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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG COMMENTS Owns'ltuild.r D(laration
<br />I h.r.t'v amrn under p€nahy ol perlury rhal I io.x.nrpt lorn rh. Contidou' L'..nse kw for rh. followrnS roson l3.c ?0:r | 5lluinBs
<br />dnd Proadsio. C.d.): Any Chy or Couoty ehich r.quir6 a r.nnn ro co$rtuct. ah.r, i'nprc\r. d.molish or r.prt..y srrucrur.. p.ior b ns
<br />tiuam...lso r.qun6 rh..pplicn lor sr.h p.mil ro fi|.a sis..dstatm.nt lh.t hcorsh. k li..E.d puulrnltolh.provisioBoalli'.
<br />Coni.acrois l-'c.ns.d l-!w (Cfirpt.r 9. (on,E.ncins r h Se!6n 7000ofD'visio.l oarh.aur.6s..d Proa.rons Cod.) or rh.l hco.
<br />sh.k.r.mprlh.r.iiomrndrhchsislorrh.sll.s.n.r.'npiion An,vtr io.ors*rio.70.115by!.ysppli.r lor ! D.mlrubj.ds ln
<br />ryplicatrr ro acivil p.nallyolnor mr.rhan n!.huhdr.d dollrN(1500).
<br />I.s.wn.ioflh€ptup.ny.ormy.'nrloy.oLvirhwag6asrh.isol.compcnsarion.qilld.rh.{.rkandth.iflrcrd.isnolinrend€d
<br />orollcred {nrrnlel sec 7044 RunNssand Prof*sotrs Lodc ll[( o rr.ro' s l-!..sc l..wdo.s noiapple roinown.rolrh.ptupcny
<br />trh. builds or nnpn,v.s rh.Eon. andNho docs yrch uork himsclror hcE.lforrlmulh his or h.r own .'npk,y.es, provid.d ln{r nrch
<br />inrpi{Jve rnk ar. nor intended or ofcred lor salc l( how.r.r.rh. buildrg or improv.m.,r issoldNilhinonc yc.rolcompldion. rh.
<br />{hTd lrlrildcr rvillh.v. rhc bord.n orproving rhal h. orshc tror huild or impror. for th. p pose orsal.)
<br />l. aso*n.rorih.pop.nr,.mcrclusiv.lr..nrncriry sirh lic.ns.d conlmdos ro co.strucl lh. projdr (S( 7044. Buiin.ss.nd
<br />Prtn sion('od. h. Cont.actor s Liceis. tlw do6 nor rpply ro.n ownq ofpropdv wl$ builds or hprov.s rhor.o. - and who
<br />conlmcts lo, n'ch rhlecb*nh. cohraclo(s)hccns.d plBuini rorh. coflriclois l-rc.nse bw )
<br />la crcn, und.rS.di.f
<br />WORXERS COMPENSA'tION I'f, CLATLAIION
<br />I horby imrB und.r Fnalty ol perjury on. oarh. aolhpios d(larari.ns:
<br />I h.!. rnd trrll marrlm ! C.nrfiol. ol('on!.nrroS.la-lmur. for Mrk.G compensrion. as p.o!id.dforhvSer6nlTOOofrh.
<br />L.h.r c.d.. fnrlh. p6f.mrnc. of rh. $ arl fn' *t'ch rh. n.m F Fsu.d.
<br />)(n,*-o*,,,-.*"-*.,k.8'ompens,on,Burn...&r.qunedhys.cr'on]?ooorrh.r..h..codoro,rhepc,ro'minc.orrh.
<br />f rqk fortrh(h'!snmir E i*d.d Mvua-r.r'\nnpenq.r'on,nru{nc.arFrrndnoh,\ numb.',,.
<br />*.-,Y.L 6Bc?.441+Y
<br />r.r-,r.,**. C\Dgulk)fudglOL _*or,- 6'31. [V
<br />I Ihir*.rhn n..d n, h.(nnDld.! r.rh.I].rmiris lorlh.hundr.ddnllaE ItlO0tor l.s()
<br />I c.nrty rhlr rn !fi. psaormanc. oflhc tr.rk for *hEh rhis p.mit is is!!cd,I.hiu nol.nDloy lny F.rsoo in roy 6enno so s lo
<br />h..rmr n'hrecr rorh.w.rkcE an,penel'on la* oa rl n'a. and asre. rhar,flshould h€come strbrecr to th. so.k.r
<br />comp.nsir ion p..\isions olSdhn lrcl)olr d..Islfll. linlh\irh c. flv trirh rh\.p,o1hl. s
<br />mnitlL ffYlM,t -<,1 I.zotr
<br />$ARNIN(; li'h,c b rc.trrc qorkeB co.,p.
<br />fi .srnt)dn.hundr.drhotrsanddolla6($100.(
<br />rh.l ?hor( dl. inr.rar lM irr.rn.! r l;.s
<br />n !nl.tratrl. and null bj..l an emplov.rro {ininaI ncnilrisahd.ivil
<br />lo rh. cor or..nDcnsrrion. darna!.s.s 11o\id.d ro llE s<rion 3076 ol
<br />LICENSED CON RACI'ORS Df, CLAT(AI'ION
<br />I h.rchy.airm under rcnally oapcriuy lh.r I anr lic.ns.d und.i tmvision orChaprd c (condrnciis snh S.crion 7000)ol l)irhioo 1ol
<br />lh.lrxsinessand fh Lssbns codc. and mylic.ns. t ii rirll forc.!nd.fr.cl
<br />!4NN n ' Atusgq
<br />@tMtLLr tvtafrv-<.
<br />NI,
<br />I h..chy altm undcr p.n.lty ofpdjury lh.t th.r. h . coBltuaiion l.odi.s ls.ncy to.lhc p.rforoncc ofthc sori for wnich rht p.mit k
<br />isu.d{S(. :l0s7,Cr! C).
<br />A]ELICAI.I.:SECTAI{TON
<br />D.molilion l.mirs.Asb.stos Notincarion F.d.rilRc!ulNrions(tillr40- ton 6)
<br />R.qoircd lrtrs.f Norili.arion
<br />I ccnilyrltt thc fcddilr.sulalions rc3ardin!.sh.slos..rnov,larc nor dpplicabl. ro lhis prcj.ct
<br />1. r'lY rhxr I hr\r '.Rl rh s apllical6n rd shlc rlrl thc ih,ve lnlornr^rion n.oftc.r l asrc. hcohtlv with allCirt rtrd ( ounrr
<br />.d Srarc I!wsrel.rin! ro 1[ilding coBtnrcr ion. and lErchyaurhorizc rcprs.nr6riv.s .fihLr ( ity ind Counly to cntcr upon rhc
<br />iotrcd pn,peny lor inspeclion purposcs
<br />^* @a\NJrtMotd^,2
<br />,,.,, Dnnl'ctr'e MaV*rnO
<br />qt.L|ct{
<br />a
<br />Site-Work
<br />Underground
<br />Pole Bases
<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 ?a-rr J)-S*&)
<br />Transformers
<br />Torquing
<br />Sub-Panels ?-?.'b ts '//drh @)
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release T>z-r{.1J.S"{o UO
<br />Rough ) -,.r\f r.{4-
<br />Service Meter L.'v \0q- ft{.
<br />FINAL /,"4-/O l/.lzt ;&)
<br />Notes, Remarks, Etc
<br />M 1\Permll l.specliod FornE\Elecrr.a lrFt,..ro. np.o,n 'lo. 03 3l 06
<br />Light Standards
<br />r.-".",r"* C\O
<br />,r,c 1.t-20rS
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