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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNES BIJTT,DER DELC{RNfl ON
<br />I hcrchy llfiim udcr penaly of pcrjury rhal I an cxcmp' fun rhc Conhdos Ltcnse llw for lhc followins rcrsn ( SN.70:1 1.5
<br />Busincrs ind Pofc$ion Cod.): An, Ciry or Counr, *hth rcquicu Fmjr b c.ontud, al'd, inprow, d.nDlish or Rpon My
<br />.ructue. Firr !o irs Gsu .c. ako rcquircs thc ,ppli.M fo. .x.h tt.ni' ro lilc r siSkd .bm lh.l tE or sh€ is liccned pu,$anr
<br />ro rhc tmvij.ns or rh. C.ntadd s Lic..$d llw lchap(cr S, Co'nm.ftine wirh Srcrnrn 7ff)0 of Divisbn 3 oflhc Businc$ and
<br />Prfcssions Codcror filt tEorsnc Ls cxcm lncrcfro'ndndrhchasnforlhc.llegedcxc'ryliotr. Anyviohthnofs$riooT0-ll.5hrlny
<br />applicur lor ! lcrmil {uhj€rs rhc lprlicanr !o o civil pcnolry of mr m,e lhan five hundEd doll6 ($5{n).
<br />-1.0s
<br />owmr ollhc Fmpcny. or mycmplorrcs with wtrg.s N dct \oL cornltnsrrbn. willdo rhc work md lh. ddur is ior
<br />nnc Ld o,oncrcd fff {lc (Scc 7044- Busincssand Pmlcssnns Codc: lhcContocrois l-iccrxc Lwdoc{nor srtlyto{nowmrof
<br />th. tmpc[y who tuilds or inproB rhcNr. alld who drs su.h so* himsclf.r h.nclfor IhrouAh hh or hc. ortrcmployecs.
<br />piovidcd rhrr \kh inprokmnrs e tu i endcd or ofl.r.n lff sh ll ho*c\rr. rh. hliBi,rg or i'ipmktrnt is sokl within onc I d
<br />olcompbl iq ltr Osncr Buildcr * ill harc rhc t'urdcn oI fmvirs lh.l tE or shc dii mr boiu or ir{Krt lhc reFiy for thc ,D,Tn{ ol
<br />-1,
<br />!s owmr .f rh. pn'lrcny. !m cx.lusivcly conlrd ina wirh liccnscd conlrrron r.r .on(D(l rlE r'(,jccr (SN. 7lll,t Bu\in.s
<br />md Ptof.*sbtr Colc Th.C.nta.rolsLicc.scLawdo.r.ordpplyb .wn.rolnrol,cnt*hohuildsorinrFrovcsrhercon.
<br />ud wh. conhcr! for such rFrcts snta Conhcton s I liccnsd pusu r ro rh. C.nrrrcttr r l-ian* trw)
<br />-l
<br />ameicmpr utrdc! Sccrion-. B. & I'C lorlhhrc$on
<br />Dsle: Orn€.:
<br />wonxnn-s iirlirrus,lrron
<br />IIIIgIIIBAIION
<br />I h.rcby rffi. ondq l).nalrr.fFrjrryond ofrhc nnk,Rihg declusrions:
<br />-l
<br />have and will fluirrin a Ccn ificarc ot Conrcnl lo Sclf.lnsurc tor qukc6 onp$snri,n. as pruvidcd rff by S(r id ]7fli .r rhc
<br />L.bor Codc. for rhc lcrlimMme oi th. woi( ror which rhc I'crnrir i\ issucd
<br />Ihrlcrnd$illn[inrainso[kcri.onp.nsrrioni'r\urrnr..x!'.qunctlhySccrk)nlT0rrofrlrL'hrCi)dc.fdrhcNrturtrui..ol
<br />rhc sork ntr qhi.h rhi\ |tnnir i\ i\\ki My$orkcr\'conl^-n\rri{tr, i'Nrr mc.rtri.rr d Ir,li(r" tru $rr ru.
<br />x*
<br />X6r",
<br />1f ,+TC f u r.r T)
<br />L LZ z\qltq
<br />lccdili rhrr i'r rhc pcrfornutuc ofrh. work fr shich ihh l.rn,ir n i\\n.d. I \hdll nor r'nFk,y rny pcrrr in.try mrnmr
<br />w' !\ b hccortr cubjd lo
<br />'lE
<br />$orkc6' conrFnsd ion hw\ olcrliloarid, aM astor lhrr itl srxn,l(l h.co'rc \uhjccr h rhL
<br />sortcF.omp.n\{lionpmrisn,nsolSdion3T(Dolrt{l{hrCodc.ldrll.i..lh$ilh.on'plrNirnrh)spm!i\t,ni.
<br />wARNIN(I: I.r lur. n, s.urc rorlcF co'nlrctrlrlion .orcrxlc s u \ful. rnd \hrll \uhl.d nn cmdo)cr t) di riMl tf,Mlri.\ rtrd
<br />rnil rnr\ up fu otr. hund..d rhou$nd Jollrr\ (1lrx).(xr(0. i,r rdd r ofcotrlt*isdin, drrm8.s as provid.d nr rhc
<br />K;:"i'j?
<br />L'htr Cixtc. inrrrr{ rid nrkn.
<br />LilT
<br />I h.rchy ilfiflnunlcr pcnrllyolp.,jurylhrl I aD lien$d undcr iorol'Chrpro, 9(conn,f,ncin!qirhSccrk T(Xn).iDirnidr l
<br />of lhc Busir*ssnnd Pnricssioni Codc. md nU ltcnr is in tlllhr.c ond cfecr
<br />x'."lL tbo33(8
<br />'fr""5l tLl(& v*5wrEL e(ECf (rc Nc.
<br />C9NEIBUqIIONIEIDIITGAiEX!.I
<br />I hercby oifirn ufldcr llcMltyofp.dury lhal rh.rc t a mn(ructiotr lcndina ascrcy r{, rhc pcrlornuocc orrhc work ror which lhis Fnnir is
<br />hsucd (sm 1097.civ c ).
<br />APPLICANT DIiCI 4RATION
<br />I hcn:by dlinn undcr !.n.lry of,xrjury om of rhc folloqing dR..le.' io.\
<br />Dtmlirbn Pernih Asbcaos Noiifi.2rn,n Fcdcral Rcgrbrn,ns (Tirlc.l0, Pfi6)
<br />Rcquircd tr(ui of Ndificarion
<br />-lccnily
<br />lhll I hrvc rcad rhi\lnnlicali{,nand(!r rrhcrh,rc iriornx ion icotr .r I rrlccbcomplywthrilCiryrtrd c.u ry
<br />.'di'rncc\ rnd Srrrc lnw\ rchring h huikln,E ron
<br />idtrvc nr ioncd pni,)dry fo, nsNdiotr purpo\cs.
<br />lurhori/u rcnr.\dirxrirc\ ol rhis Cny rnd Courtyro cnrcr rNr ihc
<br />\pplic0r or Asenl stcn,ruft
<br />/p"*l* n"." rp,inu J u,trJ A E{^Art A
<br />Xslt$M
<br />Site-Work
<br />Unde rground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Bool To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)
<br />[/]eter Release
<br />Rough
<br />FINAL BI /4/rs 5 A )Llfu\+<)
<br />Notes, Remarks, Etc
<br />_\
<br />Sub-Panels
<br />Service lvleter
<br />l.nJrr'.AJJ'r$
<br />l.cnifyrh r rhr fcdrrxlrreulnri,'is r.8rdi'rg r\h(no\ rcnn)vrl rrc nor tdi.xblc r, rlti(Iniccr
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