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ELECTRICAL.INSPECTOR RECORD
<br />COMMENTStD/slG.APPBOVALS
<br />Site-Work
<br />Under round
<br />Pole Bases
<br />Li ht Standards
<br />S S Pool Fountains
<br />Si NS mon um enl
<br />Lile Safet /Low Volta e
<br />Fire Alarm / Dam rS
<br />Communications Cable
<br />Transformers
<br />To uetn
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To ul mentE
<br />Wired UnitFacto
<br />Walls Conduit
<br />Ceilin Hard & Soflit Rou h
<br />Ceilin T-Bar Rou hs
<br />[/eter Release
<br />Rou h
<br />Service ltrleter
<br />6FINAL
<br />Notes Remarks, Etc
<br />otl NFiR BUI-DUR Dlll,C,\R,\l I()N
<br />I h.rcby rlrior und.r lcnah, ot p.rjory rhd I m cicmlr rnnn Ih. Conrtu ra6 License L2w lor lhc folk'$int aosn (sc7o'll5
<br />Bulnr\s orr Prcfc$ioo Cod.): Any Cn, or Counly whtfi rcqLi,t\ t Psr.ir t' on{ru.1. !llq, inlt)rovc. &mlnh or qun anv
<br />sh.ruLc.PriolloilsissnMce.sl$tcqutcsrhclmlkanlforsx.hlEnnjll.ljlc.si8ncd{at.ft6llhtrlheorshchliccnscdrlBuanl
<br />rorhepGiobsolrhcContacrolsLicet*dLiw(ChaPlerg.Conmctrinswnhsc.ttun?(r00orDivisiotrlofrh'Busim$and
<br />Pof.$nnNCodc)orrhtr!h.orsh.tci€mprrhcrcfromantlrhchasislorlncall.gcdcxcrnPrionAtryviohtionofSdion?0'll5byrnl
<br />rynliconr tn r Ni,nir sulrsrs rh. aPplicnni ro r .ivil pc.ally of nor nmt rhnn five hutulEd dollaG (S5m)'
<br />l, os o$ne. o( rhc pmpc,1!. or nry cnPloy.cs wirh sre.s as lheir sL sml,cnsalioo. will do th' wok lrl rhc slnEr@ i' n
<br />inrcndca "r .ncna ro st tio 7(}44, Ausinesr rnd Profcsions C.r'tc Thc Conrractor's Licctrs LsQ do's rcr aprlv ro owmr 'r
<br />rhc pNpcdy who ttrildr ot irrll,mrcs Oc@n..it *ho d{*s \mh so* himscltorhcGclfotrhmu8h his or her osn 'mplovcc\'p,n'i(lca rt ,r *.r, impn$rmnk art ,t inrfthd n oflcFj rd srlc Il notuw rhc hurldins or iqmrcnEnr ir sll] rilhia otu ]ttu
<br />;fsn{,hrion. rlE Owtr Suilds willhavc rhc hurds ofpNvin8 rhd he or shc did tur bnild or ia{rolc rhc pmFny f'r rlE I'uInE of
<br />l. !sosncrolrhc tmFny. amctclxsivclyconlraclins wnh [ccn$d ofu .loF lo cofirru't ltr pmFr (Scc' ?04]r' Btr(imis
<br />otrd Ftrftssin codc: Thc Coht0dols l,iccnsc Liw doci nor aPplyt, tr. osnct olporcrtv rho h!ilds o! imprcv's rhc?n'
<br />.nd who.ontersrotsuchl,ojc.rseirhrConr{dodrliccnscdpu*na b thc Comhcrol s t'iccn* t2w)
<br />I rmqcn,fl undcr Scdio
<br />D.te: o*ner:
<br />wonxrns' couprrrs,lttolt
<br />DECLAEAITO!
<br />I hercby a,tud undcr pcMlry or l.lury om ofrh. rolloeitrE d(lar,rnnNl
<br />-lhlveantsillruinlain,CcnifEarcolConrcnrlosclf'lnsu,€l(,rworkcsco'nFnsario..0spmvidcdlorbrS"rion:l?(nor$cknor Codc. lor rh. lxrloirDncc or rhc wolt {ot qhich rh. p.rmir h hslcd
<br />I nave and sill nrainlaii workcr'comrtn\rnon insurarcc. !\ r.qtrircd bv sc.iion l7m orrhc ljtur Cod' ror lhc pcrli,nmm' of
<br />Il.rnrir n issuc{ M, workcr' comPcn\dion nr{utucc.tricr otd Folicv numbcr uc
<br />t^.J Last^
<br />,,,',, r-*,, EINU\!9{E!?:-
<br />I cenily l hlr in rhc lcrformtuc or rhc wort tor *hich rhN n irn tr n:ucJ. t sholln'r cnnlovanrlc^'n inonvnBn'lr
<br />- s n r'rirm uo1.ri r rrr u orlch' cnmFncai tr'n las s ol CalilcmD. lnJ ssr. thd il I 'hould b€'onr sh,'rr h' I k
<br />m.keB.ompcns.lionDovisbnsofS<rionl7mofihcLlborCodc.Ishsll,aodhsirhcorylvwiihtho*Imvisions
<br />WARNINC: Fuilurc ro Klrc *.rkcs conu.nsalio. covcm8c is lnhwtul and \hsll subi{ an cmploru lo oim'01pcuhi's dd
<br />ciril6ncsupbomhundrcdrhousnddollar($loo{Do).inaddn'6lorhcc.{ofcomF'stiondaflugcs'sPmvid'dt'orlhc
<br />D&CTABAIION
<br />I hceby 0finnundq pcnalty of Pcrjury rhd I am liccnEd;;Ar @vnion ol Chantcr 9(conmncing silh SNrion ?(x)0) ofDivision l
<br />of rh€ Busim$ and Pmte\ci.ns Codc. ald d, li.cnsc k i. flll foN .ld cild
<br /><3 (o c/r1 g 1.\.iz.to 4ltv'-
<br />CT)NSTRII(:TI(}N LEI{NING A(TENCY
<br />Ihcrobyritmxnd.rp..ohyolI)€rjuirlharlhercisa.on{rucrionhndinCsscrcv*trrhc|FrtbrmrctorrrEworkf'rshichrhhFmirh
<br />isimd rS.c 1097, Ci!. C.).
<br />trndcr's Addrcs\:
<br />-
<br />{31eiiri rhd I rxNc ftd rhrs,rtlric rrion dsarcrhrl rhc 0lxx! iilitr'narion ncotud lrArcck,.oMplvwilhnllcirvrndCou ry
<br />odirrtr.cs aid sfurc ti$relxtingtu
<br />$.re nrnlilri.d pfl,piny hr i'NF.ti
<br />rc*nrarivcs of rhi\ ciryand Counrylocnlcr tr|x E
<br />Applironl o. Agenl Si,lnrltrre
<br />A ,"1
<br />1z-1q
<br />DATE
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Walls (Rouqh)ssrion -10?6 ofrhc bhor Codc. inrcn( and anontr\ ltcs
<br />u,," n ' 2' \to- Apprimnr:
<br />Llnder'\ Namc
<br />APII.ICANLDECI,AEAIIO!
<br />I hdrr,y,frmundcr pen ry of p€riury.n. olrhc follo*inE d(lmlions:
<br />Dcmhion P&mnlAsbcsroc Notificrlion Fcdo,l Rcguklions tl itb 40. Pan6)
<br />-Reqoared
<br />Irlcr of N.rinodon
<br />-lccnifyrh
<br />lhc lcdcral tcsulur ions rc8,rdins sttsros Efr)volarc nor alplic(hle ro rhis,'r'iccl'
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