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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNf, R BUILDER DEL(ATIATION
<br />I hd.5y arrm undd poahy of pcrJury rhdt I m .xcmpl 6om lhc ConlBcro6 L,cen* Larv for rh. follovins ra$. (S( 7011 5
<br />D8in6s a.d Prcfdion Cod.): Any Ciry or Counly shi.h ratut6 0 Fnit lo otsrucr. aho improve dtulbh or r.rEn v
<br />nrudue rfi ro irs issoecc. aho r.qun6 lh. arpli.er for slcb P{tnn to 6lc a tisn.d siatmol lhd h. o. sh. i liccN.d p6ufi
<br />ro rhc FtrvisioN ol rh. Conl..clo.t Lrc.nr.d L€w (Chaplq 9- Cofrnmcin8 wilh Sclion 7000 ol Division I oa$' BNinR( trd
<br />Proi.sions Codc) or rhar h. or sh. is .xmpi lh6€,iom ed lh. l,si! lor rhc .llcs.d crdprion Any liolation of S.rio. T0ll5 bv anv
<br />apphca aor d p.nbn subjEls lh. applicdt to a civil pcnally oi nor nrcrc lhe fiv. hundrn dolles (1t00)
<br />l. s o* or of rh. ploprty, or my cmplo)G wilh was6 6 rh.i $lc comPos.lion $ill do lh. worl ud lh. srMr k mr
<br />inrdiLd or oit@d lor sal. 156.?044, Busind ed ProadioN Cod.: 'llE contrc.loi s Lic@ Llv &6 .or aPpl, to u oM6 of
<br />rh. rqFry who hril& or iqr.\6 tlEatr dd vho drB su.h s& himscla or h@lf or rhrou8h hi m hq own dplot€e.
<br />prolh.d rhar such idtrovd6rs @ nol nnsd.d or dk d tor s.l. l[ ho\s6. tlE hildinS or imFovo@l i! $ld $ hin onc ra
<br />ofconlpLlion. ltE (}Mo Bdil&t \rill h!rc lhc hrdd otplolDs ttun h. or fi. dil ml build or imprDv! tnc proFrv 6r ih. puloF of
<br />-1.
<br />6 o*nd oarh. propaly. m .xclBivcly .om..cri.8 wirh li.65.d conlraclon ro conrrucl rh. p.oi61 (Sc 7044. Rfin<
<br />dd koftiiion Cod.: thc Conlr.tdls Lic.B. kw doB not apply lo d oMd ofproP.ny who buil& or nnptov6lhomn,
<br />md who conlrscls for su.h Fojds*ilh t ConlEclo(s) licd*d pu6Ml tolh€ Conlnctor'! Li.@. L.w)
<br />I m cr.mpr uodrS6!io.-. a &PC ao.rhis rcson
<br />WORI TLt'COMPrNSATION
<br />OICLASAIIAN
<br />I hdcby 6mm undo p.nrlly ofFjury onc ofthc lollowinE ddhr.liore:
<br />-l
<br />holc ed will roinrri. a Cdlifical. of Colsl lo S.la-lNor. for sorkda comp.n$|tun. s proli(H lor b! Sclion 3700 oI rh.
<br />bbor Cod.. for th. prfomec. of thc mdr for which lh. p6mii n isu.d.
<br />-I
<br />hrv. .nd will Bainlajn wo*.B comp.Mtion iNutMc. s rcquircd by Sd ion 3700 ofrh. L,hor Cod€ fo, $c p€tolro" or
<br />thc Nork lor*hichthispo i! issu.d workEa co,npdeion iNuruc. cnd md lDli.y nunbd E.:
<br />-l.dlilylhar
<br />i.lhcpnfolnanccolth.{otk lo. rhich this pcrnril is irsu.d.I sh.ll nol oploy dy pden in v6Mnd
<br />e s ro b.comc subjrl lo lh. *0lt6' comp<slioo laws oacaliaomit. dd asr lhat if I should b..om€ sub4d to th.
<br />sork6' conp.nsl ion prov6io6 oasdrion 3?(]O oflhc Lihr Cod( I siall, fodhvnh Nnpl, with thoF prcvi.ioB
<br />WARNINC: Failur. to suc {o.k6' .omF@rion covdas. is unla*ful, Md sholl subjd e dplord ro oiminal pdEhi6 md
<br />civ'l a..s up lo on. hundrcd lho6dd dollm ($loo.0uj). in addnion lo rh. cost olcomp.Mrion, dmaacs 6 pmvi{ldl r'r th'
<br />Sar'on 1076 of rh. Lrb.r Code intq6l dd onorney s ld
<br />(I)L( L\TIJIIQN
<br />t heb! llIm uDd.. Fnally of pdjury rhd I en lianEd undr Forision oachaPt6 9 (condocing sith Salion 7000) 'r Diriri'n 1
<br />ol thc BN,.e sd PofsioE Codc, &d my licre is in tull fotcc dd.fidt
<br />coNsrLllcl toN LFNI)tNc acINcY
<br />Ih6cbyaflim6doFEnyolpgjurylhalrhaci!aco.d.1ionkodinsasdc,aorth.pdaolfuc.oafi.*orkfor{hahrhi.Fmirb
<br />issu.d (Se 1097.Ci!. C ).
<br />L.ndd'i Addr6'-
<br />ATIIICANIDICI.IEAIIO!
<br />I hotby rlfim undr pallty of prjury onc of th. following d.clrEliont:
<br />Ddolirion Pmit-Aub6ros Nodlic.lio. F.d.@l R.Subtions (Titlc 40. Ptn6)
<br />Rqun.d lrt6 of Norificlrion
<br />-l
<br />.diry thal lh. f.ddd rcsuhtio6 r.grdin! sbcl$ rmoval vr not tp?liabl. to lhn pmj€l
<br />& "airyd,a r r,.,"."a rto rpdkarion att srirc fiarl1'. aho!. inro'rn lion i5 corer I asE ro smplv viih cnvedcou v'ordif,mcB md $!r. k* rclriig io hildrg conslclhl! ed h66y aulhoria rcpremriv6 of lht Cnv ed Counlv lo dld uFn tu
<br />,.,., ( t3'lg
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rough {l*lt9-.{/*1119
<br />Service Meter
<br />FINAL F/t/ rs /<,(Z f (7
<br />Notes, Remarks, Etc.
<br />Air Conditioners
<br />( 11,t.i
<br />,",", S.l3 l?
<br />,,^*, uaazglAlf i3b
<br />D",. S l-5 lq - c-,.*". ACrC
<br />L.id.ir \rm.
<br />-
<br />abov. mahon.d mD6lr tor rEdion o@s
<br />",,"--"ffil-,.#JffAral,p.mi,cn.m.,pr,n,): Ytm ll aMnlX)9t
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