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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DOLCAIIATION
<br />I hcrcby flfirm undn ,.n.lry of F ju,y rhar I !m cxcmtr fmm thc ftnrracros l-i.cnsc llw lor l hc follo*ins r*,n ( sc. 70l l 5
<br />Businc$ !d Prolcssinn Cule): Any Cily or Coul, which rcquiEs ! Jxrmir ro conndcr, rlrd. imlrov.. d.mlnh or rtrtr lny
<br />iru.ruic. t itrro its i\sudn$, rlso naun s rhc.lpplicd ror {u.h pcrnf b filc r si8md rlarcnEnt lhal lEor shc is liccnsd p!^!anl
<br />k, rhc pmvtions ofrhc Conrra.rols l-icen*d tlw (Chlprer 9. ConnMio8 wirh sc.ri.n ? to or oivhion 3 ofrhc Busircss lnd
<br />PntssionsCodc)o.rharh.orsh.is.xcnp'rhcrcftoma6drhcbdshlorrhc,llcgcncxclnption.Anyviol ionofssrio!70:ll.5b)lny
<br />trptlicrnr t'or a pcrnit subjsts lhc atpliclnt lo acivilpcnaltyofnol mrclhm nvc hundrcd dour6 1S50o)
<br />L a\ osncr of ihc lhrFdy. d, m, cnrrn,ylcs *irh *nge\ a. rh.t {lc rDmltnslbn, will do rll Nork lil llr sInIlm h nor
<br />inroncd or ofi.Ei tar srlu 1sN.7044, ausircss rnd Phfcssi.ns Codr: Thc Conrrclols Liccnsc L€s docs nor opply t, an owncrol
<br />lhc nmteny who builds or irpmrcs rncNn- lnd sho dms su.h rorl hiosclior hc^clfor ihn,uah hh or hci own cnfloyc.s.
<br />tbvidcd rhar such inlF$wmnrs .m nor inruxlql n offmd fn $L ll h.Krq. rhc h,iliirg or inlpmrnEnr h sld *irhin onc ,tr
<br />oiconDkrion. rnc Owm! Buiklcr willhlve tlr hlldcn ol povins lnar hc or sfu did an buiu.r in!tuvc lhc pDp.iy tu th. pulTns of
<br />L is owncr ol rh. pbpcnt, i'n cr.tu\ntly cofud ir8 wirh li..n\cd .otrtra.roN !, $n{rucr rlE 0rojccl (Sa 7l}{, B!\inr\\
<br />r l !\trfcisbn(odc:'lhcCoarrrtr\l-icctr\cl.rwdoc\noraptlynJB.sn.roll]tr|x(ywhobuildsorNnnrcsrhercor.
<br />r.d who conra.rs l{r $ch Dm]cch wnh r Conrrrcr.rlr ) li.c.s.d purulnr ro rhc ConrrrcroaF l-kenrc tjq )
<br />I ncxc rpr undfiS(ri( .a &PC li,rrhi\rcason.
<br />]Il)nXLBli-(Ollt[ SrlII0N
<br />DECL -8iUtA!
<br />I lrrchyrlfinnutrdc' pcnrhyol tElnry'nc"f rhc nnLnvilll dc.hnri,rr\
<br />I hrrd d willntr'i[rdirtrC.nificrr.ofConscnrloSclttnsudlinsorkcrs'cotrrpctrsdnr.rs pmvidcd for bySsri{,i ]7U)olihc
<br />LohrC{xlc.ao.lhcpcrhnunccolrhcwor[rbrNhichrhcpcnnit isisiutJ
<br />Ihxkandwill ri'nri'r *ork.ra .onlr \didr rNuranc.. ar r.qutr.d htSNrion lTlX).irhc L$orCodc.Iorlnc pcrforro^.-c of
<br />tlr *ork for which rhisp.rnir i\ iso.d Myuo.kcr! compcnurn,n in\unftccdi.r dnd Brli.ynum$.ruc
<br />-lccnilyrhrr
<br />in th. Nnomr:'rccollhc *qk lbr uhich rhh pcnlir i\ i$ucd.l \hrllnor cn{lorrnyFN)d in any Dmncr
<br />{, r ro hcmE ubjcd h rhc Norkcr\ dnn|xnsrn,n hss oiCllilnnin. and aArc rhnr ifl \h.uld tEconE subJcsr ki rh.
<br />$orkcn conFn\rrin, pn)vi\n,n\ ufSccri(D 17fi)ofrhc ljhn G'dc.l shdl. fonhsith.,rnlly *irh lh.c pmvnnnB
<br />WARNIN(;: I,lllhtrc ki \.curc sok.ri con,i\ ntrlrwful. md n ll \uhJLCr rtr c l|]rDtr r, dnni rl JxniXi.\ rnd
<br />uilil fincs uD ro onc hund.cn lhouslnd dollm addirion ro rhe c.u orcodpc.s(ion, drtu8cs as plovidcd for lhc
<br />sd.rio.1076ol rM l)tir (itrl.. nr.r.n tul$
<br />'i-zz-?a/9*,
<br />I hcrcby,rtrm undcr lcnlhyol pcrjury lhrl I m licctrsd uldcr povish olCharrcr 9 (qnnmn.n,g wirh sc.rion 7m0) ofDivision 3
<br />of rhc BDrin \strid Pmf.scionrCodc. !d my li.cnr h in full lir& lnd cffNt.
<br />coNsTntlcTtoN t rNDtN(: At;FNcY
<br />I h.nby amrn Dnd& FnJry ol Friury rhd rhcc is 0 cooso.rio. lcndi.S lscncy fr rhc tErfomruc or rhc sork ihr whi.h lhis F n i is
<br />hsucdlsc. :1097, Ci! C,
<br />AIEUCANLDEITASAIION
<br />I hntry afllm und.r Fndxy ol Frjury orc of rhc rollowihg d larntio.sl
<br />D.rmhbn Pcrhils Asttllos Nori6ca'k,n Fcd.Bl Rcgll,rirns (Tnh40, Pd6)
<br />_Rcquncd Lrirfi of Norifi carbn
<br />Iccdiryrhnrrhe rrdcnIrceulatd s rc8nrdi'rB nsh.nos rcnx)vrld. ur .trdicrblc n) lhis pnjccl.
<br />ro onply wilh ICiryMd Oounly
<br />frhk Ciryn.d Counrylo cnlcr uF,n rh.
<br />*,,,5-4-//2./g
<br />I ccn'rt rhar lh.v. r..'d rhr orili0lon0nd rdcrhor rh.aL.vc 'nl.rNrion hconc(r I rErc
<br />.nr,naruc. ma srarc r.r, erar j.9f,'r,:*s..",.o.". ,'d r'c,chy au,hwc ,cFc\rn,anrc. ,,
<br />rr. nrnrioftd pr,Fny hr in,Y^ry
<br />^tlpt
<br />nt ot
<br />^aent
<br />sir,ttft^/ :Ze-
<br />prmi,e nnme, prin,,: 2'_Vru/"42 24/ / Zi Z
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Groundinq / UFER
<br />Transformers
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It4eter Release
<br />Rough ql,ult?I 4,A6n*/{?-
<br />Service Meter lt
<br />FINAL 4 btu lrv fz)4/to./O ) ttz-(Notes, Flemarks, Etc.
<br />ID/SIG.
<br />Pole Bases
<br />Li.cnscclassr Li.cns. Numhcr:
<br />-
<br />Drr.. Co mror
<br />L.ndcir AddFS
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