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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.rchy trffilni oid€r pcnalry ol p.rjrr, rhar I an cxcmpt from rhc ConlncroN l-iccnse (jw fitrrh. folln*ing rcrsn (Sc..7011,5
<br />ausincs\ Md Pn,rcsio. Code): Any Cny .r Coumy ehich ,cqutcs r Fmi ro .o.drucr. alto, inl]Jn*q d.nblirh or rcpat ony
<br />srrcturc, Eior ro irs issuM.c. slso nquncs tu applicdn loi su.h Fftir ro filc , si8n.d st0'c'mnr lhar hc or sh. i. liccned pursunnl
<br />io rhc ptuvhnrns of rhc C.irrdct, s l,il{nscd hw (Chlprcr 9. Com rcncins oirh S.crt'n I)(x) ol Dilhion :l .r rhc Busirrc* dnd
<br />t\orcsiotrs Codc) or rhd rEorshc hcrem,rr rhcrlfrom aBl rh. hNis rorrh.allcgcdcxcnFion. Any violrr ion of Ssl hn 70:11.5 ty ony
<br />,dd, ;ffi il;;ffi ;ffi ;ffi ;il;**,**,,,,,*,,
<br />rhe ImIEny who hoilds or imrmEs ih.mn. rd who dfts rmh s& himsclf or hci.clf or rhrongh his n tur ow. cm0Lyccs.
<br />Fi.viddl rhai such ihpn tmna rc nn inbnded or ofcrcd 1.. saL ll tn*cv.!. rhc huildiry o. impnlcmnl t $ld lirhin on. ,cu
<br />ofc.mpLrim. rhe O*n.r Build.r willharc rtu hnrjor ofpovinA th, hr or shc dil mI hlild or improrc rhc pofcny lor thc puqns of
<br />-1.
<br />as ownq of Ih. tm!.ny. am cxclucilcl, conracring airh li.cnsd .onr,.ros ro consrd.r lh. frci{ (Se 7()14. Surms
<br />u'd PbaEsbn Codc: Thc Conrracrois Liccnsc h! nocs nol q'rly to an owrcr o f rropcny *k, builds or n.pmvcs rhcr.on.
<br />lnd who .on(mcrs for su.h prcjc{s wnh , Ct nlr .ns) liccn*d pnr\xndr k,ihc C.ntr.lois Lic.n* tiw).
<br />;:i/jpt l^4ff
<br />Ihdch)rlh r d$Nn lryot|[iuryr c lihcn)l[){tr,8
<br />I hdvc dd qillmri'n raCcdlfi.rrc.fcons.rrrS€lrln\urefor*irlcrr.onrpcnsaii{ .ns tiovid.d ld byS{rnnr3TLD.flhc
<br />Lr&, Codc, nn rh. Ii.rforhxnc. ol rhc 80 r(, $tich rhc t mi k n$cd
<br />-l
<br />h(!c dtrd *ill m,inhin wo*cr' conreNarbn nNui,R.. ,\ r.quircd by s..r nnr l7L\) ol thc l bor Codc. hr lhc psntrmamc of
<br />rhc work ld which'hh p.flnil is i$ucrl. My workcre' .onp.ns,ri.n rnsunncc mricmnd l.riy nun$cr arc:
<br />%M*l*,..Ir,,,**;J: s,il'tir;:rH :t i*,,,* r,,*,1^,*,,,,,,,,1,*,,*r",,;,**
<br />workcn conrncnsolion pmvhionsofScction l7(,$ofihc L fl Codc, I shall. lonhwirh comrrly wilh rhos pDlisions .
<br />WARNIN(;:l'nilurc ro *rurc wolkcH otrrFnsnlion .ov.ag. is xtrl,wful. od ndl
<br />lo onc hundrcd lhous.nd dollus (Sloo.tno). in addilion b lhc cosl ol
<br />subrccl m enl,'kDrr to ri.,inrl Ir rlris and
<br />srion. d!roscs ar pn,vntd tn rhc
<br />{if iy"ll
<br />Ihrr.hy ntn utul.r l[nrlryo, pcriLr], rhrrI r$ lic.fql trr ,vnion ol ('hl'lrcr 9 (ro,nnrncinC eir
<br />ol lhe Busircss lnd Prefcssions Codc. arn my liccnsc h in 6ill r'ore oxl clf(t
<br />Liccns€Class:-
<br />AffIICAILDECLAMIIA!
<br />I h.rE-t y anim undc, Fnalty of pcrjury orc of lhc followin8 d(leolions:
<br />Dc,mliliotr Pcflnik.Asb.(os Notiicatio. Fcdcrol R.Bultrtions {Tnt 40. tun6)
<br />-ReSUtcd
<br />Lctrcr of Mlificalhn
<br />rc Dr rpplicrblch rhtr F,J..r
<br />s ro.onDly q,irh rllCiryitrJ Counry
<br />nrncs oilhn Cir, ond Counr,
<br />lit
<br />It
<br />,^",4lo
<br />Site-Work
<br />Under ground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />!!!e Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Rough
<br />Service lvleter A
<br />FINAL v)y.1l+16
<br />Notes Remarks ,_/
<br />Transformers
<br />Meter Release
<br />EtC.IO!$IB!!: aNl}]lDlNljrlilNq
<br />I h.rby lrfirnund.r F.ahyorp.rruryrhar rhsc t a.lnntodion kndins f,gco.y ror rh. pcdnrnra^'c ofrh. work lor {hich lhh pcrmit is
<br />hsued(S( .1097- Civ. C )
<br />trtrd.-. NJ F.
<br />tr lcr'\ AdJn\.
<br />t-
<br />I
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