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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DI'LCARNTION
<br />I hcEhy rmfln undcr pcnatty of lrcrjury rhnr I on cxcm0 ftorn rh. Contlcror' Liccnc t,, f.r lnc followi.g En\on (SN.7011.5
<br />Busincss o Prolesion Conc): Any Ciry or Counl, whi.h rcquncs a pcnnir lo consldcl- alls. introvc, dcfrrhh 6i rcl,ir any
<br />dtudh. rin ro irs nsuancc. rl$ rcqunes rhc ,ppltarr for ruci pcmir i{, lik r lieed darcmnr rhai h. .r sh. ir li.cn*d pursua
<br />lo lhc ,,rovisions or thc Conlructols Liccnsd Lrs (Cn.picr 9, Co,rmcrcinS Bith Scclion 70(t) of Divhion 3 ofrhc Burin.ss a.d
<br />Pnrie$ion\ Codc)orrhat ncorshc hcx.mpr rh.rctmmand rhc $asis lorrhc alLscd cxc,nprion AnyviolrlionorSccti T03l.S$y,try
<br />applicrnr for 0F.nrir sxbr.ck rh. appli..nr io ncivilt'cnslryorndr mr.rh,n,lvc hundrcd dollrs (S5m).
<br />L as ownf of rhc ,roFny, or m, cntloltcs wirh snscs dr rhct sld .!mpc {rn)n, will do tF. work ald rhc slnxluc is mt
<br />inrcndGl or ofcrcd lor eh ISe 7044. ausie$ and R'ofc$ions codc: _rh. conlncrtr s Liccnr Liw docs nol amly ro an os(r or
<br />rhc pn,p.n, * ho huikh or imFmws rncmn- ud who d€s slcn eork him$lt or hc elaorIhrolshhhnrh.row.cmpbyc.s.
<br />rovidcd lhar such inrmEmmorcmr inrdld.d oroftftn tursrL ll ho*cw. rhc hoildinS or nqmv.mnr is sold Nirhin onc rr
<br />of.on{,lcrion, rh. O*rcr BuikLr will h{\r ltl hxrdcn of rtuvine rhd tE o. th. dd mt tuild or in{row rhc pmFcny aor rhc pu4ns of
<br />l,Jsoancrolrhcpmpcny..ncr.tusnrlyconk,.lir8sirhlic.n\cdcotrtr.rork,conslru.lth.I'rl,jc.l(Sa 71x,r- Bt\incs
<br />rnd t'rohri,r Codc: Thc Conrnd(\ Liccnsc Ln* d.c\ nol ADply ro !no*ncr o, n^,pcny *ho I'uildl or nnpn,!.s rhficon.
<br />,nd $ho .oniracr( f$ such t'n,J..h qirhacontrcrn({) lic. \cJ pur\u trr t, rhc contrt x Liccn{ tjs)
<br />-l
<br />aocxcnrpt undcr Salion-. B &PC r'orlhisrcoson
<br />D.le: Onner:
<br />][a.8f,EEl:coltttNt rtqNDE!L$dlto!
<br />I hcrcby nllirm u.dcr p.mllyoiFrjury onc oirhc nrbwirB dLrln0rions:
<br />I h.!c willmrinr0ir0Ccnrfic.tofConscnlIoScltlnsurck,*orkd{conrcnsoli.n.os nnvidcd ior by Sdion :l7m ol rne
<br />hbor Cod., fff rlr p$lo.mr. of rh. *ork for whkh rh. lcrmir is irsucd
<br />Il,,r.r qlllnLtr'tr'q,1lr.\'.1,trfcr.ri,.iir.r'....ilrH;ilr"sf.rirnr.l7mofrhc Lrlorcod.. f{n rhc Nr,nnn mco,
<br />N1\ca n ,rrl iri.t nnn$.r ec:
<br />o
<br />lcrnifyrhrr in rh. Frfo.rnan.c ofrh.{ork f *hichrht!.nnir ni$ucd.I \hallnor c'nlby rtry trcr\on nr ..y nnnrcr
<br />$ $r)bccotrr \ubjc.r t)rhcporkcrl conllr.trs[bn ldss.rcrliroirid. in,r l3Nrh iilshould hc(nc shid t,rhc
<br />*ortc$' conrNns.h.n |n,vni(i sorS$riotr 37(x)oithc t-rhor Codc.l drll. rbnhwirhconrplr $irhrhoscpmri\ions
<br />WARNIN(;: Frlu'r r, \ccu'c so'k.^ co rt)ci\nri(u rf\c'xgr s trih(nrl. n lhill{'hi(.1nn.nrf
<br />cnil ,n,c\ trt) 1o o r hr dtud rhou$ l dol xr, nr ld iofl b rhc co{ ofco aan[!.s r\ fmvidcd f,n rhc
<br />:::t':#iiil /(--
<br />I h.rchy a,lnm udcr rnalryolpcrjury lhal I aar limtr*rl undcr,'rovnion o c.9 (c.nxmncin! wnh Scri). ?m0) olDivhion l
<br />of rh. ausircssand Pmrcssio,s codc,orn mylic.ne is in tullnxccrtelfer J
<br />q (o
<br />Er
<br />I hcrcby atim undq Fnehy or pcrj ry rhlr rhcr. is a a,niB.rion lcndin! dScky aor rhc p.rroimrcu or rhc work for *hich rnn p.rmir t
<br />hsucd (Scc.1097. Civ. C ).
<br />Lf,ndcr. N.,m'-
<br />AfPur NfDrct xruo!
<br />I hcrt y !ffinn utrds l)cmlly ol rcrjury onc ofrhc tnlbwins dccluralions
<br />o.rmlirio. Pcirnir!Asbcsos Norificari.n a,cdcrul RCEUbrnN (Tnb 4, Pd6)
<br />Iteqtrrcd Lcrrcr ", N.iili(rrrrr
<br />I cdiayrh l hr\r rudrhi\ rl,tli.rtron aM n .rlrar rhr rtr)rnrrirr i\coiic.l I usrc_ ro.onlnly *irh rllCiry ]id ( ()unry
<br />urlntr/.it,fc\cnrirncs ofthn Ciryr C.unry r,) cnrcr !F)n lh.orilimnr.s rn,l srrlc l-x*s'c['ri',9 k)
<br />rh.v. nrnriiinc(l ,,ropcny lnr in\
<br />Appli(otrl or AAol Si,tnP
<br />Site-Work
<br />Underground
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service IVleter
<br />FINAL
<br />Notes, Remarks, Etc
<br />Pole Bases
<br />'1 -l)
<br />lvleter Release
<br />:AQ Pi.\--r{,
<br />1-la-lq
<br />l.cnifrrhnrrh.l.Jcrrlreguhri()n\ rugtmln,a r!h.i.s 'cnx)v lrrc oorrfIli.rhlch lhis tojccr
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