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ELECTRICAL.INSPECTOR HECOHD
<br />DATE ID/SIG COMMENTS OWNER BTIILDER DELCARATION
<br />I hc.$, afinn undcr Fnalry of pcrjrry rhsr I d cxc.rrr fron rhc Cnnfr.krs t-i.cnsc trw ror rhc idlowilrg rc$otr (Scc?03! 5
<br />Busi.c.s md Prorcssn,n codc)r Any Ciry or Counry $i.h r.qu,ros i Firnn lo conslrud. sh6. inlrovc. dconlth ;r rcnrn Jn)
<br />nruclurc- prio! ro ns hsuarcc, aho.cquncs rhc oppliclnl l'or suchpcrn tlo filc a sigredsrrremnr ihar tEor shc h li.cnrd Nrsudt
<br />ro rhc pmvnions ofrtE Conlrrcioas Lians.n L{w (Chotr.r 9. ComnrminB with Ssrion ?o(Xr ol Dirkion 3 6f'h surn'.$ and
<br />Pmlcsn,nsCodc)orthrrhcorsh.ncicmrrthc,cfromlndthchNistorrhclllcscdcxcDprn,n.4.,vi.lr(ionofSdlion70ll56y.ny
<br />trtpli.snr for a pcrnn \ubjc.( rhc appli.anr roacivilr.uhrolaor nr,ftrhdn fivc hundtddollei (!5m)
<br />-1.
<br />$ oetrc. of thc pmtEny. or my cn{brrc\ wirn e08cs as thcn sb .omFcnsirhn. Nill do rh. wort aftl lhc \rMl@ n @r
<br />iircnd.d or oltcrcd for sle ( Sc 7(x4. Alrinc$ aod &ofc$ions Code l hc Conrrscroi i Lt.ns. Lns docs nor dl)pl,
<br />'o
<br />,n owrcr or
<br />rhc p^rli.ry whd builds or id{,rDvcs tlEmn, uld rho docs sx.h wlk hinscllo. hcrcllor lhml8n hh or hcr own cmplorc.s.
<br />Frvidcd rhrr soch i {mrmnk m nr i'neadcd oroftrn lor$h li ho*chi rllc hikling or iryhkmnr is$ld*irhin.nc t d
<br />ofconrrlclion- th€ Owmr Buius *ill havc lhc hurdcn oi [ovin8 rhot hc or she did mt tIild or irorolc rhe pm,'cdy ft, rh. purto* or
<br />l. o{ncrorrheF)pdny.,ncr.lu\ivcltcontrcrit$irhliccnrdLonkr.t,6b.onstu.rltrrn)jcd(scc 7{x,1.llu\irtrrr
<br />ixl l,bt\sion Codc TncCotrtrcrors Liccnsc L.$ docl mr nnrlyto rtro$ncr or nrcncny*ho huilds or nnpr,lcs rh.rcon.
<br />!trd who .onlri.( for su.hlojccrsw[h0conrtu.n"(o licctr{d puNr0trr
<br />'.rhcContrdols
<br />l-icetrs ljrr.
<br />-l
<br />amcx.nlpr u.dcr Sccln U & P.C-.lirrhis rerson.
<br />raatr[&l-collllNs rIoN
<br />DECIAAAIIO!
<br />I lErby .ftirn uidcr p:nrlrr ot pclurr o c or rhr lnlbwi'{ d.chrrn,n\
<br />Ihr\cmdwill uinrainnCcdifi.rrcofcon* rt,Sclflr\u'eturqorkcf{.o rtr sarion,d pmvidcdlnbySc.li{nrl7(r0ollhc
<br />rM sillnuirtrir wortcrs' .onpctrsarion iNurr .c. rs ruquircdbySccliotr:l7U)ollhclitxtrCo!c.nnrhcncrfonntmrof
<br />ir n h\ucd Mywortcn conwnsarion iNunmc .aricr a'ld Fni.y nun,bcr m
<br />a-r\
<br />0l \r
<br />I ccnify rh in rhc pcrf{trmicc.frh. *ork lnr whth rhi\ pcdir is k\u.rl. I shrll tror cnrploy nry pcrsnr in ony mlnncr
<br />b !s ro h.conf, {,tjc' lo
<br />'hc
<br />}'orkc6 .otrDcn{rion l{rr olCrlilhrni!. lnd a8rcc rhrr irl should hcom suhFr brhc
<br />worteE onpctrqlion nmvGions olSccrion.lT00ofrhc Lltbr Codc.l\hall.lonhwnh conuly wirh rho$ ptuvisn'ns.
<br />IiARN!NG: I'durc b $curc wortcr .unp.Nrtio. covcmSc rs unlawlal. rnd shnll suhicr on cmploycr ro rininal Nnahis and
<br />civil nms up r. otrc hundrcd rhousrnd doll.6 {SltX),(XXr). h rddilidr ro rhc..q ofcontcnsalion. drmgcs !\ p.ovided for rhc
<br />htr Ctd.. inrcrc{i rnor
<br />Dirt r8
<br />DIST.8]!II1A
<br />r-i.-*cr"* C4(b,B vo
<br />,,,," ar l5hg
<br />galirf,lcrQtrI[xDtNc-ecENq
<br />I h.rby stnrn und.r Fn,l.y. r pcrjury rhnr rhcrc is a.on(dcrion Lnding,gcncy ror rhc rcrfonnincc ofrhe work lor which rhi\ Flnrir h
<br />hsucd (scc .lrYr7, Ci!. C ).
<br />nrrofln,litnr is.on$l. l.3rcc Ioc.nuny snh rllCilyrnd Counly
<br />aulhorizc rcmc{ntarives ollhn Ciryand Counrylo ctrrer uF)n lnc
<br />IA *," 115/lL
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding i UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Rough lttltt r>,'/lhL- t o2--'
<br />Service lVleter
<br />FINAL /o/alil 't 'Ah^flP 162
<br />Notes, Remarks, Etc.| - tl1)
<br />APPROVALS
<br />Meter Release
<br />runanmn.colrl,c tror[ lnrq[]ch rhr |Ennir i\ i*ur{l
<br />I h.rchy alfiirnund.. t nrlly of p.rjury rhnl I 0n lic.nst u.do rmvision olChoflcr 9 (smnrcming qith Scdion 7(x)O) ofDiirion l
<br />of rhc Ausitus* and Pbfcssn,nc Codc, ,nd ny li.cn{ ir in txll fd.! and cffc!.
<br />l!nd.''\ AddFs(
<br />AP]LICAILDES,AAAIION
<br />I trEby lnlm undc, Fnalry orrerju,y ooc ofthe follosin8 dNhrrrion{l
<br />D.mlilion Pciinik-Asbcstos Nolificllion Fcdcrsl Rcgularions lTitlc40. Pon6)
<br />-Rcquircd
<br />Lxs.r Notifi cation
<br />c.nil.vrlhr rllc fudcHl rcllhr i{,n\ r.!rnli'ig r\}.no\ ronn'vrl u. trorrfflicnhh ri rh'\ frol.cr
<br />:
<br />I
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