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ELECTRICAL-INSPECTOR RECOBD
<br />DATE ID/SIG.COMMENTS OIVNER BUILDER DELCA RAIION
<br />I hcEhy afim undcr rcndly (,f Fcrjury lhat I !m.xc,npl ri{D lhc G'nrmcror' t,ic.nsc tis tu rl[ lbllowin8 re!$n (Sc.?O.ll 5
<br />Busincss rnd Prorcssion Codc) Atry Ciry.r Colnr, which rc+ids r l.nnil In connruct. alrs. iryrrcve. d.lFlkh ur rllJn dy
<br />stru€rurc. prior lo ns nina@. al$ 6quir.s rhc atplicant ror su.h lt.rtritlo iilc r sisrcd suremnr rhd h. or sh. is liccnrd pusuanl
<br />ro rhc rolisio.. of thc Conrraclors Liccnsd Lls lchaprcr L Conntn.ing wirh Scclion 7000 of Divhn,n 3 orrhc Busincas and
<br />Pmtc$ions Codc ) or rhlr heorshc h.r.npr lhcr{fomind lhc basis lor rhc aucsed crcnrplio Any vn,hlionofScclion 70:ll5 hylny
<br />aprlicanr lor a F,nir \trhjdtsrh. applica.r b acivilpc.alltolnot morclhlnfilc hu'xlr.d dollds I S5fiD.
<br />l. ns owncr or lh( |n)lEny. or my cmpk,yas *il h w,gci 0r rhcn $h .o rr.trs0linn. Pill do rhc *trk dd rh. {tu1rn is mt
<br />i cndc{ or ofcrcd lnr salc (se.?0{4. Businc$ nnd Irtolcsio.c Codc Thc Conlr.ctt s t,i.€n\e riw do.s nor nPpl} lo anoencrol
<br />rhcpmlMy who huilds or in[,nE rlEren, Bd who dtrs stch Mrt hinsclror hcr(lftr rluoush his or hcr own emrloyc.s.
<br />prclid.d rhar such inl,l rfnr.rs sc mr i.rcden or alicrc( tu $k lt k,*cti rll hrikli4 ot nv.oEmd t $B siihin onc ,u
<br />or drnukrion. rhc Ow cr auibr will havc rlE hurdcn of tmlnrB thd hc or shc did ml bxiki or imFov. dc pmFny nn lh. puqx,* or
<br />-1.
<br />n\ owNr ol rh. !npcn!, so.r.lus(cly .onacrinS with li.cnscd corrradoFlocond ci rrr l,ott' (Sc. 7(}14. Bu\ircs
<br />and Plsf.(ir Codc Thc Contnchl s Liccnrc l,aw docs not apply b rn osncr of ProtE y who builds or inrPrort! rh.rstr.
<br />lnd sho contncls lor such pft'1..k snh a (\nrh.ro(s) li.cnscd lunulnr Iolhc G)nt,ct, r Lkc.\. h*).
<br />lrn,rrd fr trnJcrS..rnnr ll ,\l'( l,,rhA,.x$r
<br />I)Rlc ()$nrr
<br />]lQA(Ii&r:raullitsArroN
<br />I2DILIBAUA!
<br />I lf,rcht lffirnr r dcr |1{ nlry or Nrlur y onc ol nrc rolhsnrt dNlirol ions:
<br />lhr\rdxiwill HinrriflaCcnificltcolConscnrrosellln\rrclnrwor*.Fcomlxn{rion.astovidcdlorhysc.riotrlT00olthe
<br />l-,hin Codc, rorrhcn rronn0nccofrhc wolt lo, which thc pcnnit n is$cd
<br />Ihrvcandwillmrinronrworkcracompenslri{n1instrrn'rc..cqun.dhys(rio.lT0OoirhctltxtCod.,ntrrhcPcrionurccol
<br />rhc w.rr nrshicn'nir ncn.il is i\qcd My*orkcn comp.trsarn,n i.\umtrc.nf,icr ad poli.yntrmh.rdc:
<br />Poli.yNunrbcr
<br />-llptcs
<br />-lccnily
<br />lh.t ir lhc pcrfor@ncc otrhc sork rn whi.h rhr pcnnir is i$ucd. I shrll nor cn1l,loy nny P.ron in rny ntnnrr
<br />{r $ h bcc.ft \uhjccr ro rhc sor krs conl|Lf s0r i,u h$s ., Colilir i!. Md rgtocrhd ilI\hould hcconE suhrcd ro rh.
<br />$orkc( comp.n\In,nF,vision\olScction.lTtx)oflhcLatnrCodc.l\h,ll,f{flhwfh.onr y wirh r hos provnin\
<br />WARNIN(: Iililur k, sc.u( qorkcr (rnpctr{dtr .ov.
<br />civil lln.\ up h oN hrRtrcd rhousrDd dolIrs (Sl0O.{xX))
<br />s..rir,.lr)76of rh. l rhrC(xlc. i' orc{.Nt rrnct-s fcc\
<br />fl8c i( nn[wtu|. and slr]l cnr ols ro crirind t^--tr hi$ md
<br />nnr. drmr8c\ r\ pmridcd f(r rlt
<br />ot(LT l ts
<br />I hcrby arfirn undc, r.n,hy ol !(riury lh.t I am liensn unnc! Ir viqion .r chapre 9 ( conn*ncin3 snh SNri,n 7000) ol Division l
<br />of rhc Businc$aod Pfl,r.*ionsCodc. md flryliccn* is in aull f.rcc a cafccr
<br />AIIUIANLI]ECI.ASAIIQN
<br />I hdxh,strmundc. p.nlxy ofrrjury orc oflhc following d(l !rionr
<br />Dcnnnitnn Permits-Ash{os Norirication F.dcr0l RcBuLlions finb 40- P!.16)
<br />-Rcquircd
<br />tlfi cr ol Mrin.dion
<br />l.cnifyrhd rhclcdcrilrqulari.ns rc8rrding r\bcnosrc mr3lrr. nor.mlicrhlc hlIh !r'JLrr
<br />-l
<br />ccnify lhal I huvc rcad Ihn uiplicorion aid srlic rhtrr thc dh'!c inaoiaulion is conccl. I dsr€e ro conPly with,ll Cily!trd Colnry
<br />ordinrturs ond Sratc tips rchrinr lo bu i ld ing .on{rucr ion, 0nd h.rcby,u$orir Eprcsctrluti!$ orlhh Ciry.nd Countylo.nlq ulxln rlE
<br />rb.v. mnrilrncd pmFny for insrcciion pu4ns\
<br />^r.,-,,".^",..--,.* [ tta r"r P l!*- ,..", al / t 7/' g
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monumenl)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Boof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Roug h //
<br />Service lvleter //JD./11 ,/-)
<br />FINAL /,I -d.tnzo fr0{'27,/
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Pole Bases
<br />Sub-Panels
<br />ot ( ? ?ltt,-**"
<br />CONSTRI1(:'fl ON LFNNIN(: (;}-NCY
<br />I hcEby omrm undcr pcnllryorpcrjxry rh"r rhdc n a.oniru.ri,n kndinS nScNy lor lh. p.rlatrtui.c orrh. wort lirt shth rhi\ redri' is
<br />iisucd (Sc...109?, Civ C.).
<br />t4ndf, . Addc\ _
<br />--_r-
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