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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS oWNER BUII,DER DELCARATION
<br />I h.rchy imnn und.r p.nalry (,f pcrrury rhar I an.rc'np! rmn rh. conrrros' Ltcnsc tjv for ih€ lollowin8 rci$n (Sa.?011.5
<br />Busims aftl Profcssion Codc): Any Cily or Cou.ty whi.h rcautcs n pc.n ro connrucl- llrcr improE. &mlih n' rcnrn M,
<br />srrucrurc. nriorro irs hsumc. rho rcquie\ rhe Bpplicrnr for such rErdn h iLo silrd {dc@nr rhar h.o, sh. is li.cnscd pursuanr
<br />Io lhc pmvNbns oi $c Gtrrra.ktr s Liccnsd Law (Ch0nrcr 9, C.mnrn.in8 wilh Scclion ?0Oo ol Division I olrnc Burinc$ and
<br />PronsriotrsCodc)orrhal hcorshc ncxempr rhcrcriorond rhc bosn lbrrhcollcscd cxctrrprion Any viohrionorS&ri,n70.ll5 br rny
<br />ltpli.a tu!rn,ir slhj.trsrhc rynlic, 'oacivilncnolryofnormn
<br />rhan fild hu nd6d dollds I $tm)
<br />L 6 osn.r or rh. rm,tny, or my cmplorNs wnh s,!.s rs rh.n {,h comFcnsarion. qill do rhc woll ad ltE (nl1m n tur
<br />inrcndcd or.ntrcd ior slc (Sc.70.14- Busircs atrd Pmfcssi.ns Codc: lhc G,nrrocrois l,renc liw dfts nor arrply ro an own.ror
<br />rhc Im)pcny *lx) h{ildr or iqrohs rh.dr. dd *ho de\ skh s!* him\.lror h.$utfor rhrcuBh hk o. hc. ownemployccs.
<br />pn,vidcd lhlt such i'nprovcnEnrs N nor i'ncnLd or ollcrcd tu $lc l,l ho*ekr, rhc t ilding or impRrknE n i,ld wirhir on! ,cd
<br />of conllcrion. rhc O*ncr Buildcr will h!rc rhc hrdcn ol novinS ln0r tE or $c dil fr'l noild or in &w rlr f,qrny fir rhc purlr* ur
<br />,e]- s otr H of r hc I'mrEny. .trr c\clu\ivcry ! nnrrrr rnp wirh li.cn{d contldon ro con(rud lhr pmjccl (SE 7()4,1, Btr\in.\\
<br />tJnl ft.rr\\i,n CoJc ThcCookr.hr'sLiccnscLtrr'duc\norlptrlyroL.osncroff,roF ythobxildsorinipovcsrh.rcon.
<br />. *hr cotrrlds lor such 0dccrs wilh r Cnnractn( I liccnscn pu.sunnr lo rhc Conlmckn s t-i(cns Laa)
<br />Irncxctrrou cr Scclnnr .lr &PC turrhirr.rvnr
<br />*'"4fu oqne.
<br />WOTi<FRS' COMPIiNSATION
<br />DECIdAA.IIO!
<br />I hcre$y rtfirmundq pcnalryofpcrjuryorc oflhc lollo*in8 d(hrorkns:
<br />)rl hlvc dwillmsrntortrrCcnrltroreolCon\cntL'Sc,tlnsuElor*ortcn $hpensrhn. as pr.vidcd roibyScli.nl7{x).frh.
<br />,btor Co,lc. lor rhc n.rlornune ol rhc sorl lor trhich'hc nnnn r r.ucd.
<br />-l havc and will minlain worlctr comFnsrlion insursrcc. !s rcquircd by Sdion 1700 of rh€ hbo, Cixlc, for ih. pdforMcc oi
<br />lhc aor* lor whicn lhis lcrmil is iss.d. My workEl mmFcns.tion insurlmc mricr !.d polty.uhbcr e:
<br />c""". Zs&;L l*
<br />IVARNING l{ilurc ro $curc s.rkcr' onrpc.snlbn d'vcrisc is unlowtul. and \hall lubr.r M .nl,lo)$ ro oimin0l lEtrrltis nxr
<br />civil ftE\urrk)omhundrcnrho!\anddolhr($100.0&).in0ddirn)nkrrhcconorco.Dcn\dn.ddm.Scsrslrovilcdlbrlhc
<br />Sc.ri,r, l076 .l lhc t.rlrtr (ixlc. i' crcn rndxrtnmy s l!.\
<br />5 2ot
<br />DECI,Af,A.IIO]I
<br />I hcrhy rmr.rund$ p.mltyorpcrjuryrh,l I mr liccn*{ undcr pmvisiotr ofCh!,,tcr 9 (oflmncins *irh Sccli{,n 7000) orDivkidn 3
<br />o, rh. Bu\inc$and PmacssionsCodc, lrld oy lic.n\c i\ in flllfoleudc[..r
<br />.t**"r*",,Cli c( L Lj.cnsc NuNh.r '? so l8q
<br />6/?a // s 5 o.ttA uQ -Tac1,q. l/ e {r'a lf
<br />CANEIAILUONIENUNG-dCENS
<br />I h.rhy.ffiflnundcr Firllyofpcrjuryrhl| rhcBisa coNi crion hndin8 ascncy tr rhc Frfontun(c ol rh. wotk lor whi.Ilhis Frinn is
<br />tsucd lscc :1097,Ci!. C ).
<br />ATILII;ANLDECLAAAITON
<br />I hcrcby lohrhds l.nahy ol prrjrry o.. orrhc folbwi.g del,rarions:
<br />DcBniio Pcirnih Asb$r,s NorifElrion ltdcrrl Rcgullri.ns ('lirlc4l). Prn6)
<br />-Rcqutcd
<br />t xcrol Nnrirk i(nr
<br />I.dify rhrr rh. Ld.rrlrc8ultrrio s rcBedins nsb.(.s rcmolrl,rc norapplicnhlc Io rhh FFt.
<br />#hflilllll[;[:'"'li;.x'r]Hi:l#:.]l;:lilii"fJ.,rixlxflrii"i"i]ril;"l,ilrxlfftx]].:'.'ll,:,'itxfi:xffi,-
<br />.:--",-" ",,,:,* -,:;:;;;";:;;" drdr *,.rts/tt
<br />". ,* ** '0"""i t )€l+^J t*- S r*pttl)
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Bouqh
<br />Ceilings (T-Bar Rouqh)
<br />lVleter Release b.,3 z-4
<br />/z ir h Ds
<br />Rouqh /t-, W
<br />Service lt/eter D 'vTh
<br />fitFINAL 'dlv 5:\a U.6\1<r
<br />Notes, Remarks, Etc
<br />Communicatrons Cable
<br />e.ri"y r.,,r,*, \r.J0ol ? 6 ?600? orr*, lo /t I tX
<br />-l
<br />ccnirylh{t ir rlF pcni,rnumc ollhc rvork tur }hich lhn rErmil i\ i\{8.1,I \lullnor.nfk,yi y P.non ina.t m,nDcr
<br />{, rs h tf,conx \trbjcrr b rtu *orkc^ co rp.is nnr h*\ oI Crlitnn,ir. Md 4tor rh.t il I should t[.onE subrc€r ro l hc
<br />workr( coD,Irn\rrn,n lroviqion\.fSc.rio.lTmofthc lihtr Cxlc.l shill. nrnhwith.onrdy wirh rhor prornionl.
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