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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tDistG.COMMENTS
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Ere Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels ?9o4.r .@
<br />Roof Top Equipment
<br />Facto ry Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceili ngs (T-Bar Rough)
<br />[/]eter Release
<br />Rou gh 2-96'lb J)Lt47 9)
<br />Service lvleter
<br />FINAL ,4e -/a ,U".*J",€9
<br />N otes, Remarks, EIc.
<br />OWNUII BUILDTIR DI]LCARATION
<br />I hcrchy lliirn under ri.nah, of pcljury rhar I am crcmpl from rhc Conrruclnl Liccn\c L.w nn rhc lollosins rc!q,n\Scc.70ll5
<br />Busi.css !.d Profc$ion Gdc)r An] Cily or C.unly which rcquirc\ ! t'rrmir lo con(rucr. alrs. iq,mve- dcd,li{h or rcFir an!.
<br />srru.r!.c- Irir ro n\ irsuare.. aho rcquncsrhc applicanr fo. such pcrnrit ro rilc ! sisncd srdcm rhar tEorsn. i\ lic.nscd puBnanr
<br />lo rhc rmvnions ofltr ConlBclor's Liccnsd trp (chlprn 9, conncmin! with Sc.lio 7un ol Divkrn I of rfic Businc$ lnd
<br />Porc$n,n\ Cdc) o! ih8r hcor \hc is cxempr rhcrlom md rhcllsis,nr rhc aliL8cd ciempln,n Anyviohrionorsc.ri,n?O:rl5hytrny
<br />aprlicrtrr ror a p.inir subjcrsrhc drnli.snr i{, dcirilpc0slrroanor drcrhai nvc huidrcddollu^ (S500).
<br />l. as oNner of rhc InrrEnI, or nry cmrLrcs s il h w!3cs rr rhci! slc conrDcnslrtnr. will do rhc *o.k ud lhc $turw i\ En
<br />iNc'dL{ or ollcrd fr slc (Sd.7(ll]l, Bu\incs! atrd Aorcsions Cod.: Thc C(n rrckr'\ l-i..ns Ijw docs nor amlt ro rtr oqrcr of
<br />rhc nRrr--ny *tn' huilCs or in{,roE\ rhcc,n. dnl wh) d,rs su.h srk hin\claor har\.ll or ihorgh hk or hcr own cmpk,lccs.
<br />providcd thrr u.h iDporcNns arc nor nrcnlcd or.fi.Nd ld *rL ll ho*rtrr. rhc lioildir3 or i.WmlcnEnr t $U sirhin "nc K
<br />.f.ompldi,n. rhc Oqmr Build( sillhalr rlr burd.n otpmvin8 rhrr tr or \hc dA ftn lrild or imFft rhc lJn,tf,it ntr rh. J)xitx,*.f
<br />_1. as owmr ofrhc popcdy. rflcxclusivclyconr(rinq pirh licned codrd.roN ro mn{tud rtr
<br />',oj.rl
<br />(SN 704t, B6inc$
<br />and Pnfdsbn Codc: Thc Conkncror's Li.cn.c Ll* d@s nor aplly ro 'no*n r n,proF , wtr, builds.r if,lrorcs rh.r.on.
<br />and who conrBcc to. such lmjccls uirh a Contmcrorls) lic..sd pusunr ro thc Conrrucrois Lt ns &w)
<br />-l
<br />amciempt under Salion-. B. & P.C lbr lhis rceetr
<br />D.lc: Omr:
<br />]YO.Itr8tr5-CQMTENSAIIA!
<br />l2EClrtItAIllrN
<br />I hcrcby ontm undcr Ftrllryofpcrjryotrc oflnc nnhqinS dcclrrrions:
<br />-l
<br />havc.,nwill min'0in. Ccniff,.'c ofConscnr k,S.lilNnrcr.r*orkc.s omp.n$rion. as Imvi:lcd for bySNtion 1700 ollhc
<br />hbor C./c. for (h. p..fo.nM. ofrhc wo* a.! whkh rhc pcmir i h\x.d
<br />_l harc and will mliniain workcr' compcnsarion insunrcc, as rcaui.d by SNr ion lTtD ol lhc Llbor Codc. aor rlt I{rfontumc of
<br />rhc wo* for *nich lhis pcmir is issucd MyworkcB ${rnqlbn i.sumnccstris t poliy numtEr 6c
<br />I..diry rhar rn rhc,).rf.rror. ofIhc qork fttr qhirh ihi\ |x,n,ir i\ i\\o. , I \hrll or cn{,k,y nny rcsDtr in rtry nutr,$
<br />q,ar&,lrc.nrvhjccrlorhc$orkcn'coNp(nsrrt)n1.w\of(llin)rni3-r rsrft rhlrirl slx,ulJ hcconr su6j.d n,rhc
<br />sorkc( ronr.tr\rrt,n povi\iotr\ otSccri,)n .r?(x) ollhc l,htr C.dc.l rhall. r('dh*irh c,Dnly rirh iho{ pmvhn^.
<br />WARNING [iilurc Io Ecurc mrkcn' comFcnsol io. mlcruBc n unkrlul. rnd shrll suhj.cr s empbrr h .nditul pc@hics and
<br />civil finer ut lo orc hundred lhousand dollnG (51(D.0uJ). ir oddilion to rhc cost of compcnstion. damgc\ as pmlidcd lor rhc
<br />Scction 1076 oflhc Liktr C.dc. inrcrc$ &d.normy s ILES
<br />lr.l.r Appltqnt:
<br />' rctrrsr.riiiriiirCi.on-
<br />D&CI,ABAIION
<br />I hcEby amrn und€r Fnalryotperjuy rh{r I am liccn*n undcr rmlhtun ofChuprcr 9l.onftncinB wirh S(rion 70m) orDirision l
<br />of lhc Busincss md PblesionsCodc. d 'nyliccns i in aull rorcc.ril crTccl
<br />Co rRlo.
<br />c()NIlBucuQN.L[!D.lNG-dti!N!.1
<br />lhcRby rffinn utulcr p.nnlry of pcrjorr rhd rhcr. i\ r con{rucri,n lcndin! trgcncy nn th. p.rformicc ofrh. sork ld qhi.h rln\ pcnnir h
<br />hsbcd{Scc :1097.Civ.C )
<br />APIUqAILI]&CLAsAIPN
<br />I h.et y afamr unncr pcnall) of pcrjury onc of lhc following dftla.d bn\
<br />D.mlnhn Pcfl nn+Asb.nos Noritl..rion Fcdchl R.SxlDrionr (Titlc :(1, Pad6)
<br />Rcqui.cd Lcnn of Norificalhn
<br />-l
<br />ccnilyrhar rhc fcdcral Esubrions rcsarnin8 astcslos rcnmvrl arc no' opnlicahlc ro rih 0rojccl.
<br />-l
<br />cLnify rli lhavc,cadrhhatllkario.andrrlrcrhdrhcah,Einlomurionii.orccr I a8re io .onDi, snh lll Cily and (bunly
<br />ordinrnccs and Srarc t $ relarins ro buildiry construclion. !d hcrchy nuthorizc icprcutarivcs ofrhn Ciryaod Colnry ro cnr6 ulx,i rhc
<br />,horc .rcnriorcd porcny for insncclion l,urllxcs.
<br />lppli(anl o. ,\,!.nl SiInnlrrrc
<br />I
<br />Pole Bases
<br />Air Conditioners
<br />l-i.c s. Cln\r l-ic.tr\r Numlrr
<br />I
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