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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS O\lNER BTIILDER DEI-CARATrcN
<br />I hcrhy amrm ,ndd Fnihy or FrFry rhar I m cxcnDr fonl rh. C.itr.r.^' Licr$ Law f.r rh. followins rc!$n (Ss.'70:11.5
<br />Ausincss ad Proicsiotr Codc): Any Cily or Counly Rhich rcqltcs o pcnnil ro coidtucr- Bhcr, i6prove, dctulish or Rp,ii rny
<br />srruclurc- !.ior h irs i\ruane. ako q t s rh. ryplicol for suct rEmir t, fikr siln dnddmnr rhd lror shc n liccntd Purs.nl
<br />ro rhc,,ovisiofls oltlE Contructols Licc.pd bw (Chaprcr 9, Connncncin8 {irh Sccrn,n TIIX) ol Divhn,n 3 .rrh. Bu\inc* aod
<br />I,rclcsions Codc) or rhlr lrc or shc is cicmpr rficEfomand rhc hasn ror rhc allcgcd cicnrflk,n Any vnndlionors(ri).70:11.5 6y rtry
<br />^Jrxltr
<br />u r, apr.'trir.dhj(Nrh.Jnrl'canrr,d,ivrlncnnlry.rn, 'ftr, rhi1l'v. hundrd d.,lrc rSru,,
<br />[L)./**,^,* **^,. n,myrmrrorrcs *i,h w,scsas rhcir $h comr*.sdion. r*do rhe s.rk ani,h. n rmisfrt.d/..j
<br />","r".4 r"' *t" 's- 7Or4. Bu\incs rd Pr.fcssion\ Code:IIc G)nta.t r Licns tiw di.s hor arply xr ifl o*ncr of
<br />rhc nn,Fn, sh. hd)kr\ ur 'nwovs r)rron. uii srF Jer such sorr hims.lrdr hrrslfor lhou8h his or hcr ornemployccs.
<br />,rrolidcd rhar suct impnrcnEnk @ ftn inrcutn or ofcrcd ior ut tt norcE. lhc hnildiru or im0rovcnrnt i\ sll lirhin o.c ,tar
<br />ol comphion. rhc Owm, Builds will h!rc rhe tud.n .l nmvins lhll tr or she dil 'yn hoild or in{rovc $. pmrdy ror rh. Il0{n{ or
<br />l. a\osncrofrhe pnipcdy. urcrcltr\ntlyconk rin!*irhli.c.s.dconta.kr\kJ.o nturr rh. tni a.r (Sc. 7Og, 8unN{s
<br />rDd Pnfts{ir.Codc: ThcConIrkror'r Liccnsc Las d({r iur iftlyh rnoBrcr i |npcn y wh. $uild\ or irprorc. rhcrc.n.
<br />;:: u1#+(6 **
<br />I lrrcht rlftr undcr pcMlryofpcrjury oic otrh. ftll.si,r!
<br />-l
<br />l,xvc3Rtsillmrn ai',trCcnfi(rcof Con\ctrrr)rc lor workcrr.ompctr\arnnr. r\ pn'vidcd lorbySc.tiotr:17(Dol rh.
<br />Lantr Co{., for rlE plrloinftnccollhc wo*,nr whi.h
<br />'hc
<br />ruinn is h{et
<br />_lharcriJsill'nxinr!insorkcscomncDuroni'trurn.c.!\rcqutcdhySc.riMlT(x)ofrhclrhor(odc,iorrhcpcrlinnm.col
<br />rhc work nn shichrhnp.nnir is i\\ucd My workcN .onpcnsxrion insurrnccc! cr rJ B,li.ynumb,rc:
<br />ff[1*"rr,r, ,,* r"r*m3nccnrrhc wo,k ro, wh,chrhis p.nnn k rsucd. r sh., nnr cn.nroyuny,.son ina.ymdncr
<br />fnlfl&/Xom ruhrd h thc ro*cr onll'ctrq,'nn hws oicllitonia. ond asrcc rhar ir! snould t8onr subi*' ro th.
<br />wnficr ' cnmten\ar i.n nr n\ nnn\ nl Sd inn .u00 .f lhc I jlnr Gir. I .h] ll. fi,d h* irh mmnly u irh rh,{ pDvisirns.
<br />WARNINC Ijailurc lo *curc wo.kcs'conDcnsrri,,n covcm8c is unla*lu shrll srbjccr an .'ntk,rr ft, ni iml llulras.nd
<br />In.usaod dollrs lSlm.ixD). ir addiri,rr
<br />Appllenl:
<br />I hcrchr rfiirnrnnd$ pcMltyolr.rjury rhd I an liccnsd nndcr
<br />or rhc Busirc$ and Pmfcrsions Cnlc. dd ny li..n$ is i'r lull
<br />Chllrcr 9(c.n nrncirA wirh Sccr
<br />COII,IIBICIIONIENDIN;3EENT
<br />I hcmby afinm undcr Fmllyof lcrjurylh,t lhcrc is r consrudion bndinB o8cNy for lhc I'erfomrde ofrhc worl lot whi.h lhis lcmir L{
<br />hscd (S< :1097, Civ. C ).
<br />AISIICANLDEIIdBAIION
<br />I ltErry a1lm ud( lcnalry ol pcrjlry onc oi ihc folk,wins dec lsarn,ns:
<br />Dcmlitiotr Pcrmih-Asbcsros Norilication ftdcal RcRuhtions (l itlc 40. Pan6)
<br />-Rcquircd
<br />Lcttcr of NolifEatbtr
<br />ccnifrrhd rhe fcdcralrclrl,ri,,ni rcE.di.C a\tino\ (nrNal arr n.r rmli.$lc h rhn oniccr
<br />ifyrh.r I hnrcrc rhis applicdion 0rt sratc rh $c.trvc inlormdior iscorer Larc b comply wirh zll ciry and coutrrt
<br />nM str. l-aws mldin8 h building c rcpr$cn(rrivc\ of ihis Ciryrnd Counry k, t 1d uB,n rhc
<br />rtx)vc n{nrnn(d pn)p.nt r(n i'r\Fcrion,urlx)
<br />,\ppliunlor,\,rrnl Sil nlurr *"ulPf6
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lighl Standards
<br />S pas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safet y /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service lvleter
<br />FINAL "VE 8r th 81IyNotesRemarks, Etc
<br />Meter Release
<br />and who conrncGlor su.h pmFcc sirh , Conrrr.ro(t li(.rs.d l]unurnr t,rhcC.ntr.roa\ l-i.cisc trs)
<br />Lcndcis Addrc$
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