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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEII BUILI'AR DELCARATION
<br />I hcrchy !fli,n ud.r !.nih, ot pcriury rhal I m cxcmlr fmm rh. Conr@ro6 Licene Las fo. rhc aolh*in! rcr$n {Sdc 70.l l.t
<br />sosinc* !.d Pmfessiin Codc)r Any Cir, or Cou.ry which rcquircs ! ric,nir ro ondtud. alrd. intor. d.'mlish or q,air any
<br />nfl.ruc, pnor ro ns issuamc, al$ rcquirs rh. $plhdr to such Fmir ro filc a siSn n satmnr dd lr or shc ii liccnsd ,usuanr
<br />h rhc polnions of rh€ Contracrois Lic.ied L,w (Ch,rrer 0. ConrmNin8 wirh sccrn,n 7(Xn of Divi\bn I or rhc Bxsincss rnd
<br />Pmictsions Codc) or lhar h. or sh. h .xchrpr rhcrfrom afld rhc hdsis { r h. .llc8.d crcmpt ion. AtryviolorionoiScctiotr7031.5 6y rtry
<br />o/Tl'cn ld!pcrmn \uhFchlhc amlc,trlroartrrlrcnal!)ofnnrmorcthann\c\und'cd.lnllu''15fl'r
<br />I/JN*,*. ",n" *."y o, my c,hrh,ycc, wi,h $rscs as,h* $h.ompcns,r$n. w,,,r. ur wdk ,,r ,rr sr*m ir mr
<br />' 6ndcd.roficrcdrorslclS&704,t.BurincsrndPFfcsionsCdc:ThcContrr.tor'sLiccnstjwdocsnolalnlyloanowncrof
<br />rh. pmFny *h. bnilCs or in{,rov6 rhtm,n, dnd who dmr {ch korl him\clfor hc*.lfor rhftu8h hk or tur o*ncn0lo}rcs.
<br />pn,vidcd rhar cuch impmremnlsNmr inrcnd.d oroficEt lor$h.ll h.wwr rhc $oildi.c or iroovcEd is y'ld sirhin onc Fa
<br />of.oq)lclin. llr otrmr Buikld wil! h,!r llr hl(hn oapmvid8 rtur tE o. sh. dil mr tdH or itr{,ov. dE FmFny for Ih. puDoe ol
<br />l. as owtrq of rhc popcdr- rm cr.lu\lKly .ontkring silh liccnscd corrr(nrs t' coi{tucr rhc pnl.cr I SLt 71)j]l, Bu\itu\\
<br />a l'rolcssinr Codc TIE Cotrr rr.ror's l-iccn\c l-aw docs mr afr ly b m owncr of l)ro,}cny rho huilds or improrcs rhcr@n.
<br />rtrd *ho conrra.rslorsu.hpnjccrr*irha Conrmcrons) lic.nscd pur\ulnr h rhc Conrrdcrois l-iccnsc hs)
<br />I hcrciy.Inn under pcmlty or Irlury om .l rhc followil
<br />I hrv. rJtd will nbinrsin r GnilEslc of Con*nr to Selllnsue lhr worlcrs co.rrcrerion,,\ ptr,viddl for by S{rion 3?00 orrhc
<br />Latior Cdc. lor rh. !c,lo urcc of thc worl r'o! *hich lh. ,,crmir h irsucd
<br />rhc$o'knr*hichrhhrcnniri\i\\trc,| Mr_ *o'k.ri.on,p.Dsrrnn, i'Nu,xncr crricra policl numhcr tu:
<br />Policy Nunrbcr Lxpnc\
<br />lh*r^oiiy,h, .,h" n"nhn'u'ft.c or,hc trorl,or trhEh rhN pcn, r n\ucd. rsturr nor en,proy any pcra,n many nmn*
<br />f,l/' t')t.-" *ta..+" "url.^ r,m|.(n.JrDn hwsorcsliromir. d 4Nrlu irl shuld tr.om\uhjccrbrh.
<br />si{li\'!,{|cn.arn,nf"tr^h.n\i'rsirL{'I'Ln'nrh.tihnc{c.l\hrll.n'nh*hro'npDtrhrh"{F.\r.'.n\
<br />WARNINC: Iiilurc ro ecurc qorkcm !_oDlcns0rion covcri8c is utrlnrvlnl. ond shrll subjd !n cmplorr ro
<br />*:-'TIfiTit,
<br />I hcEbyalfirmundcr FnaltyofFrjurylhor I om lienst under
<br />ol rhc ausi*ss nnd Pmfcssdns Codc. Md ny li.cns h in full
<br />nbnotCh prcr 9(commncinE sirh Scrri,,n 7{Xx)rofDili\nnr ]
<br />ca!$f,lcuoNrENlllNc]lli[Ntr
<br />I lrnby,fllrn uM.r Fn,l'yoip.rjuryrhd 'h.r.
<br />isa co srflcrion LndinS ag.ncy for rhc I'crloinmcc ntthc work f.r *hich lhn pcrnril h
<br />nsx.d(scc :ll,97.Civ C)
<br />AIIUCANIDIII;LIXIU!]!
<br />lllrby!finmunder penllly olpciury orE oilhe,ollo$ins dccln ion!:
<br />Dcnnililnr PcnniIs.Ast'c(os Norilic0ri()n lrcdcr{l Rc8uhrioN (Titlu.10, Prra)
<br />R.qtrrcd txrrcrorNorifi.nrhf
<br />/Ar-d;-ffi;il.
<br />atr\c nEnrioncd prorcny ir in\pccriotr
<br />Applic{ni o. Aa€tri Signrlurc
<br />Prmril& nrn. ( prinl ):
<br />\ r.Bmlirg rsi.nosrcnnnrlrc tror atflicrhlc r. rhis l,n+!r
<br />i,rnntl nrrc rhrr rhcrh,\o I a8m ro omply ! irh 0ll Ciry {trd Counry--T,i;ld; ".
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq i UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Flool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service IVleter 1l
<br />6 5 -.,c-t 1u 'y*\7f
<br />Notes, Remarks, Etc I
<br />Communications Cable
<br />It/eter Release
<br />FINAL
<br />Lxn,lc'\ Add,c'
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