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ELECTHICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUIL]'ER DELCARAIION
<br />, hcrchy siftrrn undcr peMlry of pedury rhlr I m cxc,npr liom rhc Contacro^ Ltcn* t2w toi rhc lbllowinS Elsn lss.?031j
<br />Bu\inc$ an{j Ptr,fcsi,,n Codcl Any Cny or Coun.y which r.quircs r Fynrit Io consrDcl- llrcr, imllrovc. dcnolilh .r [p,n any
<br />slfl.lurc, prior ro irs hsu.ncc, lho rcquirs thc on icanr {or such pc.n ro lilc r ailn d {dcmni rhor h. ot shc is liccnsd Pur$ul.
<br />ru rh. !tr,vi\n,ns o, tlt Cdnra.ror's Liccnsd t2w (chtrptcr 9, Co'mrmins wirh Seclion ?000 of Divkion I ofrnc Busincss.nd
<br />PmicsionsC{dc)orlhathcorshctcicmpllhcretmmandrh.h6\is{orrhcrlkgcdcrcBlrhn.AnyriohlhnofSNrhnT0llSbrany
<br />lpplicanr lor ! pcrmir subF.rsrhc appli.anr r. d.ivilpcnrllyornor mrcthd livc hun<lrcd dolles ($500).
<br />-1.
<br />a{ owncr of rhc flolEnr. or nry en]rlorlcs sirh slscs Ds rhcir vrc .omp(nslnnr. will do lhc wolt lnd ltf, nturm n
<br />inrcdcd or o,Icrcd ao. srk lsd.7ol4. ausinc$ and Pr'lcssions Codc: fic Conrncbr's l-ncn\c li* doer..r amly to an oPncrol
<br />rhc pm!.n, wtu hxikls or in{,mrs rhcetr. aftl who des such no hinNcllo,!.rslforrhhnghhisorhcrowncmpLyccs,
<br />pmvidcJrharsu.h iryrcw'rcnt aB n i.tndcd or ollir.d ftn dc I f. ho*cvcr, rh. hoildin8 or irymrcmnl h sold $irhin onc yc(
<br />oicotr{'hrbn. rh€ Owncr Buiucr williavc rhc burdcn olpoving rhd hc or sh. dd ftn build or inqm,E rhc pmp.ny lor rlt purlx,sol
<br />_l. owncrolrh.popcdy.r'ncrclolivcly..ntr.rnigsilhli.ci*d.onrhcx6loconsln'cirhc,Iric.i(S..7Ul,1.8unm$
<br />a.d hJfdsion Codcr 'lhc Contrc(tr's Liccnsc l-aw d..s nor otplyro rnown.rolpr.pc y shl) buildsor imlrorcs rhcreon-
<br />nnd who conrnc.lor such pfl'J.{r\ wirh a Arntu.ft'n, liccn*d r$rtrt k, rhc Conrrlcroir l,tcn\c lj*)
<br />-l
<br />amcicnrpl utrdc! Scclil
<br />OrEi
<br />ItORXX ILS' C( IM PFNSATI(TN
<br />qI(;LABAIOT
<br />I hc.cbr arfinn undcr rcnolryofrrrFryoncotrhc tolk wins dccl,$rion\
<br />-IhrvcurdwillruinllinaCcnificrlcolConscnrloSclllnslrclo,*orkds.onlPcn\alion.a!t'mvidcdfort'ySdion:l70oorrh.Ijbor Codc. tor rh. Frrortumc ollhc *olt lo. which the pcrnrn h nsucd
<br />I hr\c fld willmiinroin $orkcrr co lncn\lrnr i!\urrnrd. r\ ru,lrncd by S.cr ion lr{)0 of rhc l,hor Odc- ftn rhc ltrrrorfrn.c ol
<br />hsucd My*orkc6 con,|x!\rrt,n in\drxntd.rftrr dDJ Anlcy trutr$.r u.
<br />_l ccdilyrhur in rhc p.nnnMmcorrhc work ld whi.h rhs fcrnrir rr hucd.l shrllnor cnpl{)yrny tcN'n inn.ytnMncr
<br />n' N ro hc.oN nrh]cd b thc vorkcn comDcnsar ion laNs oi C.lilo.irr rnd lgtc rhd if I should ttcom subFl ro rL
<br />w.rkcr' .onDcnsarion ,rovhion\ ot Scd n,n :l7t$ of rhc llhn Codr. I shnll. rdhsilh conl',ly wirh thoE prcrnins
<br />BARNINC l.rilurc r, scuru workcr\ .o tf,trlrr.t.rvcrxsc i\ nih*t|. tnd \h!ll \uh]ccr , en,rloyc' k' mnitrl p(tihics rd
<br />ilflffff'Iir'?it Tri.,
<br />I h.Ehy firn und* r.nrxy ol l.rjury rhar I !m liansn undcr tmrnion ofChafld 9 (c.mmin8 wirh Sccrion 7(x)0) orDivision 3
<br />ol rhc Buiirers and Pmfe$ionr Cod., aJxi ny lt.nk is in rull for.c criacl.
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<br />,i{ljN Ll
<br />COISIAIJCITONUNPINGIAE!(I
<br />I hcrcby amr6lndcr p.nalry.rlxrjury th.l rhtrc isa conslrucli.n hndinS a8cmy tnr rhe pcta.FEncc oflh. work ir,hth rhir Fnnir h
<br />i$ucd (Scc. 309?, Civ. C.)
<br />APIIICANIIEII.ABAIION
<br />I hor6y,Jfmn undfi p.rrlly ofrcrjury onc oflhe followin8 d(laErions:
<br />Demolirion Pqnirs Asbcrro\ N.in. ion Fcdcr0l R.Suktio.s (Iilh ,10. Pan6)
<br />R.quir.d t itrr of Norificalion
<br />-leniayth
<br />rne icdeBl rcgxhri.ns rgdrding rsb.s'6 rcmvd arc not lptli.ohlc lo rhh poj.cr
<br />4 .enit, rhd I hr\r cd rhir ap,rlic,rion rd narc Ihot lhc olFv. inrbmr.tion i\ .oft.r I rEe ro comtly enh 3ll city and G)unl,
<br />ordi'unes ond srdr. LiB rcl,line 10 building construclion. aln hcrcby aurhonu c rcPE*nr iw\ oa rhis ciry arld Counly to cnlcr uFn lh€
<br />atn,vc nEnlion.d po,rcny lor in\INrn,n puryx'sus.
<br />Appli(nnl or AEenl SiEnnluru
<br />P€mirft nome ( prino, .t>.L-,",1Ut*, r I 20lB
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinos (Hard & Sollit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough tg u0t4 k1.
<br />Service lvleter
<br />FINAL /"F> *l
<br />Noles, Remarks, Etc
<br />ID/SIG.
<br />/tK
<br />\c.
<br />| .FJ ',\ N "nr
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<br />l6hol
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