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ELECTHICAL-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNER BUIL]'ER DELCARAIION <br />, hcrchy siftrrn undcr peMlry of pedury rhlr I m cxc,npr liom rhc Contacro^ Ltcn* t2w toi rhc lbllowinS Elsn lss.?031j <br />Bu\inc$ an{j Ptr,fcsi,,n Codcl Any Cny or Coun.y which r.quircs r Fynrit Io consrDcl- llrcr, imllrovc. dcnolilh .r [p,n any <br />slfl.lurc, prior ro irs hsu.ncc, lho rcquirs thc on icanr {or such pc.n ro lilc r ailn d {dcmni rhor h. ot shc is liccnsd Pur$ul. <br />ru rh. !tr,vi\n,ns o, tlt Cdnra.ror's Liccnsd t2w (chtrptcr 9, Co'mrmins wirh Seclion ?000 of Divkion I ofrnc Busincss.nd <br />PmicsionsC{dc)orlhathcorshctcicmpllhcretmmandrh.h6\is{orrhcrlkgcdcrcBlrhn.AnyriohlhnofSNrhnT0llSbrany <br />lpplicanr lor ! pcrmir subF.rsrhc appli.anr r. d.ivilpcnrllyornor mrcthd livc hun<lrcd dolles ($500). <br />-1. <br />a{ owncr of rhc flolEnr. or nry en]rlorlcs sirh slscs Ds rhcir vrc .omp(nslnnr. will do lhc wolt lnd ltf, nturm n <br />inrcdcd or o,Icrcd ao. srk lsd.7ol4. ausinc$ and Pr'lcssions Codc: fic Conrncbr's l-ncn\c li* doer..r amly to an oPncrol <br />rhc pm!.n, wtu hxikls or in{,mrs rhcetr. aftl who des such no hinNcllo,!.rslforrhhnghhisorhcrowncmpLyccs, <br />pmvidcJrharsu.h iryrcw'rcnt aB n i.tndcd or ollir.d ftn dc I f. ho*cvcr, rh. hoildin8 or irymrcmnl h sold $irhin onc yc( <br />oicotr{'hrbn. rh€ Owncr Buiucr williavc rhc burdcn olpoving rhd hc or sh. dd ftn build or inqm,E rhc pmp.ny lor rlt purlx,sol <br />_l. owncrolrh.popcdy.r'ncrclolivcly..ntr.rnigsilhli.ci*d.onrhcx6loconsln'cirhc,Iric.i(S..7Ul,1.8unm$ <br />a.d hJfdsion Codcr 'lhc Contrc(tr's Liccnsc l-aw d..s nor otplyro rnown.rolpr.pc y shl) buildsor imlrorcs rhcreon- <br />nnd who conrnc.lor such pfl'J.{r\ wirh a Arntu.ft'n, liccn*d r$rtrt k, rhc Conrrlcroir l,tcn\c lj*) <br />-l <br />amcicnrpl utrdc! Scclil <br />OrEi <br />ItORXX ILS' C( IM PFNSATI(TN <br />qI(;LABAIOT <br />I hc.cbr arfinn undcr rcnolryofrrrFryoncotrhc tolk wins dccl,$rion\ <br />-IhrvcurdwillruinllinaCcnificrlcolConscnrloSclllnslrclo,*orkds.onlPcn\alion.a!t'mvidcdfort'ySdion:l70oorrh.Ijbor Codc. tor rh. Frrortumc ollhc *olt lo. which the pcrnrn h nsucd <br />I hr\c fld willmiinroin $orkcrr co lncn\lrnr i!\urrnrd. r\ ru,lrncd by S.cr ion lr{)0 of rhc l,hor Odc- ftn rhc ltrrrorfrn.c ol <br />hsucd My*orkc6 con,|x!\rrt,n in\drxntd.rftrr dDJ Anlcy trutr$.r u. <br />_l ccdilyrhur in rhc p.nnnMmcorrhc work ld whi.h rhs fcrnrir rr hucd.l shrllnor cnpl{)yrny tcN'n inn.ytnMncr <br />n' N ro hc.oN nrh]cd b thc vorkcn comDcnsar ion laNs oi C.lilo.irr rnd lgtc rhd if I should ttcom subFl ro rL <br />w.rkcr' .onDcnsarion ,rovhion\ ot Scd n,n :l7t$ of rhc llhn Codr. I shnll. rdhsilh conl',ly wirh thoE prcrnins <br />BARNINC l.rilurc r, scuru workcr\ .o tf,trlrr.t.rvcrxsc i\ nih*t|. tnd \h!ll \uh]ccr , en,rloyc' k' mnitrl p(tihics rd <br />ilflffff'Iir'?it Tri., <br />I h.Ehy firn und* r.nrxy ol l.rjury rhar I !m liansn undcr tmrnion ofChafld 9 (c.mmin8 wirh Sccrion 7(x)0) orDivision 3 <br />ol rhc Buiirers and Pmfe$ionr Cod., aJxi ny lt.nk is in rull for.c criacl. <br />I <br />,i{ljN Ll <br />COISIAIJCITONUNPINGIAE!(I <br />I hcrcby amr6lndcr p.nalry.rlxrjury th.l rhtrc isa conslrucli.n hndinS a8cmy tnr rhe pcta.FEncc oflh. work ir,hth rhir Fnnir h <br />i$ucd (Scc. 309?, Civ. C.) <br />APIIICANIIEII.ABAIION <br />I hor6y,Jfmn undfi p.rrlly ofrcrjury onc oflhe followin8 d(laErions: <br />Demolirion Pqnirs Asbcrro\ N.in. ion Fcdcr0l R.Suktio.s (Iilh ,10. Pan6) <br />R.quir.d t itrr of Norificalion <br />-leniayth <br />rne icdeBl rcgxhri.ns rgdrding rsb.s'6 rcmvd arc not lptli.ohlc lo rhh poj.cr <br />4 .enit, rhd I hr\r cd rhir ap,rlic,rion rd narc Ihot lhc olFv. inrbmr.tion i\ .oft.r I rEe ro comtly enh 3ll city and G)unl, <br />ordi'unes ond srdr. LiB rcl,line 10 building construclion. aln hcrcby aurhonu c rcPE*nr iw\ oa rhis ciry arld Counly to cnlcr uFn lh€ <br />atn,vc nEnlion.d po,rcny lor in\INrn,n puryx'sus. <br />Appli(nnl or AEenl SiEnnluru <br />P€mirft nome ( prino, .t>.L-,",1Ut*, r I 20lB <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Lile Salety /Low Voltaqe <br />Fire Alarm i Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilinos (Hard & Sollit Rouoh <br />Ceilings (T-Bar Rough) <br />Ivleter Release <br />Rough tg u0t4 k1. <br />Service lvleter <br />FINAL /"F> *l <br />Noles, Remarks, Etc <br />ID/SIG. <br />/tK <br />\c. <br />| .FJ ',\ N "nr <br />I <br />-T <br />I <br />l6hol