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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DELCA R-4TION
<br />I hcrcby afll,n undc! pcnalry of Dcrjury rhut I a excnqrr 6om thc C.nhck,r Liccn\c Ls* lor rnc follo*jos r.avn' (S&70ll5
<br />Busircss md Pior.rsion Codc): Any Ciry.r Connry which rcqlirc* ! remir ro conilocr. alrs, idprok. d.rmlish oi rcpri uy
<br />\rructurc. rh!to ils isslarcc. al$ rcquncslhe alpli.8ni ror such II mii tu fiha sigrcd nalcmf,t thot h.or shc is licensd pulsanl
<br />to th. pmvkions oftE Co.k0clofs Liccnsd tlw (Cha!r.r 9, Comtuftio! wirh S.dbn 7000 ofDirhion 3 ofrh. Busincss rnd
<br />h,fessions Codcl or lhrr tEorshc t cxcnrrl thcrclrom $d thctnsis for lhc alhScd cxcnUtion. Any violalionofScdion7011.5 hy lny
<br />^rffli.0
<br />ntrancn ruhjr,( rh. arplicrnr rn rcrv,lrcnJlrj ornor mrrhu filc hundBldnlr,'\r15U))AII Vllf * ,,wE nr lhe nmncd y. or my cnrr ln)rcs * h wagcs !s rh.t blc compcn$rion. will.lo lhc wolt and llE ttmnmr
<br />im.nd.\c or o,Lrcd for sale (Src 70il4, Brsi*sr and Phtcsions Code Tte CorrEroas Ltcnss ti{ docs .or allnly t, r. .sn$ or
<br />rhc,mpcny sh. boilds or nqrmrcs thcmn, nd uho dds s.h sbik hituclf or hirslf or rhou8,l his or h.r o* n chployss,
<br />pmvidld rhd su.h i.Dn,Efthrr ft nor inrdi.d or odcrcn lor slc ll, howcrcr. fic huildi,3 or i,qrmwmnr h sold wiihin .m Ffl
<br />of.u,rphri,n. rhc Osncr Buildcr will har r}]. budcn of IDvinB rhd hc .. shc dil mr h{iU or tqms lh. pDpsly for rlrc ,{rIN of
<br />-1.
<br />6owrcrot rhc,,oFcny. !mcrchrivrly.onr.din8 qirh liccn{d.ont .bR ro.onstru.r lhc pol.d (Scc. 7(x4. Businc$
<br />anl Pn,r.sion Codcr Thc G,nrracloas Liccnsc Ltrw des nol atrly lo trn osncr oipropeny who huilds or nnprovcs lh.rcon.
<br />and vho .onln kr.r su.h pBrc.t silh n Conhcr.nr) li.co\cd pusnanr ro rh. Conhacxtr * I-icdne tis)
<br />;:-i/ti\'t
<br />Dlllr\ll:!l!01
<br />I hcrcby rflnn undf p.n y ol lf,rjry otrc .r rh. rr,
<br />I h0!c ut willminrain, Ccniftr lc ofConscnl r. S.lf l.\nrc fo, sor!(r .o'np.n{rion, aqmvidcd for by Salion l7(Dofrhc
<br />tjbr Odc, ror rhc rqn,tu@ 6r rhc w6rk for *hich $c psmit n issucd
<br />_l hnvc and vill minhin Norkcs compcns&n'n insnrrncc. .i r.qxncd by S.crion r?(x) ofth. t.bor Codc. for thc lEdormnce of
<br />lhe sork lor which lhh lErmn is nsud My *ork.rc' mo$nsrrion insumkc ca,icr dld polkytrumb.rsc
<br />y rny llcr{,n r rtry nrtrncr
<br />WARNINC: F{ilurc ro scurc workc6'conrNnsarnn $vchlc h u lnl. and \hill srhicct an cmDloycr nr Lri iml pcnalrt\ trld
<br />.nil riN\ nP ro.n. hu lh.us!nd {lollx6 (31(xr.(x)O). in Md {xri.n- lamr8c\ as pn,rid.d fn rhc
<br />u
<br />I hc'rh, rllnmr dcr n lry.locrlu'rrhrrIrmliccn*luntur n ol( hrnlc' 9rronnncn. nt 1r I
<br />or rhc anrims and Profc$bnsCode, aJd nryli.en* n in 6rlltucc nlcflccr
<br />ContE.lor
<br />CAISIB]]I:IIONIENDINGAIjIIII
<br />I hcEhy offiirnundcr pcnallyofr.dury lhar lhcrc h a snslflclion LndirB rsctrcy fo lhe ncrfonDne ofthc work for whih rhis rEnnir ir
<br />issucd (Scc 10S7, Civ. C ).
<br />ATIL!(JII.IECI,ANAUON
<br />I hcr.by afim nndn pcn.lry oi Frjury om ofll* folLwing delffrrions
<br />Dem,lira.n Perdirs Ashcros Norifiork,n FcdcEl Rcslhrhns (TnE{0, Pan6)
<br />_Requtcd trnc!.i Norifrurion
<br />I#*-*H
<br />drrhc lidcrrlr.trhri(nrr rc!uding xsbc$o\ rrnn)vrl rr. nol r]rpl'cnhlc t)rh^ ,R)lc.1
<br />Ihrvc rctrd rhnaltlicarionondsr cIhd rhc ahrv. iraonMrirn hcorccl.I r8re lo conrly wirh rllCntand (irrnrv
<br />hisCirymd(\)! , bc rrr ut rlrrc I;nv\ r.ldi"3 ni 6L l(lltr!n- uxl hcrcby rulhorizc rcprcrcn,arivcs ofr
<br />Arplionr or aectrr sian{ure
<br />tr0
<br />bln lb
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lVeter Release
<br />Rou gh
<br />Service lvleter tl
<br />FINAL Lli-blla tw\zfl
<br />Notes, Remarks, Etc
<br />Pole Bases
<br />Air Conditioners
<br />F
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