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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER B(nLDER DELCARA'NON
<br />t hcrcbr rmim und.r Fn,hy orpcrjury rhor I am cx..rfl lmrn rhc Conrra.r.rs l-iccnsc Lr* aor rhc filllo*in8 r.tr$n (Sc.70315
<br />Businc$ and Pmfcssion Codc): Any Cil, or Counry snich rcqutcs r Fr.rir t, .on(d.r. tl'cr. inDmvc, dcmlish nr mFn an)
<br />iocrurc. r,ior ro irs hslatuc, !l\o rquircs rhc dptlic r rd suchFnnir to iilc !.i8md (etc'mnr lha! tf,or \hc L licctr€d putru, r
<br />ro lhc pmvnions ol lhc Conl,acrors l,iccnscd lj* (Chaprcr 9. Co'lrmkine wi'h sc.rion 7u)0 of Dirkion 3 of rhc B!\im$ and
<br />Pn,te$i.nsCode) orrhar h.urshd i{crcnfl rh$dfi.mDnd ih.b is rorthcallcscdcxcnrDlion Anyvidrrio.orSc.thT0:rl.5hy,ny
<br />,tplicr.rr(rrp.rnitruhj6rqrhcapllrrnttoa.ivilpcMlryorminNrclhrnnrchufrlrcddollad(S5(n)
<br />-l-Nosmrolrhcpmpcny.ormrcmpk,rrcswirhwrrc\!srhctv,lc.o'ni\,rtru.silldoih.sotk0ndrhc{Mrumnrtnintu'l.ldl oroft nd tu $lcIsd 7044. Busi,rcs Md kolo$bns Codc IhcConrricrol\ l.iccnsc La* docs nor lPpl!hrtro*n$ol
<br />rhcpmDcny who hrildso! iq)mEs rhc@n. xl who des such tr{l]i l,iD\c lf or tur{lf or rhtuugh hi\ or hcr own cn,tl(,ycc\.
<br />pnrvid.d rhrr such n pn,vc,mi( r( nDr inr.*lLd r onird nn a'lc Il k)scrr. rhr huikliDa .r inpmrctrEnr is {nd *irhin om ltr
<br />ofcoDlPkrion. rhc O*nq Brikicr trillhtrrt rh. hdRhn ofpntrins rl.,[ h( or \lf, dil mr hxikl or inDm\r rhc pNFny for rhc purF,r of'
<br />-1.
<br />asowncrolihc prol.ny. rncr.lusivcly.offi.tin8 wirh h.cnscd conlmcron lo consrtud rhe prcF<r (sd..7()4.1. Busi'rcsr
<br />0nd Pnrissbn Codc: The Conlra.lols Liccnsc l-0w dcs nor apFlylo ano*n.r orpmr.fly wh. builds o. ihr.ovcs Ihctcon-
<br />3nd who snrEcrr fir skh lmJeck sirh a Cn d.k{s)Iic.ns.d N6u,trr k' r he Ct.t&lor's Ltcnse Law)
<br />lrn.ren,lirJ.'S.(r(tr, .ll.\l)('l,rlltr\r.i!,r
<br />lhrr (nrn.r
<br />ronKfBs:g)MtlNsAltaN
<br />lJli!:tattruax
<br />I hc'cbrrfl n uhdrrpctrrlry.f l]crjuryoNr'fr$li,lk'singdccl.rrri({r\:
<br />I hrlc nd will mrihuir r Ccnificdc ol Conenr b s.li lnsurc lin solkcF sr.nctr{rn,n. u\ providrdlorbys.crionlT0Ooilhc
<br />l,ah.r Codc.lorlnc Frfonnan.cofrht work f.r which rhc pcrhir is isxcd
<br />I havc and will mainrrin wo.kms .on{rnsdr ion nrurflEc. rs rcqtrncd h, Sd ion :l7lro of rh. ljhor C\d.. lor Ihc PcrfonMrce ol
<br />rhd work Lr shi.h rhhr.nnir is islucd. Myworkctr mmpcns0riotr insurnrccc!tricr udpolicy numhfidc:
<br />Pl,li.yNumhr:' tixoircs
<br />ll.cnilirhd inrhc pcrfonMnccollhew.rk lor !'hth lh \ t'crnril ir i\!kJ,I shrlltror c itl(,,n.t P.son inanynunncr
<br />{!slobcom{$jdx,rhcsr.^m'nptnsi'ionla*\.,Glili,n,ir. nd ngrL{ rhtl ii l should lE{.m sul,jd h r}E
<br />worlcn comEn{rionpmvi\t,n\ofSdrnnr.lTlX)ofrh.ljlirCi..lshnlltunhwilh.omllysirhlhosorovni.ns.
<br />'l4ARNlNcr Fdilur. b $curc vortcm caflrp.trstinn covcrn8(
<br />!.!rl rinc\ df rn t,nc hundr.J rh.,u,nnd d.llJn {lliOrxxli. In
<br />Sc!rrcn 1076ofrhL L'bor C.tjc idc,csl,n,l Jnorrcy.lcc\
<br />,^,", . 5 -74- ( n,,u**,>1
<br />rl trfl.tr\lnl xtul n lL {,h
<br />H5*,,,'*'r*'*
<br />Ihcrhvniltmu .rp. xlr!oltc'juyrlr lr |i..tr{d undcr f'.\i ol Chrprcr 9 (comrEncil8 *ith Sc.rbn 7tr0o) ofDivi\irr l
<br />ol rlr Btr\in.s nl ln)lc\si(rN ('(nlc. rr n,r_ li.cn\c n h lnllior.c tl.lla.r
<br />p, ai o, cvr,a4,,,,",,," *7;z'
<br />5 -uLlq..,^,.",".ta
<br />I lrruby rrfiflnu0dcr tlcnrlry.ipcrjury thit rhcrc h. oflsrrucliotr bndins rycicy ror rh. SrlonMm..lrhc work tur shict thi\ IErnrir ir
<br />t\rcd rscc .1097, Civ. C )
<br />I cdilyrh ihc fcdcElrc-qulations rcsardin8 shcsros rcnE\nlarc nor rpPli.$L u rhis tojccl
<br />Acd'b rhrr I hrc rcdd rh'\ {firlnsr'.n Jrl {Jrc rh
<br />'
<br />h. uh,vc idniindiur i\ cotrccl. l 4B ro ompl, s irh trll Ciry rnd c.u ty
<br />nrdi',rn.c\ rtr Srrrr Lrw\ rul,tisr)hor n! tuJ,rc\cnrI nrs olrhi\ Ciryrtrd (-ou ryni ctrrcr trJrn] rhc
<br />rhovc nf,ntn,n.d pn,pcny rar in
<br />,\pDlirrDr or A*cnr siEnatur.L
<br />Prmilce nanE lptrnt,; t(OL1!L L.Ar-fYv"-
<br />5-z-d
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Salety /Low Vollaqe
<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 />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Itlleler Release
<br />Rouoh
<br />Service IVleter /,^\
<br />FINAL L-1-11 Y4llr()l
<br />Notes, Remarks, Etc.r\7
<br />t
<br />APPLICANI NECLARATION
<br />I hd.r,y afiim u6d.r pcn,hy of p.rjury one ol ltr. following dlchralions:
<br />Dcmlirion P.rmir Arb. os Norilicalion Fcd.ral Rcguhrions (Tilrc 40. P!n6)
<br />-Rcquiftd
<br />lrnc! ol Norifulion
<br />tt
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