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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />l. N owncr ol ihc pmncny. or my cmplores sirh *rScs !\ rncn sob conrtr.nsarion. sill do rh. wrtrk tfil th. nf,r1rrc i nol
<br />inr.ndcd or oflcrcd i{r el. (Se 7(l,14. Busin.s d Profcsnnr C,xL Thc Conta.bls Licctrs liw docs Nn spply r. rnowicr oI
<br />lhcpnrlf,ny wlnr huilds or inuovcs lhcron. anl who docs {rch s.rk hi,.sclaor hcrslf.r rhtuu8h hk or hcr owtr cmployccs,
<br />piovnbd rhrr such nnr'ovcmnh nc nor inr.idcd o' olItrrl ftn slc ll lnrw$r. rh. huilliq or iqroEnE nsldwntin''ncytr
<br />otco.nrhrioD. rlE Ovncr Eoikler will halt rhc h{nici ot prorine rhnr lt or \hc dil frI brild or nr'r$! rhc l'mpcny br rhc purF,{ ol
<br />l. A uwnc. of rh. ropdy, am .x.lusivcly conh.ri.8 wth li.cnicd cotrrEcrtrs lo con(rucr rlr pr+.r (se 7014, Busrnc$
<br />lnd PiDlissiln Codc Th.ContrucloisLicclscl,awdocsnorlpplyloM.*icrofprolcntwhobuildsorimtrcvcFlhcrcon,
<br />dnd who.onr&hrorsu.hfr&ckwirh.conrmdo(r)liccnscdNsurtrrhrhcConrracroiiL.i.cn*hu)
<br />I Ncx(,r,uiJcrSc.hoi .ll &PC hrrhi\rcrvn,
<br />Dote: ORmr:rvolxFls c-onlraNs^ixrN
<br />DICL$AIION
<br />I hcicby rl1nDUndci p.nrlryo{pciuryonc oilhc rolhwirg dLihrulnns:
<br />I irk rnd will nBnnrin rCcnifi.rrcofCon\c t b Srltlr{trc kr qorkua .oDrcnsrrion. !\ pnvidc{t fq hrS..ri( l7(]oolrhc
<br />Lltor (t c.li)llhc pcni,rmrrcotrhc $o* lar whichrtu p.nnir is is{tJ
<br />,lhavcrnd will mon uin sorkcr('conr.n rcquncd blSccri,)n l7(X)ofrhc L'l\tr C.rlc. li,r rhc !crlonnrm. ol
<br />lltr *ort n,*hich lhh!.nnil i\ n$cd Mt cn compcnsaln)n i'rsunncc cMif rrd JxilicynuDhcr ne
<br />I rn r.\
<br />_l crnifyrhri irrh. p.rfo'tunkc ofrhc work ftr whi.hrhnr..nir is i\sucd.I {rrll mr cmploy 0ny rcrv,n in rny utrrEr
<br />$ask,bccorsuhj..tlolhcwork.rj.onDcNalionlnw\olCalilirrnirrtrdogrccrhtrrifI\horldta.otrEsubFcrt'rl'c
<br />wrrkcrs.onlFn\nrnintrurisn,nsolsccriotrST(xrofrhcljhtrCode.lshlll.lnnh{irIrolPltwirhrl${pnvisions
<br />IYARNIN(;: Fiihrc t, r.uo sorkcrL .ompcns,rt r ..vcrn8c i\ utrl.wl'ul. n \hall \lhjccr rn cmnk,ydr t, dinihrl Pc rlric( ond
<br />civil linc\ up h onc hu6di.d thousond dollars (Slfi).(I)0). n rddition Io rhc cod of comncn\in,n, di,u8.s !s Povidcd lor thc
<br />Scrrn r.10T6olrhc tjlff G)dc, ir crcsmdnfimcy's ltcs
<br />SLzi/ t6 ct Qtt Zzp+l>,
<br />DIIIdBAIIIIN
<br />I h.ebt anrnr undc, Fn.llyofFcUury th.r I ah lic€nsn udcr pmvisio. ofCh4rcr 9(.ommncirg Bilh Selion ?fi) ofDivist,n 1
<br />or (h. Busin*s a.d Por.*ions Codc. ud nyliccnsc n in rul lorcc ond cnccr.
<br />,"", {/Zt1tB-"*,on*' Dq,zoo ?ry,., /,--5
<br />CONIIf,IJ!:IIAXITNDIIIj.&GENCI
<br />I hcEby !flnm undn Fralty of r.rjury Ihor rhcrc is a co.(rudion krndinr as.n.y ror thc,crbmncc oflhc worl lbr whi.h rhis F rir ir
<br />issE{i (Scc :1097, Civ C.l
<br />LcrJcis NJn'c
<br />-ATPI.ICAITDIgLAMIITN
<br />I hcrnyammffdc. p.nany orp.rru.y ore ofrnc followi.B dftLtr io.s
<br />Dcmlirion ttrnil\ Asbcstr Nolifi.di6n F.dcral R.gxlari.ns (Tirlclu). P.n6)
<br />-Rcquircd
<br />txllcr of Norifi cari.,n
<br />I ccnnirh,r rhcttdcrulrcBUl0rion( rc8nlinE r\bc{o\ r cnrwl rrc nor rpplicxhl. b rh(rn)j..r
<br />-l
<br />ccnilythll ! hrirrcodrhnlpplicari,nund d6icrhnrrhc!h'!c infdrnuri({ is.oftccr laArarocomPlywirhallCiryrndC.u.ty
<br />ordiEnces trnd surc Luw\ rchring ro brildinB .onntucrnr( aJd hcrcby rurhorizc rcprcscnhrilcs oirhis cny und counryr..nrd ul.n rhc
<br />lhic nrnriorcd propny ntr in\lccrion purrN\
<br />ADnlir{.1 or Aft.l Sirn.l0rc
<br />-te /4{
<br />€/2s18
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels 7-7-/g,J/dolz (v'r)
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />I\4eter Belease
<br />Rough t-/L-t8 J)elal {rE)
<br />Service Meter
<br />FINAL 7-7 -/ /JJ"bh (-",/)
<br />Notes, Remarks, Etc. ,
<br />trtl
<br />OWNER BUII,DER DELCATATION
<br />I h.rcby ,rfi n und.r Fn,lry or pcrjury th,t I m .x.nry lmnr rhc Co r0cror' Liccn* Liw tor rhc following ftas.n (Scc.70ll.5
<br />Blsincs d Pn'fcssiotr Codc) Any Ciry or Counl, which rcquncs ! pcmir lo consltuci. llrer, inlfr,t. d.nmlhh or eiEt {ny
<br />(ruclurc. p or lo ns hsuarcc, ,ho rcquncs rtc lpplicdnr for s,ch Fmir k, filc a signcd sdc'Rnt rhar hc o. shc i\ licnscd lltNa"r
<br />b rh. B)li{ions .frhe Conrn rols Licctrscn tjw (Chaprcr 9. CDm,rcrcins *i'h Secrhn 7m0 or Divisi(,n I oI thc gusiN$ .nd
<br />PmL$ions codc) or thar lEor shc ircxcnlt)t th€rcfrom od lhc bost tu lhc allcscd cx.nFrion A.y viol,liotrolSstionT0-ll5 byuy
<br />aprlicant lor 0 pcirnit sul,jrck rhc opplicur ro arivilp.nulryofnor nx8rhd fivc lrndrcd doll,r ($5m).
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