1fl :A'lJrcs
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