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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ()wNDR Dt lLt)t:R I)I,:t,C,lR,1 ll(lli
<br />I hcrcby 0ffirm undcr pen,lry or p.rjury rhar I m cxcnlPt ron rhc Conrncl{,1 Lietrs t w for rhc rollowin3 rc!$n (s'c 70ll 5
<br />Busincsi and P'ur.sion Codc): Any chy or Counly which rcqrtci d Fm t t' @n{tucr' axcr inpro's dcmlish or rIEt rn,
<br />stru.rw. prior io ils nsuam., also rcqlncs lhc oDli.aot tur ru.h lE mil ro fild I siSmd slarcmnl rhdt tr or shc n licdnsd Nnulnt
<br />ro rhc pn,vhions ofrtE Conrraclor'l Li.cnscd Lnu (ChaPrcr s, Conlnencins *irh s..rion 7000 of Divhbn .l oflhe Bnsincs snd
<br />Porcssn'ns Codc) oi lhol lEorshc iscrcnrpt lhercftndand rh. bdsis forrhclllee.dcxcmplion A.v viol,lionotSrrion T0ll'5 bvonv
<br />dmlica lorapcmnslbjkrsrh..mlicBnrr.a.ivilrcna[yofrclmorcrh2.fiv.hu.dEddollrs{5500).
<br />-1.
<br />ss owtrr of rhc lotcny, or ny.mrloyccs wirh wascs N lh.t $k ompcnul bn. sill do rtr so adrh. sf,dEn mr
<br />iicndcn or ofiircd Iq ;k rsd.?o4,4. Business and Pturcssn,ns codc: Tne c.ntdors LtcnE trw d@s ml aPdv ro r .wncr oi
<br />rhc pmrcny wh(l trikls or iry,rcw\ tltmn, dd who des su.h srk him{lfor hcrclfor rhmu8h hn or hcr nwncmPlovecs-
<br />providcd thar su.h impFrcmnh m mt i.lcn& oroffcr.d trrsL li: ho$cki rhc hoildinS or impmvcnxnr k sld wiliin onc ,td
<br />;r&nd.rb.. 0E O{ncr Bui}dn willhorc rhc h!.dcn ofproling ihd hc or drc did mr hoild or inlrorc lhc Im,p.d, ror thc purP€or
<br />L as.wrcrol lhc prop.ny. ancxclusittlyconkrcin,! wirh li.c.scd co ra.trsroconnrucl lhc roj..t (Scc.7C)44. Busncss
<br />ortl htrli:\i,n Codc: Thc Conkacrois Li.cnsc L.w docs nor +plyt, r,r owncr oiProFny qho builds or i.{rov.s lhcrcon.
<br />and who conrEcrs rd \u.h rmjccl s wirh s Conto.to(s) licoscd Pu*unr rothcConirrtr's Liccn€ ti*)
<br />-l
<br />omc\cn,pr ond.rsccrion-. B &PC for$nrcason
<br />O*n6
<br />woRl(x Rs' ( r( )l\IPl'NsaTIoN
<br />DICLAI^UAI
<br />I hcEby Emrnundcr pcmlty oi fdjury onc oflhe n bwin8 dehralio.s:
<br />I hlw Bnd vill mintain , Ccnirrft ol Con$d ro Selal.surc for sollcR €mpcn$rihn. ,s Foviled for bv Serion l7I orrh'
<br />Lihor C-odc. for ln lcrfonEBc oflh. work for sfii.h the P.mn c tsucd
<br />-l h.w ond will 6ai6rai. eorkcG cohp.nrdrion imursmc. as rcqlndd by Scdion 3700 or rh€ tibor Code tor de n'rr'lmncc 'rhi\ ncnnir t tsucd My wor*cn conDcnsarbn insumNc clricr d F,li.v nunlbcr Lrc:
<br />Ca
<br />6w o \tl
<br />I .cdify rhrr i.lhc pcrfonn.n.e ofrhc tro.k ftn which rhir,Ernrir i\ irsucd. I shnll nor enPk,y uny Pcnon in any tn'nncr
<br />s $ ro hc.l,tu subF.r h llE wortc* conp.nsarion hws ol'Calirornir. ttrd asB rhdr irl sh,uld bcconE.rhrd ro lhc
<br />sorktn L\rlp.trs0rionprovnbnsors.rliotr l?UJol lhc uhtr Crxl..l shlll.,nnh*irh.onillvsirh rfu)*lmvisions
<br />WARNNG Fnilurc h s.uc $otkcs' conFn\arbn ovcmsc ir lnlrwful. nod shall subi.t an cnlllloler r' dininrl Pculrts 3nd
<br />.ivil fincs uI ro onc hundrcd lhousand doltn l$loo.firr. in flddirn)n ro thc cosr o, comp"salion, dunugcs as Fmvidcd ror rh'
<br />sccron rUrAr, hc L'h{c.dc. in.cl.J,nd Jii,trm} , rcc, ---.-:---
<br />,,",.,1. 2.1"o Appu@n,: G-z-' l tcFr8Es-Fa1(iRAcr(rf,
<br />UECIABAITgX
<br />I ncrctyrmnnundcr pcnolryofpcrjury rh,r I un liccntd undcr lmvision.{Chrprcr 9(colnnrncinB wirh Serion 700t)) orDirision 3
<br />ol rhc Ausinc\slnd Pr.rcssiors Codc. rnd nryliccns G intull lhrc.,fil clIccr'
<br />_Lic.n\c Numher ovfl bq
<br />CONSI!(JC'IIoN I FNDING AGFNCY
<br />I h.Ehy afilnn undcUEnrlly ot p&iury lhal lhcrc h a o.{tucrion hndinE !sc..v ror dc pqlornnnc. ollhc uork tor whichrhis Pcrmi n
<br />issucd(s( 1097. civ. c )
<br /> PPLIC NI' DFCI ARATION
<br />I lrntyafimu dd rn,lty olrcrjury onc ofuhc hllowin8 d(lararidF:
<br />Dcrrclili Pclnik Ast sros Noliicarion Fcdcirl RcBllarn,ns fliilclO P.n6)
<br />_Rc{tuncd t.rrn of Norificdhn
<br />I.driryllurrhc ltdc' r.8uhli,)n\ rs nling r(r{o\ r.trx,il rrc norr!lni.{hlc ro lIn Pn']..r
<br />E,-"'rlulhr\crcddrhis.pflicarb.a,rldnr.rhdrhc{{$vcinlnilnrli.tri\cotrccrlasrL{ro.omnlvwirhnllCirv!trdCounrv
<br />ndSrurcl-o*srelarin8tobuitnrsconn crt,r.,ndhc ofrht Cilyrnd Counry ro cnler uF)nr
<br />rh,v..rtrrtnEd notrny for insn.lotr
<br />AppllGnl o. Aa€nl Sianrllrc fun M-,,","
<br />t1 t-l t
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Life Salety /Low Vollage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Rouqh AJ6b
<br />Service [/]eter It/4\t9 b-.1.{)erl-fh zL,Ul4nO
<br />T INotes, Remarks, Etc
<br />Meter Release
<br />FINAL
<br />G I
<br />' 2. 'roo Vel-L'{u1
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