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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oll Nt:R BIiLDUR DUt,C/tR.t',tI(rN
<br />I hercby oififln undcr pcnrlly oi pcrjury rhar I m cxcmnr rrom rhc Contrcrotr' Li.cnsc tj* tor lhc nlowing ..,$n (S!r?0315
<br />Businc* rnd Prorasion Co<lc): Any Cily or Cooiry shich equncs a lcmir to connD.L itrer, inprovc. d.nBlhh or Epnn y
<br />nflcturc, n .rro ils hsxancc, rho rcquires rhc 0ppttlir for ruch lfmi ro nk. sirrcd narm.i rhd heo, rh. n liceNd !u u r
<br />(o rhc pmvhions or rhc Cotrtrcrols Li.cnrd lje (Chrrr$ 9. Co'nmcrcins wirh sc.rhn 7(xlo or Division I oflh. susin.s ud
<br />Pmfcsn,.( Cdc)orthd h.rrshe irdcnv'r rhcr.liom!.d lhc blsis r(r rh. rlcadeicmfrio. A.tviot.rionorscclionT0]t.5byan,
<br />aprlicant lon pcnn suhjcck rhc applicam ro !cnilp.nahyotml nmElhln 6ec hundrd doltan ($5OO).
<br />-1,
<br />* owrer of rhc ,tmr.ny, (, ny crylolEs wirh *as$ 0s lh.n crd *'mlcnvrion. [ill do lhc worr ard thc nnrlure h nol
<br />inrcnded or orercd tor slc (Se.7044, Boiircss and Pmlcasions Codc: t hc Conr&lors Licensc L.w docs nor arply ro d owncr of
<br />th.ImFcriy who hildr o, in{ro!.s rtcmn. dd wto des skh *.rt hidsctt or hcselfor rhough his o. hs o;cmpbyl{\.
<br />Drovidcdrhar such iml,rkftncremli cnddl fottu for stc. tt txNclcr, thc buitdine or imrmkmnt issuwnhhoN,uorsn k'nn, ttE Own.r Build.r rill harc ltt hidctr oi n .vine rru hc or she di:t nor bxih o. inDNc thc rslsry ror rhc fl{xxc of
<br />-1.
<br />asowrroarhc pmpcn y. , m crclus ilc ly ronrnct ine sirh ticcnsd .ontrrros r, .onsttoct lhc lroJc<l (Sc..704.1. su$ncs
<br />dnd Pnfcsion Codc: 'I hc Contrsdols Liccni. L{* docs nor appty ro otr owns otlroFiry{ho buitds or nn!rcvcs rh.rcon.and who cunrEcts for such !tuidr wirh a conh.d(, ticcnrcd pursrdd ro rhc conr.rctois Li.!n* tlw)
<br />-l
<br />!mcrcnDr u cr Sccrio
<br />5 -2>- )k 4/144J aK-^-
<br />DECt,ARAl'IIIN
<br />I h.'chy r,lim uklci pcn,lry.lpqjuryom oi rhc nnbtrirrr dc.tx'rriur
<br />_l n0k md will mainroin a Cdifi.Nrd ofConscnl ro s.[ tnsrrc tor ]oltnt ompensdnrn. us pmvidcd fo. bySdn,n:t7{r) olrhc
<br />Ldnn cdc.li,r rhc l]cnornrftc olrhc wort lorwhi.h rhl nc.nrir; issu.d.
<br />I hrvc rnd Rillnrinrain workcrl.onrFn\arion insuru,.c, ar ruquted hyScdion 3700orrhc LsrxtrCodc. rb. rhc rc n,nun.c orrhcr [ ,,tr *hrh rhn p.,mir i. i..ucd. M, ] '.c'. \nn'Jrr\rrtr.n'n\u'JncccJrErdF,ttrylumhcruc
<br />-l.cnify
<br />rhd in lhc pcrlonnin.c oflhc work for whirh rhh pcrnir h nsu.d. I \hrI frn cnpLy oDy p.ts.n in any mnE!*, b bcoDf, subj.d h thc *ork cr( .o.rr.nsd ion ln$ orcrlironia. and a!rc hd ifI shurd hcc.onr subi(r lo trEr,,Acr.onfn.Jn,,ntmrtri.lsnlSccr,.n.rrfi,otrhcLhrC',,lc.t\hz[.ronrwh.oi.nlyr,rhrh,.sfrnihion.
<br />WARNINC: Iititurc r. kuto wo,kcN'
<br />civil fii.s uI ro onc hundrcd rhousond
<br />Scction 3076 ofrhc li-rCM. i'.r.d
<br />u".,543- lV
<br />(nnpcnr"rnrn cotcrqc h utrl,wrul ,nd \lEll \uhtcct 0a cnDloFr ro dnrinrt rEDotrts ind
<br />dollatr (slm,ffD. in ftdirion ro rh..osr olconDcnsdion, da'Mgcs nr providcd for lhc3ildirry'\lX
<br />S </-
<br />NFCLANATI()N
<br />I herebyati.nuftier pcnalryofFrjury Ih l ad ljensd u.d.rpovhi.nofChopts 9(om'mnci.g sirhSecltun7{lo0) ofoivirnrnl
<br />oi rh. au\i,rc$ and Profc$iors code. !d my liccnsc h in tutl fore and cficcr.
<br />CONSTNU(:TI(IN I FNIIIIIG ACFNCY
<br />I hcrch, Bffirn u cr pcnslryofpcrjurythot rh.rc hacon(rudion bnding agc.cy for rhc I'cnoirmtu. orrh. wort to, which this Frnn h
<br />issocd (Sd.1097, Civ. C.)
<br />A DPLIC,{NT TF(J .,T R{TION
<br />I lbrhy riim nnd$ p.n,lry oipe[ury orc ofrhc rolk,winx delararions]
<br />Dcmlilion Pcrmns Aslt*os Nolificorion F.dcrsl Rcsulariont (Tirtc 40. Pan6)
<br />-Rcquncd
<br />kr rer ol flotifrcoion
<br />-lccnillthdlhcfcdcrdreSlhrionsrcgddi'rg$trslosrcnn'rrlffcnorqrpticlhhrothisOn.r
<br />thc trhrv. , nf{mBr t,n i\corcct I
<br />.. d h.rchy rhorirr.r.enrar
<br />aArc
<br />'6.on'ply
<br />snh.ll Cnyand Co!trry
<br />iv.s orthis Ciryand Counryro cnld uFn rhc
<br />*,". -f-ZJ -l K
<br />I c.nil) rh, I hrvc Ed lhi\ atplicrli.n and irre lhit
<br />ordinakc\ and sr0lc tiss rl inS lobuildirS.otr{ru.tio
<br />rh,!c mnri.ncd t,u,Fny kr rnslr.r nnurfxis\
<br />nrr,'.rr, n, n*"n, r'*nu,u*L 444-.
<br />PcmilE name lpnnt):
<br />t {a-,
<br />Site-Work
<br />Unde round
<br />Pole Bases
<br />Li ht Standards
<br />S AS Pool Fountains
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dam rS
<br />Buildin g
<br />Under Slab / Fl
<br />7tr-11 Pc-z)
<br />Translormers
<br />Sub-Panels
<br />Air Conditioners
<br />UI ment
<br />Facto Wired Unit
<br />Ceilin S Hard & Soflit Rou h
<br />Ceilin S T-Bar Ro h
<br />Ir,4eter Release ?J tSTq /2.-21 I
<br />Service lr/leter z-t{-l\i Z<'z-7
<br />FINAL to/t9/r-,>/W)
<br />Notes, Remarks Etc.tlu
<br />Signs (monument)
<br />Communications Cable
<br />lBondins tgr-ouMt UF-R
<br />Torqueino
<br />Rool Top Eq
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Rouqh
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