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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNI'R BT]II'ER DIiI,CARATION
<br />I beEby dfinn u er p.nah, oI pe,r'ry thar I a .x.tr,pl I@ rlE (ontacros Lic.nsc tiv (n rhe following r.avr (lis.70ll.5
<br />Bu:incss afil Pdlcssbn Codc), Ahy City or Couiry wbich rcquncs a p.nnir h .ondtucr, al{cr. i,npro!.. dcmlish or rcpai' ony
<br />nfldur., l'irtr tu irs nsu.n6. $ ftqunts rlr .tl)Plicrir nr su.h p€n k' lil. a sisrEd idetunt rlrr lF or *\c ie li..r€d pur$.nr
<br />ro rhc pmvisi.ns ol rhc (ont croas l-iccnscd lrw {Chaptcr !, Commcncing *nh Sccrion 7000 of DivkioD I ol lhc ausincs and
<br />PlofesioN Cod.) orrhrr fu u \lte is dxc'lln rlHcliomn r he balis foi tli ulkgdd exc.lpd,n.
<br />^l,,
<br />violar ion ol Se.rlon 703 L 5 b, an,
<br />ipplicn ror r lFnnit subjdch rb. rppli.rittoacivilpei.lryorior,tur.rhri fiy.hundeJ dolhrs ($5110)
<br />-l.a:o*nr.ltlFpolcny.ormrc'nphlccswiths3g.rasrhcnsol.co'rycnsarion,willdd(h.worlandthe*toctdeisnorimelUed orofla'cd nv eb (5e.7044. Busi,,.s onU P(Ic$ions Codc The CoNicror's l-i..trs. La* does nor apply 6 an owncr of
<br />rhelop€ny wfu huilds or inr[ oks rltrrd,L rx] wlb do6 such w,rk himsell or lEBcll or rlnough his oi l*t osr dnrloyces,
<br />proridcd
<br />'har
<br />such imrov.ftnk m !o( inrendcd orolTead ror sa.lc ll no*ever rtE huildins or inFowftnr is$ld lithin o.e
<br />'teotonrpldbn. E{)wmrUuilterwillhav.rhctudcnofpruviqlhrlEorsh.di'lnorbuillorinrpRve k pop.ny lorrlt purpo*ol
<br />L ownroarh.pinpcny,a.x.usnrly.orh.ri',!wnhlicenseJ.ontrck,Btocon$uctth.pojet(S...701-1.Busin.$
<br />d liresi,.aidc I'heCont&rtr\LiLrtrs.L,$d(rstror{plybarow erofpro|lny*l'obuildrorin\noverrh.icoi.
<br />iod vho .rntrcrrnr nrh tr'j.c!r snh i Gmt&ro(n li.c nd!u^0mr k' rlt Gntacr* s Liccnic tj*)
<br />-l
<br />xnr.r'npl un,l.r Scctn,
<br />gaa4!&tta!!!u!td!llN
<br />DECIAEAIIAX
<br />I hcreby .ftt,n urdcr acnaliy of pslurv onc ol rlE follorinB dcclea[oN:
<br />-l
<br />hav. ri willnrnnri', r Cdrili.nr.oICotr*trr b Self-l'xum fr *orker' .onlP.NrtioD. r! tx,vi'leJ I{r hrSecrb,1700 oftlr
<br />Lahor Codc. Ior thc lisldnErcc ('f rhc \ork lor qhich thc pcflDir is dsucd
<br />_l1Bv.a wi ll n ntxin *orkers .onp.ns,rnnr iruEnc., as r.quircd hy S(rion l?CS of rh. l-ab(r Cod.. for rh. lE.fomru o[
<br />tlE wort Lr slrich llrir lEnnt is isu!{ My*olkds c.nlEosarion insura.ecanr$andplicynu. 'c! dc:
<br />PolicyNuDt!.r: ErpiEs
<br />I cctrifyrh irnE ErLrnrDcc (n rlrc wurk l.tr wlrich tbn l]cnnn ,r Nrucd., slEllno. ctrDloy my p.6otr rn 3ny nunnct
<br />$ {rro hcc.'rc suhj..r ro rhc !o rk.rr conlpcNlr io tr l,ws.tC.l'ronria. andas'ccthi irlshould bcco,rc bjcd hlhc
<br />u.'{c(.oDlEDlnriotrpror\otrrofs..!oD3700ofth.Lltror(:od.,ld'ill,rdnh*irh.otrDlywtrhrlurprovisions
<br />W]\RNING, Frilur. ro \ccur. lork.n conp€mdion coveBg. is unLawful, and sh l subj.c( m chploy.r to dniMl p.n.hi.s and
<br />civil li!.F un bone htr r.,1tln$ud dolla's ($100.000). i! add ronE c.sr oi.omp.Nrion. dmuges as lrovided tor rlE
<br />s.cri.n 1071 .rrhc !ib.r Cod. i
<br />DEr.: Aplh.s r:
<br />LICENSEM
<br />!]DSLABAIIOI
<br />I hcrcbyrfrtr u ertxtrilr!oIperjuryrhdI.,li€ns.JtnJ.rprovisionotchnpr.r9(conftNi.gqirhS.(ion7000)ofDivirionl
<br />of th. Burness d PreteriofrCode. rd nrylreNe N in lull f..c.rndeJrer.
<br />Li.eNc cldss:-Liensc NuDb.r
<br />C.ONSISIJEII9N.LEIDINGAGENCI
<br />I hcrcby.llnmu crNnahlotfcrjurvrlmrrhscN!con{toclo.l.ndin8agcnc!lorlhcpcrlo narc.o,thcrork 16r *hich rhis pcrmir n
<br />issu.d tScc. 1097. C iv. C.,
<br />l-qL!!4!l]IlSL43r!-!9!
<br />I [n-hy anh,unnc' rcn ry ol N' irq onc.1 rhc 6lloqin( dcc]aarn,ns
<br />DcnDl&.tr Pcrnir+Asb.ftr N.llicanon lidq al Rcgulrlon\ (rnh.l(r. Pd6)
<br />Rcqun.d L.n.r.f M[ifr.a[Jn
<br />Ir.tq-
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />N/eler Release
<br />Rouqh
<br />Service lvleter
<br />FINAL
<br />Notes, Flemarks, Etc"
<br />Rev.08 07-2015
<br />Air Conditioners
<br />D,l.
<br />-
<br />CoBltador
<br />-
<br />knJ.r \ AJJi.\..
<br />I cdili rhai Ihc fcdcral r*uldi.trF rc8ediry asb.sos r cmval a.c mr applicabh ro thh tmJ.!.
<br />-l
<br />ccniry rlur I luve Eld rhn ar,'licarn,n,nn salcnlal r[c !b!c inn,nurio, t cord I asrce ro onDly with all cir) md couDty
<br />odiMrcs rnd srarc kqs rchlin3 t. blildinB c.n$ud i.n. dxl ncrcby aurhornc Eprcxnllrives of rhis Ciry lnd Counry to enrs upon dr
<br />trh.y. rftntion.d pmp<dy for insp.ction purpos.!
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