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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DiL(:ARATION
<br />I hcrchy aflth utulcr pcnally,n tcrlxry rhat I m cxcmPr in,n rlt c.nta.to6 Lr.nt Lrw tx rhc ltUowins rcain (S'c 70lr:'
<br />Blsincs rtui ProLsion Co{cl: Any Cny or Counry *h'ch tquir.s a Pcmir ki onslrull. altd, ialh,vc. demnih o' rpatr 'nv
<br />{rucrud, tri,Jr lo irs nsuanc, aL$ rcqulrcs rhc iptlt]nt tu such lErmi nr lilc a ngnql (alcmnr rh{ lE or shc n liccnscd pusurnl
<br />k) rhc F.vNnrr of lhc Co.karkn \ Lr.cnkd ljw ichatrcr 9, Conrmcfring *irt Stnon ?ort) ol Drvhbn r of rhe B!'nc$
<br />'tu1
<br />Pftrcsons Codc) o, rhar lt di sh. $ ercnDr lhcrctnm,.d rh. b.sis lnrlhc alLgrl cxcmprion AnvvnnitionolSccri't70'11'5bvrnv
<br />rmlMnr tor ! pcmir \ubj.tc rhc lrPlitanr b !civilFcnaltyofnor mnurh,n live hutrdrcJdollais (S500)
<br />l- al ow.cr ol rhe proncny, or my cmDlo)c$ virh wa8.\ a\ th.t $lc compcns, on. vrll !o llE work dtui rhc slnf,rm '( frn
<br />id.nJal orolttRl tur ek {S(.r(!4. Busitus Md PrtLsions C{ c Thc Conkiur.i s Li&nt Lrw &.s nor ,plly lo an owrcr oa
<br />rh. ptuFdy wl$ huitrls or rmpn,v.s ltrNnr $l whr nes \Eh wor* h,mscllor h.rkltor rhnrgh hi\ or h.r.wr cnPkly"s.
<br />nnvidc'l rhd iuch ihpnrvcnr s rc nor u c cJ dr offd.rl for et. li h,mvcr, llE btrilliry or ihlrortmnt F sll wirhD oB )te
<br />ofconDlcri& rhc Owmr Au dcr wrll haw rhe hrilcn of lbvinS lh.r lE or rh. &l mr tsru ot !r{mE rh. t)fi)lErv Iq rhc nnqt'{ of
<br />I,a\dwn.rolrhcrmndy.rfr.rclu$vcly.onrracrirywhlicctr{d..Drrrcr*k,conrN(lrh.tbjcd(Sc.7lr44.Bnr0rc$
<br />rd PDiesbn CL\ic: Th.Conrra.ntr \ l-ir.n\c l-dw docs Dor!!plylo rnow.crol pnl--ny Nho burlds or imrruv's rh'rco!,
<br />dnd who c.nnar s li]r \xch pnt.ts w h a ConiE(k,(n Lccn*d ptrnurnr b rhc c..r&rr's l,'..nsc Lrq).
<br />I
<br />lr uE.llaxAllgN
<br />n,nhJcr IlCnJlr] IrLtury !trr olthc li,ll.tq'ng J(lrrlon\
<br />th{vcanlwillhrn rin d Ccnili.ar. ofcons. !o SclllnslE n, *.rk!R onrP.n:d on, .s Irrrvidcd fot bt Scdion :l?00 'f rhc
<br />btu C{xlc, lnr lnc p.rfom.c ot thc *oA ror wh'.h Ih. !c ir i\ is!.'l
<br />I ha!. aBl w,llmlinr{in work ra com!.ns.lion insurarcc. a! t quir.i hyScrn'n.l7l$ol rhc tihor Cod. r.rlhc Pcrlom ccot
<br />llr ,ork fd whrh lhis lrcmir ir ir{cd. My woIkc6 clhl'cns on,nsur.n e ff.r r.d poltv.!mlt m:
<br />l.cniiyrhar in rh. n nnrmrn.c ol rhc worl toi whi(h lhis pcrmli '\ rsEl l shrll lor .ntpbv .nv l'c6on 'n 'nvm!trmr$rsk,lr(mrruhjcdlo(hck.riconrp.nrirn'nhwrotCal'hi,nr.inJasEcrhrrflshruldttort'uhjcct(rlrE
<br />woRcr ( con\|ENit ion pmvis'on\ ol S.clion 1r0O ol rhc Lt tr Codc. l shall n)nhw(h .omflv wir h ih,{ pftJvhbnr
<br />WARNIN(;r rdntrrc r() {eurc wo'kcr\ compcnrlrtrin colcrr3o r\ trnla*ltl. 3trtl drxll $hl..r,rn cf,ltl('y.r b uinnnrl Ixn'ltis rnJ
<br />c'vll tur\ up r, otrc hundr.'l (hou\xnd d.1li6lSl($.(XXl), $ rddrn, n, r,t (x( .l B'nvf,Nrrion d!nE3c\ r\ PntvBt'ri td' rhc
<br />scdi)n:1076 orthc tjl{ cni., mcrc( d tmy'srccr'
<br />DECLARATIoII
<br />undcr po6n'. olch,/cr9 (lonmtuing wilh Scclbn 7(110) ofDivnn,n.rI hcr.hy dlliD undc! !.ml(yol pcrlury lhar t m l'/d\;d
<br />.l rh. Bn{ncs MJ PsrtsionlCudc, dkl my ltcn$ is
<br />CONSTRUCTXTN LXNDIN(: A(iENCY
<br />IhcrcbyallirnrrnJcrl. JryoitErluryn rh.rc is . con(n'.rbn !.ntl'n8 a3ctuv fitr rh. r.rli)rmrNe ol rhc ktrk lnr whth rhs lrmir s
<br />i\\rl rSc( l(ri)?. C'v C )
<br />AXPIICA{LDECIABATIO!
<br />I lEEhy r,lim under pnnky ol Frjury on ol rhc folkrwrn8 dalurn'n\l
<br />Drmoldxr PcrmllAstl.(or Norincrron tulcral R.srhn,ns (Ttr1c40, Pd6)
<br />_R.qumd t rrsot Notliurin,
<br />I (cnrltrlr.r rhc tcdcr.l!cEUldirn\ ft8uJ!rB.shcsros lcnbvxl t. noriPolrci6lc b rhis phjc.r
<br />I ceniiyrhd I h,v.r.dlhGlprli. urutslar.Ih!
<br />o^linanccs rnd Sir. ljws rcLrin3 h buildi^3 9.n(ruclir
<br />ltnv. rrcnrtr)rc'l p'ot dy tu insFdlrn pkt es
<br />rrh.itxn. n,liirnr(!,n a(onc!r liSre n
<br />nr x l ltEhiatrrln,c r.Prc\..hrrv.! or
<br />) complyPith trllciryan{t counly
<br />ADplic.nt or Aq.nl Sian.krre
<br />\Z-L--orr <.,-Jo,tira"'I
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Ivleter Release
<br />Rouqh
<br />Service Meter 1, 1
<br />FINAL 0/z z/tZ z AHza/(:
<br />tJnrl.r s AJJr$'
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