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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\)