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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DEI,CABATION
<br />I hcrchy ,fiirn uid.r pcnrlry or Frjury rhar I dm crcmp' tiod rhc Conm.h6 Li.cnsc rjw ior lne following rcaen (56.?0:11 5
<br />ausincs .M PRn'csion Codc) Any Cily or Counly which rcqrics . !c!n r. .on(rucr. !ncr. idp,ow. &mlirh 6i rcpnir dny
<br />struclurc. priorlo ns nsuincc- aho rcquncs lh€ .mlicul for su.h pcrmil b nlc a sisncd sllremni rhar h.or shc is li.cntd Pusurtrl
<br />r. rh. l,t)lisidos olrhc C.nlructtr s Li.cnsd tjw (ch{'cr L CosnMcnrS silh Scclnnr ?0m ol Divhioi .l orrhc Burincs nnd
<br />Pmf.$ionsCodc)Drrh.rh.orsh.ircxcmJ lhcr.iorna.d rhc bast for rh. alLsed cxenprion Anyvi,Urn,nofSetion?0lt 5byrny
<br />opplicrtrrloroIlrrmirsubr.ctsrhc.pplic.ntroacivilpcnanyolnorrmrclhonfilchuidrcdd.lltr^(S50o)
<br />_1. !s oqturolrhr prt,Il(ny.,trnyc Dn,yos wirhw+csarrh.ir v'l.inNialiotr. wllldo lhc N.rt and lhc \rBluc is nor
<br />inrcnd.J oroffcrdt lor eL lS(.7O14. Busimss rnd Pmlcsions (odd Th. Conrroclor'r l-icensc lj* docs nor{ply ro,n owNr of
<br />ihc pmp.dy who hilds or inll)r.lrs rh.mn. rd eho der :1rh urnk hnn{lf.r h.rclr or rhmu8h hh o' hs oqn.mPk,rccs.
<br />lrovidcd rhal such imnorcrmftd ft, inrs cdoroffcrdlnrsrlc l( lbwcv.r. rhc hihirS or inqmlcaE hsoldwithi",,nctt.tr
<br />or.o Dlcri.tr. rlf o*rc. Buildcr willhrvc rtr burd.nofpovir! lld hc or \hc did not buitl or inr!.ove rh. Ir,r'cny r(tr lhc purF'tof
<br />l. asotrncrorrhc t!t{ y.rNcxclu\ivclyc.nlr$riresirhliccn{dcodrrbnt,con{tucrrhcr(ic.r(sc.7rr,l4.Bu{ncss
<br />d tn ssbn Gdc: Thc Contrkr'\ l-ic.i\c Lrw dor\ tror q,! lt b rd .\ Nr , 'l F,N,l y s ho htrilds .r nnlmtcs rh.j.oi.
<br />rnd who ..nrndsld\uch tmjccr\RnhaGr rrrons) li..rNcd pur\urnl tr, rh. Co rrttr \ l-i.ti{ tiw)
<br />Ia rcxcnrpr uM$Sc.rtr a & PC Lrlhis r.rv,n
<br />Drlc. orner'
<br />woRx$ts coltPmsarloN
<br />IIEIIA.EA.IIAN
<br />I hcrchy 0lrtnr utrdcr p.nalty of Nrjuly.nc.f rhc lollowinE dcclar!rions
<br />I hrlc nuillnnrinrrh0Ccniic0rcoiconscnrroScllln\urerbrworkcn.omr.i\rrion.as lrDvnlcdiorbyS€lioD.l?rnollhc
<br />Irhtr C.d.. tu. rhc pdrr.nmm. ol rhc work for shich
<br />'hc Fnni is nsucd
<br />I hnv. trd willnriinriin so.kcr' conrpcn{l
<br />lhc qork lor vhich lhispcnnil h hsed Myso
<br />rc,tutrcd hj smrion.lTrt)ol rhr tib.r Cud..lor rhc n(YI.rnEmnl
<br />rkq.,2rt'cnsrnn inuBmr rlrh, ml !ol(y nu,nh., i,c:r
<br />I .cnil_y rl,rl ir rh. ncnni,nrn.c ofr ork lnr \hich rhi\ l[nnir N,\{1rn. I \l'nll tror .i!n.t rnt |tr.tr n' rny nrnNr
<br />q, rs b h.coft rubjc.r b
<br />'hr
<br />wolk$J conr.nsal i( l.qsolc,linntri.. d rsacrhar ilI \hould tf,co,ft \ubj..r ro rtr
<br />worrLrs.oinp.ns.oonpmvisioflsolSe..ri.nlr00oflhcLatnrCtuc,lshrll.fi'nhsnh$nlnlysirhrho$trovisions.
<br />$ARNIN{: l.rilLtr. b sc.urc rorkr^ !onll)rtr\xtof .o\is unh$lnl. nM \hrll qrhj.cr otr dnploy.r b cri'ni'rl fti hrs r d
<br />civil il'kr !n h onc hrndrc rhousrnd dolld\ (Sl in dtion b rlr.on ol'.onpcnsuli(in- tunB!.lrs tmrdc'l for rhc
<br />Sc.rion l!075 of rh. bh.Laodc nkftn and
<br />*.", fzlle
<br />^LIUj!LIJ)IAII!rI!IA.BD!!L!&!rUt
<br />I hcmhy ilrnr undcr lcn,hyollrrjurylhd I rm liansd uMcr lrelhion olChanr( I (cotmncing wilh sdion 70(x)) olDivhion l
<br />of ric Businc*{nd Pmtu*i.nsConc. drd 'nylt c.\c h in lull Lr.c .r*lrillcr
<br />a
<br />*, ?/zl/t g
<br />coxrlxuqlaNuillzlNc ErNLr
<br />Ihcrcbyailtmln.lcrpenrlryolrcrjurrrhdrhcri\rconsrDLIi,nkndinga!c..yforlh|t.lornnNcolrhcworkf(tr*hi.hlhhtf,nirt
<br />ksucd lsc..lur7. Civ. C.)t ndcr's Ntr.r:
<br />-
<br />AIILIIANLDIIIjIAIdJIIJIi
<br />I lrnbynfnmulrdcr |[nrlry.fncriury otrc orrhc n,llowins dcclnrrll.ns
<br />Dcnn)lirion Pci,nis Ash.sl.s Notificrli l'cdcml Rceuhrions (Iirlc.l0. Prn6r
<br />Rcqnircd Irncr oi Norirtlri{u
<br />-l
<br />c.nifyrnd rhc ltdcrrl rc8uhrin\ rcg ding a\lf,nos r.nDrrl nrc norlPflicrhlco rhisI',,}.r.
<br />I.rdifyrlrdr lhrvc rcad rhi\trpnlicirion md slarcrh.rrhufinc irfonniri,r hcotr..r lrgren,.onlPlt*irhrllCiryrklC unty
<br />irsconsd.tion,udhcrcbyourh.riTc,cp.cscnrrrivcrotrhilCny,ndcounlyroc cr !,nnrh.
<br />linc trr 1i,u.tlt'o|c'ry l(tr i'nNcr
<br />,\pDlir trl or .\,:. t SiAnrltr
<br />frcrn (& nanrc(nrinlr: ,1 Da-+?/2r'a,
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFEB
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lt/leter Release
<br />/,{
<br />Flough l0 -l-lY V-WY,)
<br />Service ltrleter U w
<br />FINAL ta-21-l(h-eu\r)
<br />Notes, Remarks, Etc.\-
<br />.--':-?
<br />t ndn s Addr"q.
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