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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER AUILDER DEI,CARATION
<br />I h.rchy aiim under pculr, of rcrjury rhar I d etry,r fmo rh. cl)nt&k'd Lidn* tjw fin rlr louo*irrs Eaviniscc.?O]l,5
<br />Brsin sl ,ii Pof.*ion Cod.): A.y C y or Counly qhf,h rqut.s ! Fnril t,r con{tucr. alr.r. in{,tuvc. d.mllsh or nPat .hy
<br />srtudurc. prior h irs isstr cc. .L$ rc{uircs lhc orpli.or lor su.6 lf,rhir b fiL ! sisn.d dal.nrnt rhlt hc or dE n [ccnsd Pu6uont
<br />hrh.lnvi\knrdr r Cont,ctoas Lr..*d tjq (ChNI .r 9. Conrmn.ins tirh Se.rnrn 7000 or Divi{on I ol lh. Burincss atul
<br />Pnrlcsn'nsCoJc)orlhathcorshcncrcmprrhcrcfrom,irh.basirturhcrllc-s.d.knprtun.Aryvtuhtionofscclion?03!5byany
<br />apilllclnr ihraFrmit subje.rsrh. applicanrroacivilpcnalryofnorfrtr rhm lrv. hu ndrcd .loll&s 1 S 5OO)
<br />-1,
<br />!s oqner of tb. ,roFdy. or my cmtloyes wilh *agcs !s rhci src conp.nerNn. wdl d. rlr wu* and ilE stutw i1 trol
<br />lcelc! or.ncRl for slc (Se.'7044, Blriress and hrnt$ions Oitc 1'h. Crontadoi r Ltcnsc ljw des nol anply ro u o*ncr of
<br />rhc tln,rrdy w,i) builds or mpmss rh.rctr, ul who dcs ruch w)* himscl{or hcrclaor rhotrgh his or h.r own.mployccs,
<br />poriJcd rlur such ino.bwtunk e mr inrcnhJ or otrcRl for srlc Il. ho*rr. rhc tuiiling o! iqm)rcnrnr is $11 wi$ ncFr
<br />o, .orylcti4 rlE Owmr Bui!., will hak ll. hunt n of t rvua rh.r h. or \hc Jil hl h! l or mtmvc rhc pnrtEly ts rh. p{qr,{ ol
<br />l. !sowrc.olrhc F'pcny, ahcrrlosivcly ronkrdin8 wnh lic.nsd .onkrcl,,n r) lllslruct ItE Fl.1rr (Sc{. 7044. BNu.s
<br />anJ Plrn6srh Cdtc Th. Ctlnr.ctrr's Lrcnsc l-aw d€s nol rpply t' .tr owocr 01 ,rcnen y eho build! .r mpovcs lhcrcon.
<br />anJ who conrracrs for ruch ttuick wirh d Conrhdo(, lk.n*d pur u ro lhc ConlBul,tr s l,Enic lj ).
<br />_l ancxcmpr unJc. S.lril)n , R. & P.C. LrlhsEaa,n
<br />!YA8tr!8SJ:O!III!SATION
<br />DECLAEAIION
<br />I h.r.by.nnm undcr l].n.lryofEriuryonc olrhc nfi,wins nccklaibns:
<br />I h.vc lnlwill mrintrinaCcnilic{rcolConscnr roSclH$!rc lor *orkdr conp.nsarion. as r,ovidci lor by Selio.]700 ofrhe
<br />tlk,r CoJ.. ror (h€ l.dormec of lh. m* lor wnich lhc pcmil is icslcd
<br />I h{v. MJ wrll rarl.i,r }orkcrr .orwnsol ion ir$r.r.c. r\ rcquir.J hlSc(( lT00otrhc ltrrhor abdc. l])r rhc Fenor nune r,
<br />(hc $ork ltr whrcllrhis p.n r is issuc'l My w{rkcr' .rDpcn$ri,n in\urr(.udrr MJ )l,rynunrhd dc
<br />CaEicr:-
<br />P.lry Nunrhlr
<br />-Etpnc\:
<br />l.cniiylh ir rhc pcnnnnlncc ollhc work tur qhich r[ir pcro,ir N isncd,I shallnot cnrtby any Pcson in any oanncr
<br />s a\ kr h.oN ruhje' k) rh. workcn'.nmltnsd ion Lws ol Crllli,nri]r. ad laNc rh.' iiI shorll lE$m subilt t' th.
<br />pork(J conFnsatrn tnrvisions olsc.rbn l?molrhc L.htr orlc. I shdl. lbnhwnbd,dtly *irh ths t'ruvh{nr..
<br />W INING: Fnrltrrc ro $(m *orkc ompctr\iion covcrdec i( url,*ltl- r shdl tubl.lr e.nrtltrr k) riminal Fralri:r anl
<br />civil tincs uI) k' onc lNet n rhou\r'rl JoUaB (5l0o.0ul). in Jiion t)
<br />Scrx.n 11076 ol rh. LahrCor., hr.rc{ dJ ormyricc\
<br />r.nrNn{rur. Jrnue.s rs nmvll.J lor rhc
<br />DECIA8AIION
<br />I hcrcby rt1trm uftlcr lcnalryorp.riury rhit I sm liLcnsd undcr tovisiotr ofChaptcr 9 (om'rcncin8 wnh Sccrion 7000).t oivision l
<br />oi d. Brsincs atul Pro|ssDns Cod.. dri ny lacnk is in tull foM rl cha.l
<br />I h.Ehy atrrm u.dcr FMlry of p.rrury lh.l rhc is a coNtNctirn Lndins asctuy for $. p.rfome ol ltf, Mtk for *6th lhis Fmil n
<br />nsucd (Se, 1097. Civ, C.),
<br />APEIICANLDECIAAAIIOB
<br />I tEr.hy lltim undq p.ru li y of p.rJu,y otu of rh. lollowmE J.cl&x( n,n<:
<br />ocnnlir6tr Pcmik-,^shcskx Noriiicarbn Fedcnl Rc8uLrons (Tnt 40, Pan6)
<br />R.(ttrr.(l lrrcr.r Norli.&on
<br />I r.n,ly rhrrrh.l.J.rrl'.!uhrtr)nr rc!ddtri! r({{,,! r( nn rl dr tr.lindrrhl. t'rlri\ pr+.r
<br />oilnrnccs dll Srrrc L.ws(l!rins ro tniuin8 uonsrrcr y rurkrtc dpd{ntrlrv.s of rhrs ciry md county to cntcr uB,n rhc
<br />rlx,\. nf,nrtrtrul I,'otNr)i l,n
<br />,\pt'lnxnl o.,\x0lSixnaltrn
<br />Site-Work I
<br />Underoround -E\\o t*.'fl)0-)7,-J1 L"t{-il
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundinq / UFER fi-17-lrt V"W,/tlrt4q Uoe?.*at L krobrt,
<br />Transformers '*ar€-t ,ot
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Rough
<br />lt
<br />FINAL Tlqw lWt.ryM,,{6
<br />Notes, Remarks, Etc I
<br />q.7 <- lq
<br />o,* ?- zt-/ q
<br />Under Slab / Floor
<br />lt/eter Release
<br />Service Meter
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