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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUIDER DELCARAIION
<br />I hc.cby afiro .nder p.naxy {Jt,,.rjnry rhtrr I d excmpr lion rhc Contrdor' LiceM L:w ror rhc follosins nNdn (5*.?011.5
<br />Blsinc$ ad Pmfcssbn Codc): Any Cily or Colmy which rcqun r . Fmn b con$d.t. .116. improrc. dcmlnh or rcpln any
<br />rlrucrurci pri.,r ro ils n{atuc. lho rc{utcs rhe alpliclnr lbr lucn pcn.it ro filca si8n d staremfi thst hcoi lhc is licenrd puNaru
<br />lo ltc rmvisions oflh. Conlractols Liccnr.d kw (ch.p'.r 9, com,ftmin8 wnh Scclioo ?000 ot Division:l of lhe Busincss and
<br />Pn,L$ions Cod€)orrhlt hcorshc isexcflrpt rlrcrc,iom lnd rhc aost for thc lllegcd cicm0rion. AiyliohtionotS*rioo703,.5 b, !n,
<br />4ffi;.'**ffi.'#;ffi ffi ffi'* ;rff *ii.Tr., ",rho pmFny *ho hiilds or nqmns llEmn. sn vho des suh w.* hinsclror hcrclfor rhmu8h hn or hcr o*n.q,lorecs,
<br />ptuvid.d rhar sn h irpmrft.ts m mr inr. lcd or oftcEd aor slc li hrwdcr, tlr bnilding or inlrowmnr ir $U eirhi. onc Fa
<br />of co.Dblion. lhc O*trcr guitlcr sill haw thc 6uicn of prcvi.g dx1 nc or shc did trol huild or iryrcrc fic pmFny ti,r ltr puqr$ of
<br />_1, rsowmrofrhe |,rDcny. aDexclusivcly cofld nr8 rith li..nscd .o.ricmn h onnrucr rh( nmJ.{r tScc. ?014. Businc$
<br />.,xl Prulirqbn Codc lh.Conracr.r'sLic.nr.ljwdocsnoiapplrt,ano*ftrof oF y who builds or nn[ov.s rhcrcon.
<br />nnn *ho onrracri for such pojccls wnh . Co mdo(g ltctrsd puru.nrrorhcContractois Liccn\c liu).
<br />;::rl;]i$[
<br />I hcrcby rnnn utrd.r pnxliyorpcrjuryotu.rlhc bllowi'rg
<br />Iluvc $illnri linaCcnific rcol(-on\cnrroSclfln\u.clorw.rtcrrrotr,lc'srri{n,.a\ pr'lirld f hySccrntrrllTfirofrh.
<br />lrtx'r c{nlc. ior rhc lshmuncc olrhc {ork for shi.n rhc ldtrrii is ksu.d.
<br />Ihvc tdsillnrinrrin*orkcrsconr.n\rri{)nin\urJme.r\rcqurcdhyS.cri,rn.rTlX)ofrh.tnborC..h.ftrrhcltfornr.cof
<br />rho wo* nn shi.h ihis p.nnir i\ ir{ul Mysork.rr dnnncnsarion i',\urrncc crtricr r dIr)li.y iuoltr rrc:
<br />PolicyNum6..r
<br />-Expirc
<br />,4\-1,-, . ^*,"*-1-,h h,htr n.mr \ F. J. r \h,, n.,
<br />tL,l\r.hcmm {hic r,
<br />'hc
<br />w'{[c,\!o,nNn{rr'n lrtr\ oicrl,'nml'. and.'r,cc,ho, irl
<br />w, le'., mp.n\rrhnFr,,vi.n,ns.,fSdctnn.17(irott\cLJh{cotlc.l.hdll.l,'nr'* l-r,
<br />cnuoy an, |xrnd in rny.rMncr
<br />sh)uld l{rom sul,J$r k, rh.
<br />nply wirh rhor lr,virioi\..
<br />WARNINC: Frlurc h surc Norkcs .o.rrc6r i.n $vcrugc is utrhstu). ind shrll suhrc.l ,r cnDbycr l. crimiml pcorlrts ond
<br />lhous.nd dollos ($100.000). in 0ddiriotr ro rhc cost olcomrctrqtion. daroscs as providcd fo! rhc
<br />l'
<br />I hcruby lllirnunicr pcnrltyolrcrjury rhlt I um licctrsl undcr vision otChnnler g (conrnEnci0s Nilh
<br />oJ rlE Busircs\ trnd PdisstinsCodc. aM nryliccis. n i'r full fd.c d.fic.r
<br />Liccnsc Clas:-Liccnsc Numbcr:
<br />c0lsrf,lcuoN.LENDNc-ac!!.CI
<br />I hcnby artr,n un{.r Fn.hy ol p.rjury rhar rhcrc i. . on{ftrhr lc.din! n8.ky aor
<br />'h.
<br />p.rfoflmrcc ol th. work ior shich lhn lrmn n
<br />ksucd (scc. 3tl)7. Civ C.).
<br />AIELIIINI"II&CLAEAIION
<br />I h.rcbyrfianuDdcr Fnahy ofpcr|uy om ofrh.lolhwnrg d.clrr n'ns
<br />D.n)hn,n Pcrmih Ashc(os Norificaiion Fcdcral Rcgulart,n\ llnt.$. Prn6)
<br />Rcquft d lxtr(.f Norili.arnr
<br />ffiffi;
<br />hc l.d.hlrcguhrtrtris r.!r'di',9 3\ltno\'.nn,vxlrn nor lI)!li.nhl. t, rhi\ t)n'Jc.i
<br />vc rcd rhn {llicorion ond (atc rhar rhc 0k,v. irfofln0ri.D iscoltcr.l r8E io conrlly*nh all Ciryflnd Cour}
<br />rucrion. ad hcrcby au'tsrizc rcprNntdir.s ollhisC ';lT;
<br />Ir D
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communicalrons Cable
<br />Bu ildinq
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />[t/eter Release
<br />Rou gh
<br />Service l\ileter
<br />FINAL L\?n \r9 I,tttht ir)
<br />Notes Remarks ,:
<br />Under Slab / Floor
<br />Air Conditioners
<br />Etc.
<br />.bl,vc nrmion d f,eFn, for inrFrbn
<br />Applidl or Aaert Siarlurcl
<br />Pemll@ tumc(prt ):ti\)
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