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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUILDEX DELCARATION
<br />I hcrcby .mrn undcr p.nalry of Frjory rhd I an .r.nfl fmo rh. Conrack,^ Lic.nc li* lor rh. ruuowins Easn ($. 7O1 !.5
<br />Busi"c$ nd Proicssion Codc) Atry City or Counry q,hi.h rcqutcs ! Fan l lo on(rucl, alts. itr1rruvc, dcmlhi or ErEi atry
<br />srtucrlr. !.in ro ns hsuucc, !l$ rcqunci rhcrpllicsnr for such pcmir b filcu signed dllctu rhar hcorshc ic lic.oscd PUNonl
<br />hthcpmvisionsoflh.Conra.lolsLiccnscdb*(Chrflcr9.Conr.rrf,ir8ailhScclion?0OOofDivi\ion3oIlh.Businc$and'
<br />Pmli$ions Codc) or lh hcorshchcx.mlrlhcEfromrndrh.bashforrhcullcBcdcxcmlrion.AnyviolalionofScclhnT0:ll5brony
<br />applicanr loro pcmit subjcchrhe oDDlicanr ro ocivilp.nallyotnor mrclhln fivc hlndreddollus($5(x)).
<br />-1.
<br />!s owncr of rhc lmpcny. or nry cq)lor$s wilh wascs as thcn $lc q,nDcnsutn,n. sill do rL w.rk md fic nMm is n
<br />inr.ftL{ or oficr.d for sL l Sd.7I)44, au{m* a.d Profcsbns G)dc: Th. C.niiactof s LiccnE tjw do.s nor amly lo e owrcr of
<br />incpmlrny who buit! or itr{,roEs rhcmtr !.d who dc sEh w.I himsclf o. herslf o. rhmush hir or tcr own ctr'l,lo}t.s.
<br />goviddd !h.r *u.h infnnrftnts m mr inrcndcd o..fi.rd f.r sL ll h.wN.r. rh. t{inin3 or nlT EnE h $ri pilhin oR }te
<br />ofcon{krhn. rhc Owrc. Buil{tr wiu hN rtr hodctr ofFovin8 thot tE or stc dil mr llild or nrq,rer! rlr phFri, ror dr purt yof
<br />-1.
<br />nsowncrofrhc propcny. ! ciclusivcly conrrldiry wirh liccNcn conrrukF ro con{rucr rhe nrojsr (Scc 7l},14. Bu\ntu\r
<br />d ftofc{ci,n Codc: Thc Co.tracttr sLicctrsc Lrw docs nor ryplyro trnow.$ oftmpcrlywho huildsor improlcs rhcrcon.
<br />and *ho oirr&h tor skh pmiecrs wirh I Gnrmcro(s) liccn*d pu$lanr hrhcc.nr..lof*Lic.nsc bw).
<br />_l8frercmfl !.d* Secri
<br />laatrE8s:r0lltrNtArlQN
<br />DECI,UAITO!
<br />I h.rht rlfnmrndcr pcnJr, ofFrjury oi. orrh. Llbwing dehitrrion\:
<br />-l
<br />hrlc md *ill mainlli! ! Ccnificarc ol Cotr{nr ro Sclllnsurc n, Mrlcr\' comFnsnrt,n. as tmridcd ar by sc.tion l7m or rhc
<br />Lat'or Codc- r'or ihc pertbnnancc oflhc uork l'or which lhc llcrmit is hsucd.
<br />I hrvc and sill h,inrrin workcri.ofrp..\rrn ii\urance. r\ r.nrnd btSccrir 1700ofrhc L.tdC.dc.,orrhc pcrlo Nnc.ol
<br />rh. uork n, whi.hrhN pcflnir is i$Md MyworkcN conpcicdR,n in\ur,'{c crricr.d lolty ru.rhc! rc:
<br />€ vt't t-
<br />WARNING roiture to se workcs' comaEnslion oveEse is unla*tu1. lod \hall subJ.{r an .mrLytr ro dimin.l p. lrax ond
<br />civil fincs ur ro om hundEl rhousnd dollun ($100.000). in addirion h rhc orr ot.dnll*nettun, dntrg.s as povidrd for rh.
<br />Scclion 1076 oi thc tihor Codc- intcrcsl !fld lllomr\ fes
<br />ocrt: r t) O'C
<br />DFCLARATI(IN
<br />Ihcrcb, aflnn undcr p.rlhyofpcrju.y rhlr I o lidns{ xidcr ptuvisn,. or Ch{rd 9lcom'mncins wilh Sccl iofl 7000) of Divisn,n 3
<br />of rhc Businc$lnd Pmlcsrions Codc. lnd my licensc is in tull lorcc lrd ctt6r
<br />t tt\
<br /><-zi- ta XD
<br />QNIIBII:IIANUNDIN!.trGENCI
<br />lhcrcbynfitnundcrtr.dhyofpcrjurylhdtrhcrckecotrsrruLlionhndinglScncylorrhco.rfom.c.ofrhcsorkforwhichlnisrcmilis
<br />issu.d (sec.3097, Civ. C.).
<br />ATTIICANLIECI.A8.4IION
<br />I hnrry,J[mr undc pcn{x, or ncrjury onc ol i h. followinS dcchalions
<br />Dcmlirn,n Permirs Ailrsros Norifi$rion Fcdcral R€sul ioos (Tirlc 40, Pd6)
<br />-Requncd
<br />kno of Norifi ca*r
<br />-t
<br />enily fiar rhc fededl rcgrlario.r Eslrding &rb.sros ercval @ oor .lplic0bh b lhn pDj.{
<br />y l_enrry rhd I hrv. rcad rtur rpplE.rtun aid {!rc rhd rhc atnvc inlotmrhn is Ntr€<i I asr roompl, wirhal Cny0nd Counry
<br />..dinaft.s.nd sr.r. t:ws EhtinS ro buildine coneMio( a h.Eby lulhori4 rcrcsnrurivcs of rhis Ciry lid Colnly lo.nln upon tlE
<br />,h-ve E.tiodd pmFdy fn i.st*.rion lDqr$s.
<br />Applicont or Ascnl silnrtuE,-L
<br />P"-rlr"" n"." r p.irrt, X-
<br />D,,".. 6 -t,,t?2
<br />t4 /i o lo,se..'=--B
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />Rouqh
<br />Service Meter
<br />FINAL )-l-/u,rdeJ*,'Gr)
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />r-:n:,'
<br />[l.ci'ryrhJ rtupcrroir trccotrhcroA ror whrch rhis p€flnit k issuc,l.l \hull nor cmpk', !n, pcN,n in ,ny nmndr
<br />{-l't,n, hc..m \uh}{r'nrh. tr 'l{\n,mnnd'nnlutrr, Ctrli'{n,r.,'tu]J!m. rld rfI rhould }E1nnE quhF!t torh.
<br />wo.(.r,mp.ni,ionpmvti.nr.fS..rionlTlDofth.bh.rCrxtc.I$rll.fonhwithcory)lywirhlhosprovnions..
<br />A"iD atltl
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