|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcby afln uMcrptnaltyofpcquryrhllIrmexcmprtonrlhcConrraur(trit-i.cisclf,wforrhclollow,igrc.it,tr',S(iorl\
<br />lrusincs a.d Proicssion Codc): Any Cily or CouDry *hich rcquircr ! pcnnir b ..ns'x.i. ahcr. inrprcrq dcnmlkh.r rcinn iw.
<br />strucrurc- nrior to ns isuoncc- aho rcquncs rhc rpplicur lor ruch p.nnn r. fiLn sigmd r,l.mnl th.l hcor shc h liccn*d puNrnl
<br />lo lhc Frovtiotrs ofrh. Cotrtracrors Liccnsd Law (Chaprcr 9. Conmcmins wirh Section 7{Xro of Dieision I or th. susincss a.d
<br />Pmfe$ions Codc ) or thar hcorshe is excmpr rhcrcrloh dnd rhch(sis i,r thc,llcgcd cxcmption Any vi.htionofsccthn?01r.5 $y lny
<br />aptli.anr ror a pcnnn subjc.ts thc rppli.!.t ro a.ivilpcnulrtol.ol mrcthfln lilc hu rcd dolh's (S5U)
<br />_t, as .wn$ntrhc lr.Fdy. oi.rycnrrl.y.cs Nirh sxgcs,\ lhcir $lc.omp.trqtiotr. will do lhc work lnd rhc sn8ue is nor
<br />i oxlcd oroflcr.d for s.lc (Sc.7Lq4. Busirrss,.d Pmf.*ions Codc Thc Connnctols Liccnse Lia does nor aDply b ai ower of
<br />llEpopcny wno huilds or impmrcs rhcNn- !n.l who docs such v)rt himseltor heselror rhrt,ugh his or h.r ow.ctrDlorccs.
<br />prorid.d rhi su.h imporcrmnh m not i6lcnd.d or oficrcd for srlc ll howcvcr. rhc tiuildirB or ii{'rorcmnr is sold wirhin onc rtr
<br />ol'coryErion- rhc Owncr lluildcr will halc rh. burlcn ofFovinB rhd hc or rhc did nor buih or inu.r lhc tm!€ny for the purpos of
<br />I. asosrcr.Irhc fot,cnr..mcxclNivcly coolmctirig silh lic.trredon acro6lo o.slrucr rhe pnjccr (Scc 701.4. Btr\i"r\\
<br />and Poiisshn Codc:'lhc Conlracrors Llccnse I.a* docs nor lprlyk, u osncr or F,p.ny wh,, huildsor i'nprcvcs llrrcon.
<br />nnd *ho conrrac( rd su.htn,ic.rswirhrConr.r.kn(s) liLrn\cd pusudtrr b rhc Conrrrors Li.cnsc Ltrwl.
<br />;-.oLL d/ / /V u-'/1
<br />l2r.L!"!-U!ItlD
<br />I hcrcby rmnn undq pcnal'y of lc.jury onc ofrht rdlowins dccluxrionsl
<br />_l harc and will nBinrlir E cenilrale ot G,nrnr ro self lnsur for w6r*.N ..ntcnsarion, as povidcd ior bys(lion 3?00otrhc
<br />Labor Codc. lor thc rnbmurc€ of lhc work for *hich rhc Ilcmit h is\ued
<br />lhavca.dwill,n{int,i.workcrl.onrrEnslliotrinsuhhcc.{srequncdbySalion3T00oflhcbh.rCod.,rorrh.pcraoamnccof
<br />lhe work ror whth lhh p.rnir is nsucn. My wortcn comp.trsalion insurnnce caricr ad Flic, tunber @:
<br />Policy Nun,hcr: [xDirc!
<br />l.crlify thdr in Ihc trcrlornun.c.irhc No.k ln! whi.h lhh !.nnil i\ isucJ. I \hrll tror .nl!)1.) rtry Pctron i. rfy nunncr
<br />v, An, hcconrc srhj..r r, rhd w.rkcN'.. rFnsario lrwsofcdlibai( itrd lsrccrhd il l should bcBnE suhrcd t,rhc
<br />workcN'.1nnpctr\rriorpn,visi(,d\.fSc.riotr:lT00.flh.tnhorCodc.lshalllonh\rirhconrtnywilhrhorlnrvhi.n\
<br />WARNING l,aihr.lo Burc sorkcrs compcNalion is unhslul. ml \hrll nrbic.r rd cnlr.ycr Io di inrl pctrJhts rnd
<br />civil fincs ut' to onc hundrcd thousand dolhn (in rddiion n) rh..oi ofco rl,cisnrioi. drnhScs n\
<br />scdnn r16.r)hc Lrrr,ndc
<br />o"eOy' / ra // a >d a:
<br />l]IrL !]!!A!
<br />I herehr!flirm under p€ndlryofpcrjuryrlur I rn liccnul undfi tovisi ofChaplcr 9lcommncinE wirh Sccrid 7txx)).fDivision ]
<br />oi lhc Busincss md Profcssi{,Ds Codc. tw! ny licci* i\ in fullfdccaidcfla.r
<br />qAN.TIBUCUANTENDINGAGENCI
<br />I hcmby,nnmundn p.nalryol rcrjury lhol lhcrc hsoNrru.tiotr lcndirsiscmy tu rhc p.rnn'mkd.rrhc work for Pnich lhn Pcrmil h
<br />issucd(Scc 3097. Civ C )
<br />AIILICTINLIIEILIEAIIoN
<br />I hcd)y rltnnr undcr pcrrlly olporj!ry onc orlhc rorl.wing d.cl"rarn,ns
<br />Dc.mliiotr Pc nih sbc{.s Norificatiotr l,cdcrul RcEuldiors (lirlc 4f). Prn6)
<br />RcqDnL'd tx(.r of Norli.ition
<br />-lccnifrdrit
<br />lhc fedcralrcsnlalionrrcgrdinga\hcnos..nx)!rlIc nor rfpli.ihlct, rhis l)nilccr
<br />lccnilirhrr I hrv. rcad rhn d mrc rhnihc rhovc i .rNrriotr kcoircd lrgrsrocorlnlr*irh]llCiryaidCou ry
<br />o(liDrn.c\Jtr{lSrrr.l- *\ rul ri,,g ildiiscoi(ru.rn{ aiJ hcrchy ur)x*iz. lttrcscrlalncs,Ilrlllris Ciry rtrd Cou ryt)otrrcrtrfi,trrr
<br />alDvc mcnti.rcd nrone.ry for i L
<br />tk-zL.
<br />0 a
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Slandards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar RouOh)
<br />Meter Release
<br />Rouoh
<br />Service N/eter I/o,/Tr/ tFINAL X, -ffi4 ,/)
<br />Notes, Remarks, Eid I
<br />txtrdci\ Addro$
<br />-
<br />Transformers
|