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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcby amrm undcr p.mhy of Dcliury lhal I m .xcnl,t fm!tr fic Conhclon Liccns tiw for th€ lollowing @$n lsc. 7o.l I 5
<br />Bosnrs a.d Prolcsion CBlc): Any Ciry or Counr, shich rcqoircs o p.rnir b on{rud. ahcr. imptuvc, d..mlhh or rcpan my
<br />nd.uE, rh.lo ns issumc. d$ rcquircs lh. q{,lt l ror such Frmir h tuc a riSncd sl,r.mnl rnar lrc or shc is lic{n{d plr$rnr
<br />h rhc povnions ol rhc Conrr&tq\ Lic..*d l,a* (Choprcr 9- Commcftin8 wirh sccrn,n 70fl) of Divisiotr 3 oflhc Busincss 3trd
<br />Pmr.*sions Codc ) or fill k or shc i\ cxcnfl lh.rc6om r.d $. ha{k lor rhc ,lGg.d crenDrion. Any liolatiotr of SNrbn 70:l I 5 by lny
<br />/fl#ffiffi ;ffi ;;d;;'-'*ffi ffiffi :Hffi n;:Tr,",
<br />rhc rmpcny who inilds or iNnorcs thcNn. dqhod@ssu.hRor*hnns.ltorhcnclfo,thmu8hhtorhcrowncmplorcer,
<br />lrovided rhnr such ihpn,vcmnk * mr im. ldl or oflc'xd lff slc !l hDkri rtr buildi4 or inprowftnt is $kl wirhin oN )nv
<br />of.o'rphrio rhc Owrcr Briklcr wilt h,v. rh. burdcn ot pmvins rhd hc or shc did mr bui[ oi inp$rc thc pop.ny for rhc Nrrns ol
<br />L r\o*nc.ofrhc pmp.ny. rmeiclusirly.onaadi'rs sirh li..nscd cofta.nn i, .oi{ru.r rhc roic.r (S( 7(}!. Bunnc$
<br />rtrd lanli$irCodc:l-hcConlllclolst.i..nscltr'wdocstrolrIFlyroino$ncr.inropcnywhoblildsornnpmrEsrfi.r..i.
<br />rnd who $nh.B tur \uch pnj..8 wirh r ComEcbrl, li.cn\.d pu unr ro rht Cont(tor's Liccne Lrw)
<br />;: uIii'I
<br />I hcrcby,flllr utrdcr Nmlryol pcrjuryon. ol rhe n,l
<br />-l
<br />hdvc xlwillminr n r ccdiarnrc of Conscnt lo sclf.,nsuE for workcB .rmp.nsarion. !s pr.viicd frx I'y Stl idr :l7m .f rhc
<br />klxtr Codc. for rhc pc.i,tunc. of lh. wDrk for which Ib. p.ml t n\ucd.
<br />Ihrv.andwillmai'nainworkcrC.o'n!.ns.rioninsudtuc.r\FqundbySdiotrl7U)ofthctlty,Codc,lorrncprtf.nrr.cof
<br />lhc wor* fitrNhi.h rhis!.nnir is isucd. My wolkcis' L$rp.ns.r bn nrsur.Ncc.nis 0rn fnicy numt{t !re:
<br />ilyrhlt in lhc pcn'onlncc ofrhcsork lnr which rhis pcmir is i\\uc .I \hxllnot c'ry'|,,yrny lcson irlrny nrnncr
<br />\ubi.r urh. s.*cn'.nrnrcrsdmn hsrofCrlilarnin. md rsto{rh ill\houl(l$lTonEsuhicrrolhc
<br />workcr.Drr.n\arioDprov$ionsolSEriotr:l70Oofrhct-rh Codc. l shrll. hnhwilh conrply * iri l tue pn,eision\
<br />e l,lilurc x, sc.uE *orkrr\ compctr\arnn, covrrrgc is nn[wlul. rnd n ll \uh]..i ri.nr oycr ro riminrl pcnrlrEs nl
<br />u"4W
<br />Jollr^ (Sl(x).0(X)). in kldiii{rr ro rhc.on of.!l
<br />I hcFby onlmundc! lcnllly oa p.rjnry rhar I aD liercd undcr Drolision olChtrprr 9 (c.dmMinE wirh s
<br />ol rhc Bu\ik$ and Pmfcsn'ns Codc. ud nry licc.sc k in lull fn.c flrdcilsl
<br />-Lians
<br />NumlErl
<br />CAXSIf,IJCI& .LENDINC-&CENII
<br />I h€rcby llfinn lndcr pc.allyotFrj!ry rhar rhc.c is! consrru.rion lcnding,lcncy rd rhu rrrontMo oflh. work for which lhi\ IErmir h
<br />issucdlSR.- lgr7. Civ. C )
<br />APILICANIIECI,ABAIIA!
<br />I H,y amrnr uftlcr pcn.hyofp€rj!ryotrc ollhc lollowirS dcclnorions:
<br />Dc'mlitior Pcrnirs-Asb.(os Norificalion Fcdcral Rcgnbriotrs (Tnb 40, P.n6)
<br />Rcquncd I.ll.r ot Ndifcdbn
<br />ffi,dril;
<br />Iticralrcguhrion\rogdinga\h.<osrcuxrlrrc norrmli.rhlcbrhnl)n)ccr
<br />rhri rtu rhrd i'rlnnnridr a.oncd lngrcc rr
<br />nrucri,,n. r hcrch) rtrrhr
<br />abovc trE.l idrd ln,pcny lor irspcclion
<br />Appliont or Astnl Si,tn lure
<br />rurrG
<br />mnml\ rirh rllCirr JnJ Cuunt!
<br />r',rti,r "',r c*nvr, *'rl,m" rr,"
<br />",1* lrc
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Sions (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondin g/Grounding/UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rough)
<br />It/eter Release
<br />Rough
<br />)r
<br />FINAL '.lLL ffi)6','
<br />Notes, Remarks, Etc
<br />APPROVALS
<br />I
<br />L ndc' \ AJd-!.:
<br />Service [/eter
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