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ELECTRlCAL-INSPECTOR BECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER AUTI)ER DI]I-CARATION
<br />I heEby dli.n utul.r pcnulry ot D.lury *ur I o.x.'pr tDn rh. Conhrod Lic.M bw for $. lollouj4 Eosn (s...7031.5
<br />Iturinc$ md Prolcsion Code)r Any Cny or Coudr rhkh rcqlnd r p.nnn to onnrud, .lts. imllrorc. d.mlth or cprn rny
<br />nDctuE. Ei.r ro irs isranc., also rcquiEi rh. ,fdicon ror sn.n ltmnr ro 6L a si3Ed sld.mnl rh.l lr o, slE b lic.trscd pumd
<br />ro rb. polkios ofrh. Conu..lols Liensd lr* (Chapr.r 9- C.mm.Ning virh Selion 70OO of Divhion I olrh. Busincs &d
<br />PrcresDns Codc) or thar tE or \he n eien,pr rhtEtom {d r& hdn ,o, rh. rllr8.d d.nqiirn. Ary vbLtion ol S..lion 7O3l.J by ay
<br />applicior tor !Fmn subjdslh€ rpplicanLtoncirilp.nihyotnor mi. rhrn fiv. hundrcdd.llds(tsLro)
<br />_1. s o*tur 6l th€ prdp.ny, or my .nphrc wi(h u.8.s 6 rh.t $1. NrD.Mion, uill do tlE wrl dd lti iec a m
<br />int trldl or olt rci fo. ek (Se 7IXr. BusnEs od Prcr.sioB CqL: TIE Cotuadoas Lt M b* &E5 nor .ppl, to s owr or
<br />E FDpdy wll boil& oi nr!rcE! rh.ror! ud *l$ d6 sf,h D* lims.,f or tErclf or rtuou8t hir tr hs oh.npk't@3,
<br />proid.d tn{ such inpmwmnk e mt inr.ndcd o..IH Im s.L [. h.scE, Ur builduU.r ir!{$Erm n $6 wthi. m,ca
<br />oIconptri.q tt owEr auiu.r *iU ltrE rlE hnLn oI pmvin8 rhd h. or sh. did Ft hri! or itrporc dE poFly lor llE ArpG. or
<br />_1. a\ o*rtr orrhc pmp.nr, d .xclusiv.ly cont{tin8 wnh lic.Nal loturoN to .oriBd iE p.ojcct (S( ?Ora. BusiE$
<br />un Edsi, Coder Th. Cont@ror'i Lrc.ns. L.w dG. mt rIDIy lo m ovrcr ol prop.ny vlE buildi or inpruvd r|e..
<br />ad *ho orhcrs ror such pmirrs vnh . ContEr.(, liccNd p{6ur!r b ttr C6o(do'r Li.ccc bw).
<br />_l mr.xcn{r und.r S.dion ,a &PC. rorrltr\ Br!
<br />!v9a6E&5:.gJI[!!,lAIla!
<br />DICIASATON
<br />I h.r.by rlltmundcr [)elahyof ,.iuryotuolrlr. Iollo*ing dc.ld.rbnsl
<br />-l
<br />h.rc aEl will nsinrain a C.nni.!t ofcoE ro S.lt lauE td cdrt6 coftp.drrion, .s ,ovid.d 60r by setiod 1700 oI th.
<br />Lahor Codc, ror inc !.rtofllwc of thc m* fd which rh. nsmir i. issucd.
<br />/b.v. drd will,rainl.in wo 6 coqr.morion iBuranc., s EqliEd by S.crio, ITOO of lh. lrbo. co{t , tot rh. D.rlo,m. of
<br />d* wor* lor which rht p.rhn n iJs.d My porlcB' conDcMioD irsuruc. 6ir and polty !!nb.r e:
<br />c*i.,, a-D ^1Pt-o- 9 7
<br />ooo LL ol 9-12-zl
<br />_lccnirythrtin r |x' fo nB'rc of rl* eor* for *hich rhk n rnir is 6s!cd, I slDIl nor crnploy any lErsn in ,@n.t
<br />s r\ t. bccom subj€r r. rh. m&.d .omp.ne..n hrs of C.lironi., rnd 03re r,lrr if I should bc.o,E sbjcd io Ihc
<br />worlcc env.nerion pmrniois of S.crion 3?0O of rh. bbor Culc, I sh€ll, fodhwnh clDply *iri rlls pDvisioN..
<br />WARNING, Failur. ro €.ur. *orl.^ s,np.
<br />'on
<br />ovciJ3. is uilisiul, iM ilkll Nbl.cr ctrrploler Io riminrl p.MhiB anJ
<br />civil frEr ulr ro orE lrndred rhous dollJr (t 100.U10), i', dirtrx, b rlr con of lonwNarion. ddu3.s $ lmvid.d for rh.
<br />Sccuon 3l)76 of rhc bhor Code. inreEs ird drMry i lei
<br />DDCIjf,AIll}!
<br />I h.Eb,artrmnnt i pcnalty orpdjury th.r I i$ li€n J u.d.r Drovisiotr orch. s 9 (ommrciry *irh Sarbn ?mo) orDivirion 3
<br />of lh. Busirc$ md PDlcsioni Cod.. and hy lk.ne is in full fore .trl .rd-
<br />CONSINT,]qI!}NIENDIIGIGENCI
<br />I hceby .m.o undcr !.nalry or rcrjury rhr (h.rc is r 6nitudhn LtdinS .8.rcy for Lhc p.rfoaumc of lhc *orl for whih tnis Fmit n
<br />issu.d (se. lr)9?, cir. c.).
<br />Arlul4ll.peclaaarlox
<br />I iq.ry anid und.i pcnahy or p.rjury .nc or rhc rollowing ddlu{ions:
<br />DcmItio. PcrnnB-tubestos NoLficarion Fedcral Rcaul8tn'n5 Onb &, Pen6)
<br />_Rcqui6d knq of Noriieuon
<br />-l
<br />cdili rl[i I luvc r ed rNs {pplicarion ud lat rlul rlE lh)vc inlornErion is cortcr. I r8ft to co.Dly unh ill Ci'y and Count)
<br />ordiranccs and Srar.t:*s rcldinE h b(ildinr .o.iocriol], 3d h.rcrrc$nraLivcs of ihii ciry dd c.!my ro c.td Lr.n rlE
<br />abo\. r*ntional p^'reny lor i'\D..rion
<br />AA,li..nl or AEent Sign.lu D.n ? -ti-Zt
<br />o cl--a .-) c,
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Irleter Release
<br />Rough
<br />Service lvleter l- t ,t cA
<br />FINAL a\'tllu DAP(6-I
<br />Notes, Remarks, Etc
<br />Bev. 08-07'2015
<br />DATE
<br />t,,,Z-t2'Zl
<br />t hLr'.A,llm*.-
<br />I ccnni rhar rh. rcdcr.l ,ryulations ,c8sding ish.sr,x rcNrrl r. nor ,p0li.^blc ro rhh ,Fj(rr.
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