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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNf, R BUILDIiR DELCAf,\TtON
<br />I hereB amrm undcr lcnrlry of p€rjlr, rhar I m excmrr tiom rh€ ConrracroN Liensc Ljw fo. rhc ,{nb*ing rc,$n (s& 7011.5
<br />Busi.css ad Piorcsrbn Cod.)r Any Ciry or Cou.ry which rcqut s r Frnil ro mnrru.r. alrci imrrovc. dcmlhh or Etl{t any
<br />slru.turc. lrior b ns nsumc. llrc rcqutcs lhc lppltatrr fo! such pcrn b 6lD o skmd (alcmnt lhal tr or stc k ltenrd r'!Fu!nl
<br />r. rh. pmvision\.flh. Conrra.ro. s l-i(i\cd bw (Chrpr.r 9, G)nnE.carg snh Sc.rkr 7m() of Divishn I oflhc 6nsinc$ and
<br />Pmfcsions Codc) or rh|l hcorshc hcr..rrr rhcrctomN.d rh. bast lor rlralh8cd.xcmplion. AnyviolalionofS.crionT0.ll.5hyanr
<br />ffi .dd;d:ffi ilffi;;;;ffi ffiil-;:r#ffi ffi , :. .,
<br />rhc pmFnt who hnitds or qrows rhcmn, ind wh. dk q h wrk hinBclf or hcrclf or rhmu3h hG or hcr o*n cmployccs.
<br />I]rolided rnor suct impmrcnEnls re mr inrendcd or oficrd lh. sak lt ho*rer, lhe brildin8 or inpbwftm is s d withir otrc rrs
<br />of coq,lcrion. lh. Oqncr Bxildcr will havc rl* burncn oi povin8 dd bc or nr did rct hoill or improlc thc ptr,Fny aor rhc purF)r or
<br />-l.
<br />.s.wmr of lhc Drcr.ny. r ciclusnrlrconlmcline wnh Iiccnrd (onlr!.n'6ro $nslru.r rtr rmrerr (S.! 7014. Btr\iR\\
<br />,trd P|sfcr1.n C.d.: Thc Contr.ror'q l-i..i\c ljs do$ &r +tly t, r..s.cr of!rop.(y who huilds or nnlrovcs lhcrcon.
<br />and who co ncls lo. such pojcds with . Cd r ado(, li..trscd t u*urfl h rhc Conrrdoi s l-iccnsc liwl.
<br />u1 i4.\i
<br />I h.rch! nlltrfr tr d.rp. lrlolncturtofuolrhc n,lL
<br />-l
<br />hrrc aBllill nEinriin!CcnilicarcolConsor ro Sclanr\urc lor *orkcn o'npcnsrrn'h, rs pnr ntr hvs( 17{x).frh.
<br />litor Codc,ld lhc perfornnncc oflhc wort lorshicnlhc pcflnit is tsucd
<br />lhavca.d willmrinr0nr qolkcrs- compcnsr ion nsufln... rt r.qunc brSdion 1?(x)ollhc t hor Cndc- t r rhe pcrfonBncc of
<br />rh. work lor wnich
<br />'his
<br />p.irnil is issmd. Mywo.ktrs omp.tr\diotr i.sururccadier dn lrlicynumbcrac
<br />4it***,,* r,r*r;;: H;lJr ;rrr :*:i,r*,,*'**.**,, ir*,*,****
<br />soikc^ comp.nsurbnpDvisn,n\orScdi(,nl70oofrtcl,ah,G'dc,l\hlll,rudhwirh.o ply wirh tho* provnions..
<br />*'*'u115\ir'*'-
<br />.onrF.$rion ..vcd8c is trtrhwtul. rnd shall subjccr 0n l0]!r u .rin,in l F-.nxi[\ ]nd
<br />dolhf l$l00.lXX)). ii rddirn r
<br />I hcrc6y llltm undcr p.nrlry.iFrjury rhrr I rn licencd udcr pm .aChl,rs 9l.onmncing snh s..ron 7fii0) ol Divkiotr l
<br />of ir Busincs ind Ptufcsiors Codc. d my liccnsc is ir ,nll f.m fln clltcr.
<br />Dale:Conlrulo.:
<br />CONIIBICIIAN]ENDIIG-AGINII
<br />I hcrby alfirn nnder Fnalr, ol p.riury rhar rh6. h a on\mcion htldaig ,g.ry ro. rh. pdloimmc of lnc *ork lor wnich rhis ltrmil is
<br />issucdl56. 3097, Civ. C.)
<br />^.8tLU:ANL!Irg,ln
<br />trUO!
<br />I turby ljmundcr Nnrlry.fFriLtr! onc ol lhc r.lhsiig doclnrnrnrns
<br />DcDxrlirnnr l,crnir\ Ash.(os N.rififarid F.dcralRcldlarirnr\ flirlc 40.l)rn6)
<br />Rcqur..l l{rrcrof N,{ifirxrrtrr
<br />lt _r.cnrr! rh. rhcr
<br />'tAl[p.,:',.r"''
<br />fcdcralrcEulalions rcsnlins asbc{o\ rcnDval arc nor nmli.rblc t,lhis pxiccr
<br />rcd rhi\ { ic.rn,nrid {orcrhd rhd rh,vr inf.nJEri,nr h.onc.r I r8lN ro comply *irh rll Cil, and Counly
<br />*\ruLri,,g ki 6uiklinF.on rorivrs ofrhis C,ly rtrd Couorylo
<br />ahivc nf,nriom,l p(,pcny fir in\ltdioi prrBr$\
<br />Applieni o. ,{g€nI Si8,.luR
<br />P€mit* Em€ (pnrl):
<br />ion, r'xl hcrbyaxr}ktrizc rprclcn
<br />blh"[8.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Condilioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />Meter Release
<br />R ough
<br />Service lvleler
<br />6lL1ll9 y')4.fis^)
<br />Notes, Remarks Etc.I'
<br />ID/SIG.
<br />FINAL
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