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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE rD/srG COMMENTS OWNDR BUILDER DELCARATION
<br />I hdeby 3rtrD undd Ftr.lty of pdjury llBl I m .xcmpr 6on th. ftnlEdoB L(cns l-3w lor lhc lollowing Bei (Sc 701 L5
<br />Itusin6s ad Profsion Codc) Any Cily or Counry which rerluir6 a p6nit ro codttucr, aho, improv., &molish or r?an ey
<br />srtudu., prior ro ns isudce. abo equn6 rh. applicsr aorsuch p-n ro fil.e n8n.n srdmor rhd h.orih. ts licNd psusl
<br />lo rh. Fovisions of rh. Conra.rofs LiceNd Liw (Chaprs s, Cohmcnci.s $ih Sdrion 7000 of Divi.ion I oath. BBin.s ed
<br />ProaBions Cod{) or rhal hc or shc i! .rcofl rh(.&on ed rh. b6i a6r $c alLg.d ddnplion. A.y viol.lionotsdlion 7031.5 by any
<br />spplicani aor a pmn subrds thc opplicst lo . cilil p.nalty of nor nore th fivc hund'cddollrs (1500)
<br />-1,
<br />s o{n.r ofrhc !ror.ny, or dy .Eplo}6 rilh sau6 6 rh.ir $1. .onp@rion. will rh th. wort 6rd thc slruclu€ is nol
<br />in'6d.d or olI6.d for sl. (Sc.70,r4, Busins &d Prcfsio6 Code lhc contadof3 Lica* La* do6 not dpply lo o o*n.r or
<br />rh. Pllpdj wbo buildr or nnFo!6 rhaon. dd who d6 such slrl hins€lf or h€Gclror ihrotrlh his or hd own mployc.
<br />prcvid.d rtat suct UDpNvdors e nor im@d€d orofiiqi forsL.ll hos66, $. tuilding or ihpmvmol is sB wilhi! on. )@
<br />ofcomplclion. th. ownE Buikld will h,v. th. bido oaprcvinS fid h. or sh. did rct boild o! imp,oir lh€ I,opory lor lbl pu'po* of
<br />l. dorvnqofrhe prcpsry. acl6iv.ly conrBcrin-s $irh licss.d olnrado6 ro .omtud ll'. pmled (Sc. 704.4. Uusins
<br />dd I'roisio. Codc: Th. Cdnlractor's Lic.n. L,s do6 not applyro e osnd ofprop€ny sho builds or inrprcv6 rhd.on,
<br />and Nho conkacrs fo. sch proj.ds $ nn a Conlnclo(s) licdscd pu6mt to lhe c ont..lor's l-i.o* La*)
<br />I &ncxcmpt uoda Sdio
<br />.gaatsE8!:cauEEllallar
<br />DICIdB6IIQN
<br />I hn.by amfr: undr pmllyofFjuryon.oathc follo*in8 delaralios:
<br />Ihav. d will mintai" a Catificate of Congr lo S€la- l6ur. for *!r[.6 6nrp€.s.iio., 4 provid.d for b, Sclion ]700 oflh.
<br />L!b6r Cod.,lor$. pdfomec. ofthc wlt lor which th.Fs n ileol.
<br />-:l ha!. md u ill maorr m wortcn' comp.NatroD B(mc., s rcquir.d by Sdion 3?00 ollhc Labor Codc, lot rhc tsfon@c. of
<br />rhc Nort for Nhich nris ponii is isu.d My rvorkc( co.fmsrio.
<br />+Co 9.(q
<br />t(,*,ry lhar rn rh€ p€rfonnance orthcsork fr rvhich rht p{!nr is iesucd.l sh.ll nor mployanypmn ifl anymun6
<br />and reE lfi.l il I should b..o!nc subj..l to rh.
<br />sh.ll, fodhNnt omDly pithlhoseprcvisioN
<br />so aro tdoii. strbjdt
<br />'o
<br />rh. sdd'campmarion lass oacaliaomi..
<br />work6' .om!.malio. prolisioNof Section 1700ollh. llbor Cod( I
<br />\IARNTNC: raih.e ro ffiuc *ork€6 co'nlsal$h core'ale D unla*lul. and sh,ll srbj(t m cnploro
<br />c'vLl fif€s up r{. on. hundr.d rhouslnd dolli^ (5ll)0,000). ,n addirnr n, rhc cosr olc.nrp.Dsil
<br />Labo! Cod€. inrer6t and ar(on'ey s
<br />c
<br />D1](.lrlll,llIlt
<br />I hd.ny smrm undd p6ahy of pojury rhal I dn lic€nscd undd Fovision oi Chaplg 9 (conmocins wilh Sc(io. 7000) of Divkion l
<br />ol Oc ausinstud Pol6sio6 Codc. d myliceaisin fnll for. ud cfsr
<br />(lo c7q c 2-
<br />IQIiIBUCUqU.LIIDAC.AGTNCI
<br />I he.by lJlrn undd pdahy ol p6jui, that lhe. i! a codtu.rion Lndin8 rgocy aor the pdlomoce ollhe work ior {bi.h rhG Fdnt b
<br />isucd (Str.1097, Civ. C.)
<br />ATIII(AAUIDCI.AAAIIQ!
<br />I hd.b,dlmundd poakyofpdjury on of$. aollowirB dek lio.s
<br />Drnolitioi Pmits-Asb6tG Nolificdion F.dqal R.gularions {TnL 40, Prn6)
<br />-Rcqun€d
<br />LerEr ot Notifrc,fion
<br />,ll r}[r rlrr fud.nl , qllhrid,s
<br />'
<br />cgdding irnst,s
<br />'
<br />rnn x xrc nol npt)l .nb c k, 1his r,r olt{r
<br />/-,irylhnr, haveEad rhis applicaiion ad sral.rhal rhc atove inromdion is corecl. I ro onllyrirh all Citl a.d (outrr,
<br />ordin c6 and Statc tiws rchiru ro blildin-! co6tn.tion. and hdcby .uthonzc ofrhis Cny ed Coumy ro €.16 upo.lhe
<br />abovc rhmrtuncd pelEdy aor
<br />ap0li.rnl or Agc r Sitn,
<br />0l/"1
<br />-,.1(/619
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Frre Alarm / Dam pers
<br />Communications Cable
<br />Building
<br />Bondin g/Grounding/UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ce ilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL 7l(Lltaj zut rrq
<br />Notes, Remarks, Etc
<br />Under Slab / Floor
<br />,"r", I I
<br />L.ndo'3 Ad&*.
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<br />i.8:
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