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ELECTRICAL-INSPECTOR REGORD
<br />APPROVALS DATE ID/SIG.OWNER BUII,DER DELCARAI'ION
<br />t hcrcby offinn und.r p.nrlry {,4 p.rjury rh,r Ln cxcrfl ln,n rnc Conlocror' t,k€n* Lrw rd rhc r.lhwina rcrwn (Scc 70:ll 5
<br />B!{in.(s ,M Pn,fcsion Codc) Any Cil} or Counry shth rcqunG a Fmir ro onsrruct. llrcr. i,nProtc. dcnx,lish or tolEt anf
<br />nocfurc. priq ro irs t\uec, ako rdquirc\ rh. nppli.ad tur such lcrmit to ilc a signcd ia'cmo' rhd hc or sh. t licco\ed PUNr.r -
<br />Io rhc povisions of llf, Contr.clor's Liceni.d Irw (Chapr.r 9, Co rmtrcirrS wilh Sccrk,n 7OO0 ot Divilion I oI tlrc Busincs and
<br />Pmiessions Codc) or rnd hc or shc n.xcnpr rhercfrom nnd rhc h{sn for ihc rlksed eierfln n ny !kr.ri.n of Sd ioi 70:ll5 byanl
<br />rppli.ntrrrora!.rnrirsuhjdhrtc{llicanrroacivilpenolryofnornrkrhn6fiv.hu.drcddoll.m(t500)
<br />-1.
<br />a\ owncrorrhcrh,rrry,(tr my cmployces with qtrecsrs lhctsobconil).n\ario,r, willdo thcwodo ir&nturm n n r
<br />nncndcd orolTcrcd for xic (Scc.70l4. Bu\inc\s sn,i Prolc*n,is cdl.:-rhc (tntnclois l,icensc LN doc\ nor,p/y ro moq'ncr ol
<br />rhc ptrrcny el.i, hlilds or i'qiR,rs rh.m[ drd Nho drEs su.h *orl hinsclf or h. c]forIhsuehhisorh.!owncmployccs,
<br />f)vid.d rhar su.h i'npnJrcmtrh .e mr inrendcd or ol!'!d lirr srlc lI how.w. rhc huildirg or impmvcNtrr is n,ld *irhin o.c }tar
<br />oicomDlcriotr. rhc Owmr Build$ will hrvc rhc budc. ollK,virr! rhd hcor rhc dil n boiu.r nqrovc rhc Pmpcny lor rhc loqrM.f
<br />-1.
<br />n*ncr ot lhc pmpcny, rn.x.lu\ircly .onlm.tin8 qilh licctrrd co rlclur r. onnNd rhc lmF_r (Ss 7044 Btr.i"cs
<br />and Pn,fssin C.dcr'lhc Cotrts.kr's Licensc Law docs frrl!,]ply k, nn.f,ncr offmncnyqho huilds or impovcs rh$con-
<br />.nd *ho co rrIs lor such proj.{s wnh a Ctrnrm.rod n li.ctrsd t'ursulnlrorheG).tacroas Lkcnsc L!w).
<br />,"" 122 ,",'.'.a)
<br />a
<br />TICLAIAIII]N
<br />I hcrchy a{fi mundcr r.orlryof ,.rj!ryoncorthc r(nh*in8 dcclmliors:
<br />-t
<br />hlvc uxlwillmrinrlinrC.dificricorconsctrr bsclllnsurc ihrBorkcn onPen\lrtrn. as Povnbd tirhlSccrio,lT0oolrhc
<br />Lohor Codc, rn lhc pc ormancc orrhc *brk n which
<br />'hc Pcnnir i\ hsucd
<br />I hdvc rnd will Drn u ir workcrr comrEnsalin nsuDnce. N rcqrircd h, S&1ion l71D oi lhc lihor Codc. &r rhc |)crfoirmncc ol
<br />rhc trork for whi.h lhi\ pcirnil is ksucd Mysorkcn LsupItrstrrnr l \urincccimicr iDd F,licy oumt[r rc
<br />Polky Nun$.r-Exptes:
<br />-lccniiy rhd in rhc pcrforroncc oarhc *ork for whi.h rhir p.nnir n isucd. I sh!ll nor.nfkry rny p.i(on in rny nrmncr
<br />$ N h h.cnm sulrjccr t, rbe w{rleh .on{'.nsdio. l.ws olCllifonria. .nd llsrce ihrr irl sh.uld tNo'r ubrccl b rt*
<br />wortc mmpcnsdion provtions orSecrion -r70Oorrh. trlrn Cod..l slu l, lonhwirh.onDly wirh rhos lmvnions
<br />WARNINC, Frilur b {.um workcrs
<br />civil litrcs u,) ro otrc hundrcd thousoDd
<br />sclr otr l(,TC.rrh. utnr CoJc. ir crc{
<br />^',,.
<br />7/ r'//td
<br />[, f0,"r",,***-u,,*,*,,
<br />2,(
<br />rhc Buqms rid ttortshnscodc.
<br />.orn|cnsdi.rr.o!cri8c i\ unhNtul. rid \hr
<br />dolhn (Sl(xr.{)([0. i', rdililion kJ rlr .o!
<br />ll subjccr ar clnploycr lo cnnrinnl lf,trrkics md
<br />ofconrpcNlri{in. ddfrae.r ds t)l.vttcd for rhc
<br />4
<br />hd I am li.cns\d lndo ptuvision ofCnaplq 9(commeing wirh Scrh. ?(xX)) orl)ivision:l
<br />,nd nyli.rtr\c t in full f.ro lid cffccl.
<br />IONSIf,!]qUONITNII!!}GEN.CI
<br />I hcrchy trflirm urder Fnalryofpcrjuryrhar lh.rc is a.o.(o.lk. hndinS asency tu rhc !.rfonnrNc.frhc wort for which rhh rcmir h
<br />issudd (s(. r097. ci!. c ).
<br />AIILICAILIIECIdIdIIAN
<br />I h@6y ar6r unJ.r pcnrh y ol Frjury one ofthc follosins dccladli'n\r
<br />Dcmlirion Pcirnih.Ash{(os Norirr.arion Fcdcral RcSuhrnnN (1 illc 40. PlnO
<br />-Rcquncd
<br />L.rrcr oa fknif$rir
<br />l..dilyrhd lhu ladcnl lcsularion\ Esrdins tshcdo\ rctrx'lrl nrc nor {Plic{ble lo rl,ispfl+cr
<br />I l.. irirl r l hrvd rrx,l rl'i\ ft)li.ar.f iM srr hrl rhc,ny)v. iflotriri,,, i\cotucr lllsrcck,.oDnly wirI rll (iry rnd (iuniy
<br />hls Ciryr Cou.ryh cnrcr urxn' rhc.'(Li'r' r.\ x Sr)rdl.x$\'.lrrnsrob ildi|!|ulluriTc r.Ino\cnrrrircs ol I
<br />abovc nririurcd |nolrcnylbr in\pccr
<br />.\DDlicnnl or '\(r l Si!trnl
<br />4/-23
<br />,.,",9/tvlL
<br />Site-Work
<br />Underqround Yuya-lA-
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER E-z-vzi-/61-/ lt -
<br />Torqueinq
<br />Sub-Panels 'ytrofi-/ t7-
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)77to/z-/d7,
<br />Walls (Rough)77/o74-/1'?--
<br />Ceilinos (Hard & Soffit Rouqh -a-udh-16?
<br />Ceilings (T-Bar Rough){I
<br />lVleter Release tn /tr/*a/B;TNAnb,'-/t/\-I\l I
<br />Rouoh &1r-.T7>-/az-
<br />Service lVleter A
<br />FINAL '241.4V Y,Y40t
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />'l- E
<br />It*
<br />Translormers
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