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APPROVALS ID/SIG.COMMENTS OWNER AUILDER DEI,CARATI('N
<br />I hc,chy lnnm undc. pcn&lry or !.rjury rhar I d crcnF rn m rhc Conkrn)m Liccns L.* fo, rhc tou.wing rcasn isec.7o.ll.t
<br />Burin.\s .nd Pturcssion Codc): Any Cily or County vhich rclutcs u Frnrir k, $Nrrud. tlrcr, nnfmv.. dcmlhn or Eprn uv
<br />sru.turc, rhrro irs issnarcc. rho rcquircs thc apllica ntr slch rEm r. nb0 siSncd slar.mnl rh ncorshe is li.!.sed txsu r
<br />u rhc Dmvisions or rlt conr.crols Li.cn*d llw (Ch. cr 9. Commcrcins,irt Sccri,n 70m ofDivision 3 ofthc gusinc$ rid
<br />Prcrc$ionsCodc)orlhaltEor\hchcicmprltercfromandltebasnforrheJle!.dcrcmtlion.AnyliohthtrofSdiohT0-ll5hytr.,
<br />arJpliclnr for a rermir suhjcrs rhc lpnli.a
<br />'o
<br />a.ivilFnrlryornor mr.lhln fivc lN"drcd dolls\ ($500)
<br />l.aldwn.r.frhcpmflny,ormycmployccswirh'ogcsdsIhcnekcoD.nrdn&rilldolhc$rkenIla(nlrirmr
<br />imcfld.t orofi.rcd forsLlsa.7(144, Buii'Esrsnd PRrrcrsi.n\ codc Thc (bnrrlors l,tenrc lisd*x nor arPlyrornowNroI
<br />Ihc ln,lxny ah, hdilds or iqnoEs rncmn- ond Nno dms such mr* himsclfor hcrsclfor thtou8h ItiF o. hct o*ncnlpk,rc.!.
<br />provid.d rhrr such imptr,kmna m tul idcnd.d M offcrcd tu sik ll h.wcvcr. Itc ltiki',g or i'lllmvrrrofl is sld wirhin nnc ttr
<br />ofconllcrir rhc o*rcr Buills *illhavc rhc blnlcn ol pmvirs lhd h.orrh did nol buitl or imtovc lhc Frp.riy rd rh. Plqxreol
<br />l.rsowncrollhcnm|Eny. n crclusilcly corrrrr ina wir h lic. \.d ..nrNM\ ro con$rucl lhc pntcd (SN 701-1. Buitrcs\
<br />snd Pnrlcsi,nCod.: Thc Co r&kr'\LiccnscLnwd.cstror.t'tlyro0trowncrolpn,pcny*hobuiltlsorim0nrcslhcrcon.
<br />ard *ho conrnch lor ruch lrotccrs *irh a Grntrron, liccn\d PoNrnr tu rhc conradois l-i(n{ I tr*l
<br />l.ncxcnr undcrSslio
<br />I hrrc rl qillminrrin r Cca 'ttrr. of conrdr t, scll:ln{rc f(trwo'kcs . nrJrns bn- a\ nDrid.d r{n bysc.ridr 17(xrol rhc
<br />Lrlxtr Cod.. for rhc tol.mrNc oirhc work r'or *hiri rtc p.' 'nir is i\\ucd
<br />_l hrvc rnd willmrinrriD *orkrr'.o.rt tr\nri(t ir{urn,rc, rr rquircd hyS..li .lT(Xrofrhc l- hor (inlc. lor rhc r^-nniiuncc of
<br />h rhi\ |xir ir i\ irlul{ My$.rkch .o lrf{ri(nr iNurrncc.rtric' :u Fnictn!.$rr ttrr
<br />L"",
<br />v..,
<br />fe- gEc'4 r7./ //aTr)
<br />5t.1C 11l194*d-* -)6
<br />-l
<br />ccniry rhar b ihc p$rorron.. olrhc work lor whth thh lErnit h issu.d. I \hrll n.r.mphy,try pcnon in rny munm.
<br />s N kJ bt$nE subF...r lo rhc so*cs' compcnsrrion hh nr Cllifinnir, dtrd ,!R r hd if I should hcc.m suhjcd b rh.
<br />*o.k.n.ompcns.rionpmvnn'trrolS6_li.n3?00ofrhcItrtnC.d..Idrll.ionheirhomPl,wirhrh)sPmli\nnx.
<br />WARNTNC: F0ilurc ro su.c worlcr(.omFnsalion covcmAc is unla*ftl. rnd shrll subj.tl arr cnDbycr io oidn8lFmlris 0trd
<br />civil finc* !t ro .m hu.dr.d ihousmd doll.s ($l(x).000). itr r'ddilion ro rhc cosr or conFnsrlion, dr uscs rs lr,!id.d ldr rh.
<br />Secrn,n ll)76 Dlrhc l-abor Cdd.. imcrcsi Md 0rlorrcy's |as
<br />P5 -Oq- I / r,oon-*,ffa/d' Ktm At e-
<br />LICEIIEDIjANIBACIOA
<br />IECIAEAIIQN
<br />I hcdhylrltnufllcrFnalryofFrjury th.t I am lietrEn undcr pmvnion ofCh{rd 9lcomnrmin8 wilh SNlion 7000).rDivkion I
<br />oi lhc Busnrs and lmlesiioni Codc. ll myliccnk is in full lom aM clfcct
<br />r-\,,.
<br />B fctda.{}
<br />qt-e=7.19 4llu 44 r€,< € yirrnL rn,
<br />coNsrntl(]Tt()N I Fr\DtN(: a(;lNcY
<br />I hcrchy lrfinn u.dcr Fnaliyol pcrruryrhrr rhcrc iM con{fl.rio,r L.dirA qcnc, llI rhc tcrronndn.c otrhc *ork tu siich rh( Iirnir i{
<br />is{i.(lrS( r1r'r7.(tr ( )
<br />APILI!:ANI.DEILATAIIAN
<br />I hstty !fimi undcr pcnally of ncrjury om ofrhc toll.win8 d.clddrions:
<br />Ocrmlilion P.irnits.Asbcstos Norificarion [cderal RcglLrn,is (Tirle,lO. PM6]
<br />Rcquircd Letlcr of llotificlrhn
<br />-l
<br />cenity rhar rhc redenl rceuldrions Egr.ding osh.slos rcmval {c aor rpplic$|. r. rhis tmlc.l.
<br />I ccnilyrhd I halc rc lnh aptlicarion ard srarc rhar rtc !li*! inrdmin i\ con(t. I asN ro comFly wnh ,ll Cily aln Coutrry
<br />ordinm..s ind sr.rc tjws rcl0tins to l,uildins c.nsrrdn,n. uil herdhyrurktrizc r.a,crcntarivcs oilhis Cny,nd Coumr lo cnts uPon rtc
<br />rho!c mdrmd Dn'mnv lor insnccrion Nm*s
<br />prFor*-r *,rxmr sror,n %:=:Z-2f.;1/
<br />\-r,.*..,p.r,,, Q77/ 2f't'/ D . Kt z2 O ^r"
<br />O./ - ot ^tA
<br />L (.>
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solf it Rouqh
<br />Ceilings (T-Bar Rough)I
<br />I/leter Release I tI l8 _\.rfteh-
<br />I
<br />Rough Eltrt tp tL$,Da-
<br />Service lVleter : t;'t'"J
<br />FINAL t\,rlb
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
<br />DATE
<br />Communications Cable
<br />Iv!18tr[IN:l;0u8ENlAr(,!
<br />IECIATAI]OX
<br />I hcrchyuln undcr pcExyorrcjuryoft orrl[ r.lk,wine d(lardhtrs
<br />trN.''r AdJr\(
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