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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR TION
<br />I hcr.hy a{firm undcr peMlry or Frjury rhd I t$ cxcryr 6om lhc o)nrrlckna Li.. \c l-sw for lhc r'ollowins EN)n (s..70115
<br />Ilusinc\s ,nd Pr.rcs\ion CL\dc): Any City or Counry *hich rcqnn \ a Frmir ro conslrucl, llrcr- imPn,ve. .hnblirh or rcF,n {ny
<br />{ructuic. prior ro ns issuancc, rle rcquircs rhc aprlkanr ror su.h lcflnil ro nh a sis.cd dtrrcmnr rhtrr horshc h li.cnscd ,rAlrhr
<br />ro rhe pmvhi{,r orirE Conrn.k \ Liccnscd titr (Ch!rl.r q. Coimcn.in8 silh Scdion ?Ux) ol Divhion 3 of rh. Businc$ rnd
<br />Polrsn)ns Codc ) or th.l h. orrhc iscrcnrfl lhcEfronundrhc hNs lbr rhclllcacd cxcnrflion Anyriol,rio.olSccrion 71,-rl5 brany
<br />aprlica l'ora pcrorir suhjcclsrhc anpli.nnr k, r.ivilP.trrlry.fnor norclhnn ivt hx.drcd dollars ($5u)
<br />-1.
<br />tr\ owtur of ihc pmFny. or ry cmplotrcs wnh w{scs n\ rhdir solc co.IFnsdion. will d. rhe w.it( arl rh. stMtE is r
<br />inlcnLd or oficrcd ld $le (Sa.?(},4, Busilcs snd Pmacssionr Codc: Thc G,nri.br's Lffnsc ljw d,trs ior drdv lo r. owner of
<br />rhc topcdy uho huilds or in'ptuld rtkron. &xl *ho des sEh Mr* hin\.lfor h..$lfot rhr!8h ht or h.r oqncmDlovccs.
<br />prorid.d rhrt su.h imrmwnrnrs @ nor hrcnd.rl d oflcrcd nn $h. Il h.wcrcr. rhc huilding .. inPmrcmni is srh wirhin onc fEt
<br />ofcofiplcrbn- rtE Ownf BniLrd eill haK llE b'irlcn of poving lhar hc or \hc dil nor hoild or imProrc lhc PDpriy ior lhc ,)!rlns of
<br />l. usoumrollhc pnr.ny. dr.r.lusivcrycnnrjdirrS wirI liccn\cd cont].trr ro .onsnEI rtr rrojd (scc 701-4, Bu$ms
<br />! t\)ltsinr Codc:'rhc G)ntraclols l-iccnsc t-as docs nor lptlyro rn.wncr 01lmpc yuho huildsor imrrovc\ rhcrco.
<br />rnd who onrncrs tr strch tft,jc.rs qilh r Cotrlrlctu( o liccnrd p!^unr h rhc C.nlticroi s Licens ljw)
<br />I neicddu.do Seton .B & PC forrhnrccson
<br />D.lc: Own€r
<br />ttoR(ERs;conlPENsATI(rN
<br />IIECI.AMtrON
<br />I hcrehy rmrn undcr p.Mky or pnjury onc ofthc tollouins d..hrurion\l
<br />-l
<br />huvc ud siU tuiflain s ccnirEatc ol Consnr k' S.lf ln\urc roi mrkcs ompcnqriqr. r\ tmvkltd fo. bvSccrion:1700 ofrh.
<br />Lrbor C{dc. lor rhc l]crfomk. o, th. wol{ for which lhu psflnil n isrxcd
<br />-lhrlcrnd
<br />willmri.irin qorkcrl c.nEnn(n,n in\urancc. r\ rcqurcdhrSarion.lTlro,rhctihntrCodc.lorlhcP..tornBn..of
<br />rhc work fttrwhi.hrhis pcnnir is hsu.t Myworkc^ dnnpcn{,rnnr tn\uhncccrtricr aBllxrlicynu rh.t.rc:.g {.-\-l-
<br />lLtg.'7/^od)nba)3 t-
<br />-l
<br />ccnily rhr( in rh. lcrfonnikc olrhc wo.k lbr Nhich rhi\ r.rnir is issuci. I rhlll nor c'nnldy rny ltrmn in uny manncr
<br />q) !s t' h.$trr suhjccl to th. workcric.nDcns riotr ldwr ol Cnlihrnir and rgec
<br />'har
<br />ill nroultl bcom {hicd Io llE
<br />p.*.ir' conf.ns.r ion pmvisbns of sd1i.n ]7m oi rhc trtnr C{tc, I shtrll, fidhwirh comPly P irh lhxc Pnivhions .
<br />WARNING: rdihrc lo *.urc worke6' mmpcnurion d,vdraE. i\ unlnqtul. trnd shall \1hid M .mpbltr lo qiminrl frmlras rnd
<br />civil 6ncs xp h onc hundrcd rhousand dollui (SloO,Oln), in tddilion to lhc cosr ol comp.nration damccs as pmvid"l t" rh'
<br />Srtiotr 1076 nrrhc trbor Codc. itrlcrcn md an.,rcr\ fer.. L->c- t9 npp**,,)4 1.-r4- c--t=,=
<br />IJIENSf,L TNIaAIIAB 6
<br />DECI.ABATION
<br />I hcrchy trtann und.r pcnllty oi lcrjurt rh, I nm li(n*l undtr pmvi(ion oiChtrfls 9 (conntfting with Sccli,n Tlxt)).rDirti.tr 1
<br />oi rhc Busims,nd Pnrcsid$ Codc.ond my liccn\c is n'tullr(trou clINl.
<br />JTapGG
<br />L >j:t?
<br />;::.;:*
<br />Ihcrcbt rli,rnundci pc.tlrroit'crjuyrh rhcrci\,coi{t.ri,)il.td$3rgcn.ylorrhcltrfon,rdnccollhc$ortli,r$hichrhnl)cnnirk
<br />nsu.t tscc. 3097, Civ C )
<br />APPI ICANT DFCLARATION
<br />I lrNby olIm undcr pcndlly ol p.rjury oR offic 6llowin3 d(hrarioor:
<br />Dc n,lirion PcnnirlAsbcsros Norificarnn F.d.r Rcgul{ions (Tnb.ltl. Pan6)
<br />Rcquircd rnllr of Notifi cart n
<br />-l
<br />ccniryrhar rh.lad.rrl rc8uhriofls rcs.rdnrs !sl'c xrcnx,lrlrrcnorlnnlic0hlclolhisProjcrr
<br />I r.rIil,vrhtrrI l[v. rcidIhi\ {plicarion r (rrc rhd rlt drrc inlannirior is .om.i I ngro to.nnIly Nirh rll Ciri_ ,trd Counry
<br />a}.^c trEnrtr.nrd rn,p.ny ft in'nccriontn,$
<br />apprrmnr r,lsmr srqmrum * l44.
<br />""-u"" *.",rnnu,X -Il.< c .-l tl<,
<br />6 >!t
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq i UFER
<br />Transformers
<br />Torqueinq
<br />Sub Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)t n -t&s,)4{
<br />Walls (Rouqh)(4.1'\d- /'rY)
<br />Ceilinos (Hard & Soflit Rouo(
<br />Ceilings (T-Bar Bouqh)
<br />Rough
<br />Service lt/eter
<br />7-70-10,[).1il{Tu
<br />Notes, Remarks, Etc
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<br />Ivleter Release
<br />FINAL
<br />Lcndca. Ad,Ic{
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