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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DTJI,CARAT'ION
<br />I hctuby nflirm utulci pcnalry (, pcrJury rhd I tun cxcmpr rn,m rhc cofk.clos Li.cnsc l,q lbr lhc followins rcN,n (S€703r5
<br />Busircss 0tu Prrtsion Codc): A., Cily or Counry shich rcquirc\ 3 pcntir ro .onntud, shd, impiov., dcfr)ihh or rc|].it eny
<br />srocrurc. prirro irr i\slancc, also dqutcs rh. stpli.nor ror {.h Fmir ro filca silmd nabnr rh0' lror shc h liccns{] punuo
<br />kr
<br />'hc
<br />provnions of lhc Conkicrols Liccnsd Llw (Cha cr 9. Conrmcrcinr wirh Sccrion 7(r) ofDivisbn I orlh. Buiinc\s and
<br />Prorc$ions Codc)orlh.r hcorshc i{excmpl rh.rcfromand rhehacis ain rhr allcscd cr.'qrion. Any vnnndn .r Selinr ?03l 5 by 3ny
<br />appliqnr n, !pcrmirslhjcch rhc rptli.a.lbtr.i!ilpcnrlryolnor brc rhan ilv. huMrcddollns (351x))
<br />*1. is owmr ol lhc poNny, or my cmolorcs wilt wrgcs !s lhcir sL mnrlrcnsd ion, will do rh( wort dnd rh. sMrurc is nol
<br />inrcfrtn or oficrcil au sh rsd 70J4, ausikts ,nd ftofcsionr Grdc: Thc Contrudols Liccne Law &es nol a,)J,ly ro an owrcr of
<br />rh. pmpcny who blilds or inpmrcs rhcMn, and who des such w him\claorhcscllorrhelshhi\o,hcto*..nploy..l.
<br />,' ovidcd rhar such impmvc'mnrs e nor inrctulcd u oflbrcd ,or $lc IL howcwr. rh. hoilding or inptuvcmnr is \old wirhir' otrc ycs
<br />oi coml,lclrn. lh. owN aui$cr will hu( ltr burdcfl of ,,mvin3 lnd lE..shc d Nr tni[ or inFtuw rhr pbpcny ror rh.,,urF)snr
<br />_l. r\o*rcrolrhcpmpcnt. ancrclu\ir.lt.onrrrcrtrg Nirh licctr{d oftnctr\ ro (on\ru.r rlE ltr.jcd (S.c ll)41.ltu$nes
<br />0nd ADLssi,nCodc: Thc Cotrn0cM s l-i.cnsc l-rw doc\ norafply r. rtr o$ncr olpropcny {h{,l,uikt\ or imrn'vcs rh.rcon,
<br />xnJ ulo.onrrclsn,$.hpmjcchqnhaG,nmb(rliotrrdnr^rnnrhrhccuntrttr'rLicr{bwr
<br />I amcxcnrnl u.dcrScrion-
<br />D.le O*n.r:
<br />WORXERS' CI}MPf, I\ISAT()N
<br />IIEII.AXIIION
<br />I hcrcby drfiirn utrdor pctr0hyolpcrjuryonc ollhc lbllosirS delurutions:
<br />lharr r $ill 'tuinrdn a C.n itrarc ol conrnr r, scll ln\ur. Lr *orkcN' co.D.nsnrion. n\ rmrided itr byS..ri(,n17(Irofrhc
<br />trhor Codc.lor rhc psfornuncc ofrhc *ork lor which rhc pcrEir is i\sucd
<br />_lhrkanltwillntinhi'!workdnconrpcn\dii,rin\urn.c.isrcqutctlbySccriotr3'7(xJolrhcLatxnG)dc.turrhctdr.i,unc.or
<br />rh! worl ttrwhichrhi\ p.rn,ir is i\sudl Mysorl$s.. r!.n\iri(,r i0sunn.c .aricr 0tu Flicy nu Dhcr m:
<br />M, o\wes1 Cc,S trv s
<br />Br.rvWcol?q0-lO ,,pi'* I l l4
<br />I.cnify rhd in rh p.rforaume olthc sork ior lhich lhn p.irnit i\ t{u.i. I shrll nur.mploy any r.6otr in.ny manrcr
<br />M' s to l,$onrc sul,rrr ro rhc N. c^conFn\ari.nlDwsorc,tinm,rnd,8rccrhdifIshouldbccomsubjccr16rhc
<br />*orkcr' comp€trso1ion p!'vtions of Se'ion 3?0) or rhc I f,h.r C(xL. I \h.ll. ronhwilh omply wilh thos pmvisions .
<br />WARNIN(;: Frilud kJ {.uB *orkctr'Nm!.ns.rion.ovcn8. ir unL$lirl. od \hall suhjccr rn cmpl,,ldr tu di'nintrl tImlras ond
<br />.ivil fi.c\ u,) to on. hundEd rhousand dollas ($loo.fiD). in sddilion k' rhc cod or comr.n\,rion, datu$s !s l,rovidcd for thc
<br />sc.lin 1076 ol rhc L.bo. c'odc, i crcsr md atloriEy s l'es
<br />rsl018""Jut
<br />t2!.(]-t!t !l(
<br />I hcruby rfirfl undcr pcnlhy oi t rjurr rhar I dn liNn$d !id.t pr.vistun ol Chryrn 9 (connBncins silh Secrion ?o0o) ol Divi\bn :l
<br />ol rnc Busincs .od Pmfcsiorx Codc. ad my liccnsc is in full lhc ard crccr
<br />,,,,"-Jfl:ll-
<br />B """N,.h.. looq4g
<br />6 (orlz,t rot
<br />co!flxullruNuNlllAlilliENrl
<br />I hcEhy llltm undcr FDlryofp..ju.yrhii rh.rc n a.onnfldion lcnding agcncy for rhc !.rformnc. orrhc sork lor whi.h rhis p.flnn G
<br />is\ucd (SLr :t(J97. Civ C.)
<br />ffi ;fl xitliil.,i:;f :""'li;iJt*i"1t
<br />i,vc 'm.ridd pm8d, ror i.sri{lion pui
<br />1yntrd (inNyn).nr.-r ponrhr
<br />nr.t\ .Nr\co
<br />Apt i.{nl or '\,len( Sig.,hrr:
<br />Pcmrircc nrnrctpanl: DG
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduil)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough ?/zohs 5D6t
<br />Service Meter
<br />FINAL ZlZo/tg ,\gr
<br />Notes, Remarks, Etc
<br />AISLIIANLD&CI.AS{ITQN
<br />I hs.-h, a0lm udd p..ax, .a Frju.y oN ol fic aollovin8 d*|tr0'ions:
<br />Dcnrlirion Pc.nirs Asbcsros N..ific,rion F.d.rdl R.gutrr ion. lTnt 40. Pan6)
<br />-R.qxircd
<br />t4ri.r of Norifi urbn
<br />_l.cnilyrhar rhr f.dcrul rcBrlrr 6ns rcEdding Nb.sos rcnx,ril irc nor rpdi.!hk rorhislnrccr
<br />Ji'l i I ?018
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