|
ELECTRICAL.INSPECTOR HECOHD
<br />APPFOVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding i Grounding / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lVleter Release
<br />Rouoh lTt rH c,\?P lEn-s<l-tService [t/]eter
<br />FINAL Il{fls 9:l 1l(bt44 K
<br />Notes, Remarks, Etc.
<br />(,\ytiltR utr ,tn,iR t)tr,( ,\RAl t0N
<br />I h.tusy oflirnr lndcr ri..alr, or rcrj!ry rhar I m crcmpt lmnr lhc CoolG.lor' LiIn{ L.w lbr lhc followiry rcav,n (5(.70-11.5
<br />Businc$ atrd Pnf.s$on Codc): Any Ciry or Counry whi.h rcqut i l*n r n, on{rucr. ilrd. inprovc, dcnmlhh ,tr rcNr 0n,
<br />dtucruc, prior ro irs issuarcc. aho,equircs rhcapplicotrr lor such ncnnir ro fiLa\tncd srarcmor rhlr hc or shc n lic.,sed pur !!r.'
<br />lolhcEovhionsorrrrco.krcrorsLic.nscdLaw(Chaflcr9,c.mmcncingwirhSc.rbnTo(xJofDivnionlolthcBusinc$rtrd.
<br />Pnrc$ions Codc)orthll lLorshc iscrenpr lhcr€fmmand thc blsis for lhc lcEcdcxcnDlioo AnyriohbrorSccrhnT0:115hyan,
<br />attli.rnltu.pcflnirsublekrh..mhcamrorcivilpcnahyofiotnrrcrhmfiv.hundr.ddollr^($500).
<br />-1.
<br />rs nwncr ol rhc prorErly. itr nry e nplo}tcs wilfi w:lgcs ns lhcn sb !o u.nsal ion. *ill do rhc work md rhc sltode i\ nor
<br />ii .idcJ or olT.r.t for slc ( Sd ?(}!1. Busincs nnd lk)fcsions Code Th. Conrnctr's Ltcnsc tjs do.\ nor lPply fu r. owncr Dl
<br />rhcnmFny wtu buift or irymvcsthcR)n. {nl wk) dcs $Eh $r)A hnnsclfor hcr{ll.r rhmugh his or her oyn enFloyrcs-
<br />Iovilcd rh.r su.h imtn^$rnr{ m fr, i' .frIt{ or oltiEd tor sL lr] h'*rrcr rlr hiklinA or irynmnEnr i\ v'kl eirhin onc rrr
<br />of.omplcrion, rlr Owncr Build.r will ,hvc rhc bordea oI prNilra rhr h. or $c dil nor hdih or inpn,w dc pmFny for rhc puri.v ol
<br />l. Nowftrofrhc F)pcnt. rtrrcr.lu\ivcl!contacring {irh liccn\.d cont kf\nrcon{tucrrh.tnlc.r(sc. ?01,1. Bu{,k\!
<br />rn,l hr6\ionCodc rheConhcrtr r t-iccnsc Lrw do.s nor.fflyu rtr.slrcr olJrnJl]cny who nui0sor iDrovc\ rhcrcon.
<br />,nd who.oikad\ror\uchpn,j..rswirhD(onta.nn(9licctr{JplsulnrtirhcConkarr,sl-iccn\cljw)
<br />D[!I,I&&IION
<br />I hctuby nflr$ undcr lcnalr!ofp.rluryrR ui rhc folh{i'rg dc.lnrJrnnN
<br />ain 0 c.n irf,,r. or conrnt r,s.lr lnrurc fd wor*cn ..nD.$0rion. $ [ovidcd tu bySccrioo3?00ofrhc
<br />c ond will mrntrain workcr' cnnDensrit,n in sur.rcc. as r.qutcd by Sd ion 1700 ol thc L.bor Codc. lor I hc pe,lomncc of
<br />comp.ns,iion inurff.c.aicr a tolicy nuD$cr ue:trorI Ii{ shich rhi\ cirnir i\ n\ucd. Mv*urlc^'
<br />"" 2v-6n<*r<ct1
<br />-lccnilyrhrtirrhcFnnnnancofrhcsorkftrwhicIrhntcr
<br />rir is n{Ed. I shnll nor cryloy uny p.non in an, 'nrtrrur$ r\ro tf,roN h]cn ro rhc worltcr\ c.'npcnsdnnr h*\ oicalinrmi!. Md agm. rhd if I \hould hcco t \rhrLrr k, rlt
<br />workc^ comtcnsari,,nnri,vi\i,,nsolSccri{'n:17{ll)olrhcl.rkrCodc.lslrll.lnnhsirh.o,tlr*irhrhu{pR,vino s
<br />WARNINC: l'oilutc lo slrc workcr' conlrcoerion co{m8c is utrl.stul. Md snall \u}+cl u cmrloFr ro rrin n,l ,..rhis ai,l
<br />civil fincs up lo orc hundE{ rhousand dollars ($IO0.OOO). in rddiliflr lo rhc con .f c.nrn€nslrion. duugc\ n\ providcd r{x rhc
<br />ri(r.ll)70,'Trhc I rtir(o,1.. i, .rc{rklinorrcy {lcc\
<br />fu.Sg:
<br />I h.Nby llr und.r pc.alr y . r p.rrury rh{r I am lierri undd pn,vhb. olChaprs 9(commmine virn Scclion 7m0) or Divhion:l
<br />.r rhc Burinc$ od PDfcsiio.\ Codc, @d n1y liccnsc n ir l.ull lnN ond cfit.r l9qz
<br />" f-zl=f Contrac(or:
<br />Llnd€li Narc:
<br />-
<br />APPLICANT DECLARATloN
<br />I lrrcbyarinnuM.r |)c..ky of pcrjury o.c olth. follosinS d..la,r6ns:
<br />O.nknnn'n Pcrnns Ashens Norifi.arid Fcdcrtrl Rc8xhrnnr (Tirlc40. Prn6)
<br />iryrhrrrhc fcJc8lrcguhri(,x rE,rdi'rg r\h{o\rc n)vrlrrcnorrppi'uhlct,rhisfroi.r
<br />.cnitirh l ltrkicadihii,rnli.atiotrdd.t,lcrhar rhc nt$!. infornHriotr is conccl IoerelocomflywirhallCiryrndC.0hry
<br />.\ xtrd sri.l r\\ r.lni,,g nl rldrn!.o {tudn,i, rnd hcrhr rurhurizcrcprcrm ivcs.lrhisCilyand Counryki ctrrcrtr)nrhr
<br />rholc nEtrriflcd nr)tEdy t)r iN
<br />ApDli(nnl or r\,rol SiIndrrre f<4.lY
<br />Under Slab / Floor
<br /><atv
<br />Frfonnrm.or rlr lork fttr q[i.hrhd J[nnr i\ i$r.,|
<br />I hcrcty nifrrft utrdcr ltcnollyolFrjuryrhar lnm isa otrsrucihn hndinS ascmy forlte F,lonmtc otrtE w.rk lo. whichrhie |rrmit k
<br />issucd {se.lm7. civ c.)
<br />knJci( Addn !r
|