|
ELECTRICAL.INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.OWNER BUILDER DELCARATION
<br />I h.rcby a,nr.r xhdm ,cn!ll, ol rarJury rhxr I an crcflrll forn rhc G)nt.crort Liccn* ltrw lor rhc louowiis rcnnrn (S.c Toll 5
<br />Bu\inc\s a*l ftolcssior Codc): Atry Cny or Counly which rc+ircs I !rclmir h conirucl alr.r, imploec, dcmohh or rq n rnv
<br />{o.rurc. !.itr Io ils i*tlkc. {ho rcqutcslhe alPlicaot f(tr *u.h pcrnil ro lilc I *igrcd n cmnl rhd lror shc n liccnk'd pursu'ntr
<br />lo llt pdvi\ions ol rlE Conl,actff r Lctrscd La* ichll)rcr 9. ComrRncins *irh sc'rion 7000 ol Dili\nrn I oflhc Busincsr and
<br />PofcssiotrsCodc)orlhnr hcorshc is crcmlrr lhcrcfn,mdnd rhc hisn lorrhc!llcS.'lcxcmlrion Anrvn,hrionofScdionT0ll5hyrtrv
<br />aptlicrnl for ! Frmir ruhic.Bthc lptlicanr k'..ivilt,.trihyolnol nnftrhm 6vc hundtcd dollrr ($5(xrr
<br />-1,
<br />N owErofthc prorErry. or ny.mphrccs wnh euses d rh.ir $h coflrp..sari,,n. silldo lh. *qt and rrb smtE k mr
<br />i' .n4el nr oflcrcd r; sh I SG ?Or4. Blsier! dnd Pnncasbns Codc: fhc Conr0dtr\ Liccns tjw d@s nol aldv ro ,n owncr ol
<br />rhc pol.ny wh. tsilds or in{m$ rENn, and who dcs sh wo* hnnrclfor h.6etror thrcu8h his or hcr owncmPlorc.s-
<br />providcd rhar s&h intturmnh src nn inrod.d n o$crcd nx sh lf. ho*erd. rh. hoildiry or nt{mt tnr h sld g irhin ofl }ut
<br />ol'complcrinn. rhc Oqncr Buildcr *ill havc rh. bodcn .f lmvinB rlFl bc or shc did mr tlild or itrTrot rh. JrePdv fi, ih. puqn$ of
<br />-1,,sowmrol$cpmpcny.aher.lusivclyco
<br />racrins *nh li.cns.d cont6cloF ro .!nrh.t ttr Forccr (s.. 7044. Bu\im$
<br />aDd Pmfcsshn Codc: Thc Conl$d{tr s Liccnsc ljs docs not al)ply lo m o*nci of prop.nv *ho boilds or imFovcs thcrotr.
<br />and *ho.o6h.lsforsuhDn'i.kwirhaConhcto(s)lien\cdN6@nllorhcG,nra.rorsLkcnscLa*).
<br />-l
<br />n crcnfl undcr s€crn,n-. B & Pc rorlhk rc!\oi
<br />lhl.: O$n.r \!(IRKllllt coNlPI:NS,\l l()N
<br />I2[CL^3rr]0]
<br />I h.rrhr rrlinr !klc' r).r:'lrr tl t.,iLtry o c,'l rh.lt,llL^1ir! Ll..l.trrrrrr
<br />l rld (,rlc. rnrrhctcrli,nnr ..,)lrh. *o lt l(n llrirhrlt |.rn I '\ \{i.{l
<br />,mp.n\ari,tr, ir$ranc. crricr,.licy.u rhcr rr.
<br />-r. I '\'(
<br />l.cdil'y lhol in lhc lcrformdmc ofrhc work ftn lhich rhh pcnnir i hsd.d. I shrllnot emPnrv an, I).6otr ir anv mr rEr
<br />$ s ro h$om sthF.r b rhc so*cn' comFnrai i{,n l,*s ol Colihrnir' and 4ec lh.l ia I rlxruld tE onr sulT cr k'] rhc
<br />sorkc!{onnpcn\lrn'npmlnionsofSdion:l?0o.r$.hhtrCodc,Ishnll.rdhwilhcom,qirhrho*pmrhnn*
<br />WARNING: Flilurc h scurc *orkctr'conrtcnsalion covcrD!. i! unln ul. rnd sl'all subirt 0n cmPbycr ro dminal P''hhics rnd
<br />civil fincs up ro onc hundtd rhousrnd dollaN (Slm.flm). in nddilior h rhc co{ oicor.Pcnsarion. d.m,8cs as Pnivid'd r'r rhc
<br />Sc.ri,{ 11176.lrhc I rhtr (t c. irrrcr.n rrlJr.tr.r'\ lic\qzt9v
<br />DECIISAIIO!
<br />I hcEby rllirn uklcr P.nally ol rcrjury rhar t tf, li..nsd undcr Folision of Chtlrcr 9 (cotoftn ih8 uilh Seclion TtDo) ofDivision:l
<br />ol rhc Busirc$ and PFfcsions codc. and nry licc sc is in tull force lndcflftr.
<br />13 \og,rr q2,l
<br />t,,", 1.2. ln-. c-r*a-, \Z <,(</f''
<br />CONSTIII
<br />'CTION
<br />LENNN(: A(]ENCY
<br />I hcEby afirm under Fnany of pcrjury rh,r thdc is a of,irudiofl lcndhe 0gcrcy ior rh€ ,,erf6@kc of lhe *ork ror vhich lhh IEmn i3
<br />is\ucd (Sc. :10'J7. Civ C )
<br />lxndcis Addrcss:
<br />-A.PIUIANIDECLASAfTON
<br />llrn1,yofrmlnder r,.nrlry oi p.rjur, o,c.frhc rollowing d€lnarionsl
<br />Dctu)lirion Pcr.rir*A\bcnos Norificarion ncderal Resularions (Tnh 40. Pan6)
<br />Requircd t licroff& ifi.arbn
<br />€.*,,rh,t I havc rcId rhh q,nli.orion rnd (rlc rhlr rhr ah)vc infdnulion i!.omr Ii8rerocomplvwnh.llCnvandCounr!
<br />n$ ol rhirCiryandC.utrlyrocnrcr uBnr rh.
<br />rbovc nrnrnnrd pn)pcny ft irtpr.l
<br />,tpplicnnt or Ag(nl Siannturc
<br />Dan 4 /,'""
<br />Site-Work
<br />Underqround
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Roof Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Itleter Belease
<br />Rouqh {/,v/l\9I)61
<br />Service Meter
<br />FINAL 6/r?16 3b6-i
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />Pole Bases
<br />Sub-Panels
<br />Air Conditioners
<br />I .cnitrhrr rh.lcdcrtlrcsuhriotrs rlrdirS rshc{or rc'nnrlrrc tror rrDt'lici$lc h rhi' Inrjr.r
<br />".,"1.2u.
|