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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG OWNER BUILDER DELCARAl'ION
<br />I h6chy amm u.der penrny of psJUry lhal I en .renpr 6o,n thc Co racloh l-ictuc l-a* for lhe aollowing rGon (5e.7011.5
<br />BBi.6s .nd ProlNion Cod.) Any City or Co$ly which lequi* a ldnn b co.nn.r. ah6. inprov€. {knolirh ot r.IEt uy
<br />(rucruc. prnr lo its i$u ce. als requn6 rhe appli.d aor such pdhil lo filc 0 sisncd slalmdl lhal hc or sh. b lhdtssl pu^ri,l
<br />ro rhr rovisions of fi. Co.rmcroas Lic€nscd lirv (Chart6 9. Conn€.ci.g *nh Sdio. 7000 of Division I oflhe lrGirc$ and
<br />Pol6sions Cod€) or thar hco!shcnq@p rhccnoE dd rhc b@i! fortn aU+€d.r6nption Anyviolalio.olS.clion7011.5brany
<br />lpplicaor aor a p6nn .ubj(G rhc applic.niro.civilpd.hyotnol mor.lhu 6!€ hund.eddollds($500)
<br />l. at oNn6 olr hc pmpErr. ohny .nployd qnh w.86 s th.ir $l€ coDp.mation. sill do lh€ $ork ad fi. srtuctr. is tut
<br />idrdcd or ofid.d aor slc (Sa.7044. Bsin6s Md PrcfsioN Cod. Th. Conlr!(oi! l-icm. ll$ doa nol tpply Io an ownq of
<br />the lrlp6ly Nho h'ilds or inpror6 lhd@o, dd *ho drE su.h $ o'1 ninsclf or h6elaor thrctrsh his or hs our €mploy.6.
<br />piovid.d rhat su.h imptu\dmrs ft nor i,rtuvlcd or.ltu.n lorek.l[ lnrtrlrs,lh€ buik]ins or in{rov.ms is$tdBirhin n.}a
<br />oaconplc(ion.rheC)*.rBuildasillha!.rhcbu&nofptuvin!thdheorshedidnorbdldo.imr.orcthc!trorElyforlh€purrFsor
<br />I m.r.mpt u.dr Scriotr .B &PC lorlhBraron
<br />]lonKrar_roufErlarlor
<br />DECIJNAIIQ!
<br />I hd.by afllrn utrder reDallyofpdjuryoneoflhe lollo\in! dclararnN
<br />a ha!. ,nd tr 'll ma'nlrin $ urlG' compd&ri.n rrudmtu.i d r.qut.d by S.clion l7O0 oflhc Labor Codc, lor U. psfommc. of
<br />rhe surl nr sh'JahE nmn
<br />'3
<br />Bsuln
<br />4zz,t o
<br />,',,tt," *,','n", frJa-- d/
<br />My *orhas- .odp.rerion i:ff:T't---
<br />U'r' ,,ot *,' L{ /'-z 9. oz5 Z<2
<br />I.dta-vrhar in rh. psfoirn.nc.otihc \rcrl for \vhi.h this pdnlit is issu€d. t shall nor mploy any td:on in any mdn6
<br />$ 6lo b..om€ subjd lo dE \ork6 compqsalio.la{s ofcalito6'a, atul ald rhd ifl shoold t .ohc subjd lo thc
<br />so (n comr$sation Drovisions ol Sclion 3700 ohhc Larnr Codc, I snall nlnhsnh cohply wnh lhos prclisio6
<br />WARNINC: Fa,lurc lo s(!r. {orkds conptrarion covm8. is unla\rtuI. rnd shau subjd d @plutd lo oihinal gmltie ed
<br />civil fin6 up to onc hun&.n rhoudd dollm 1llOO.000). in rdd ion lo lh. co$ olcompGdion. dmg.s 6 prorid.d lor the
<br />sdrion.1076.lrhc Lal ( ode. iflid6lan
<br />/.21 ZD (-
<br />- pucaglol
<br />I hqeby amm undE p..alty oi pdjury ln{ I tun licas.d und.r p.olision ot Chaptg I (emftdci.s wnh s.(1n!. 7000) ol Division l
<br />oa rh. Businds sd ProfdrioB cod.. dd mv li.m. i!
<br />'n
<br />full force od eiTel
<br /><^t--.>*ad*-:::i5 ,.".i*_,*, 97 m €'.-
<br />Q.'Z.
<br />cox$a!lElIQ!1,!B[I Glcf,Ncr
<br />I h6cby afim undo Faahy o f poju.y rhd rfi* is a coNtruclion kndins .socy fot lht pdlonndc. of $. vork for which ihis Fnnil is
<br />issued (Sd.1097. Civ C ).
<br />ATIUCANLDICIJAAUOT
<br />I hqeby amm unds F.alty ofprra, o.. oarhc lolhwnu del..olioml
<br />D.nrlnion P6mits-,\sb6los Nolificalion Fcdcnl Rcsulaliotu (Till. 40. Pan6)
<br />- Rcquted 1,.1ld orNorificario.
<br />I cdiry lnar rh€ fcdm! EsubioN Es&dins 6bdos rtdoval ee not lpplicabl. to lhis pmj.cl.
<br />a*rr*n*,,*o rns apphcaron md srar< rhar rhc rbor inromaio. is .oE..r I asre ro clmply wnh all carr.nd coudy
<br />o-rd'nrnc6 M,l SDr. tis5 Rl,ring rohildrnB codructrctr ed h6ebyaurhoria rcprG.tutivsofrhir City d Counly lo dlo uron 6.
<br />abor. mdtioo.d mp.rty tor apc/o" p,rp"s.
<br />a.petr,^n *e^,cn*yLc2 4--:::,. ^,/' 2 ?'2,t
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER 7-oS.2o lt rr{ 1dt
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release a +l?-ZPLwt+ 9'? /b,2 -ll - zo E-{ lo?,)nrcco 4r fi7 >--f-
<br />Rough L-ot <.,
<br />Service Meter ?.-oS -.?p g.ltel$
<br />FINAL 2-lt-21 D<f to)
<br />Notes, Remarks, Etc
<br />QAt Ot"*]./.9, -y' uor r.* ecrZ<n r c 5r^Advrso* r r urtst rJtifg,
<br />,t1i.e{ f}€ \,J q4ti- 6uy}6{-r\ CD \J !,j ,Cot - * PA^r\8r- l t betCa
<br />J(^l 4\A Pz,}rYl- r..l <frft.c,/arfl orJ F aort uIrL! cr rvr.&5.t
<br />r,d (\^'E )vg rz-'^. 6.i \) €LL Arrg $:o[l, tarrA .fr.E .Lp1-f5n3
<br />?tz-lr-<n r,,\Fourr <tts @zJr. rr
<br />COMMENTS
<br />I
<br />1,6 o\v.& olrhc ImlElr, ,n .r.lusir.ly conr.acling $ irh licasd contraclors ro cod(tucr rhc rot.{ (sec 7or4.8cm6
<br />Md P,ol6ionCod€:'l hc Contraclors Lic.ns.l-a$ do6 nol apply ro d d$'nd ofplop€ny $to builds or impro!6 rhs.on.
<br />and qho conta.a lor such pojcB wnh 0 co trocrorls) licos€d pusuanl lo thc Conlraclor's Lkmc h$)
<br />I havredsillmainrainaC€nificat€ofconsdlro S.lf-lnsur ror \$rlm .omtmlion.6 rolided forbyS€clion1700orlhc
<br />bb.r cod.. frn rh. pqfomancc of the sort for rvhich th. pmil is issuBi
<br />I
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