|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAI'ATION
<br />I hcEhy stfirn undcr tE.bhy or prrjxry rh,r I m cxcnfr rmm (h. Conkd.ro6 Liccnse tjw r.r
<br />'hc
<br />iollowin8 rcasn (Scc 70ll 5
<br />Burinc$ 0M Pr.Lssi C.dc) Any City or Counlt whi.h icquircs 0 lxnnil ro consiruct. sllcr. inrrovc. demlisl or Nlan eny
<br />slru.luc. rior h ns iisunRc. also rcquncslhc applic0n' r'or such,rirnir to lilca sisned sr0tcmcnl rhal hcor shc is l,c.nscd pursun
<br />h rhr Jtrnvisi.hs.rlh. Cohlm.rols Licctrscd rf,* (Chaptft 9, ComnlRin8 with Scclio. 7{D0 ol Divhnnr I or rhc Busin.qfund
<br />lnilc$ions Codc) or lhoi hcorshc is cicnrrr th.rcfon and thc UsG lorrhcallcCcd.xemprion. Any vnrhri.noiSccliotr?011.5 6yony
<br />xptli.rlrin,prnirsubjcckrhcappli.anlror.ivilpcdlrrdrn.tmorcrh,ntivchundrcddollatr($5(xJ).
<br />-1.
<br />$ ow.cr oflhc ImFny. or ny cryloler wilh srscs 0s rh.n sb c.mr.osarion. *ill do rh€ *ort drl rh. $drm ir mr
<br />inrcndsl or oficrcd fo, sk (Sc 7s4. B!i.c* and Pmfcssions Codc: Thc Conkkrof * Li..ns ljw dfts n.l arply lo an osncr of
<br />rhc tln,rcny qho btrilds or inpmres rtEmn. !d lho drs such wod hirsclf.r heRllor rhri'tgh hi\ or hcr own cnrr)Lyccs-
<br />proli.lcd lhsr ruch inlpmk'ft.k e nor inrcidcd o onbrcd ld srh ll lk,sclc il'6 ltriHiru o. i.DmwEnr is $H wirhin om )tr
<br />ol con{,lclion. lhc Owmr Buildq *ill hlve lhc burdcn of pruvins thol hc or shc did nor hild or iryr.vc lhe pmrcny lor ltE purlIc of
<br />_1. ns oNmr of lhc popc.r y, amcrch\ivelycolticri'rs wirh liccn{d contactn\ tu otrsrd.r th. lmiccr (Sc. ?ol.t, au\ints
<br />snd \ho conlrachlor iuch pnr
<br />r . ,cmmdl'n.ld sc.lotr;" qttr fttr
<br />olsLic.nsc tjw docs nor 0pplyto owflc.ofl)ropcdts
<br />Fcr\$irha an nrrn)nn liccn\cd pr^uMr k,rhcG
<br />[,\CL
<br />PICLASAIION
<br />I hcrchyallnmunncrpcnilryolFrjurlone.rrhclnlkr*i'rEdcclxrrrioi\:
<br />-l
<br />havc and will nuintlin a Ccdificic orConrnrk, scll ln{trc rn s.rkds' .omp.nsario.. s pmvidcd lor hyScdn,n.lTlxrorrhc
<br />tjhtr Co{c, for rhc ltyfonMncc ol lhc *ort tor which rfic Frmil is is\ucd.
<br />I hrvc rndsill mrinrri'r sorkcr{ cotrrpctrsali,)n insurn .c. rs rcquncd hyScclion l?(xrol'rne liborGdc. for rhc |.rLntun.col
<br />rhcw.rkf{trwhichrhisp.nnirisisucdMyNorkcrr.onFns.rioniNurrtrrrc!trier dFnic,trumhrrd.:
<br />Policy Numbcr:-Erl,ncs
<br />I.cdify rhd iI rfu rurl.nnrrc. ollh. sork Ii, *hi.h rhis pcflnn is isucd. I \htll nor cn!rl(,y Liy t r$n ir rny nurncr
<br />n' trsi,6cconr ubjccrr, rhcsorkc^.ontF sari, hu\olCalironir.rndr8rcclh.rillshoulnhc.onEuhjcdhrhc
<br />sorkcrs..'nl.nsariqrpn,visnrtrsofSe..n:17(X).frh.IihrCodc.Iiml!.t,nh$irhomplysilhlhospmv(i(,N.
<br />lVlRNlNl;: Frilrrc n) wu. *orkoi.o rfcrsrii(fl .orcrnlc N u y.r ro diMin.l ilcmlris a
<br />dD'tore.s ,s proridcd lor rlrc
<br />,,e: I/tVl /{. nou,n^*,L
<br />Liens. Classr-Lic€nsc Nomlr
<br />D.l.: Conlr.cto.
<br />AITUCANLDECIABAIIOA
<br />I[nbydtinnundf pctrrlry ol pcrjury one ollhc lblloqirs dsl.rations:
<br />&nnnirn,n P.rnrns Aslror No(ilioiion Fcdcrrl R.Sul.rions lf itL.l0. Pan6)
<br />R.qun d lxnc! of Norf{rrirn
<br />I c.d'fyrlurrh.lcd(rlrc!tr]di,!r rcgrrdin8 ash.(o\rcnnnn Jc nor ftli.rhlc h rh^ pn+cr
<br />le.liryrhat I h0vcrcad lhirrpplicrli{nr nl
<br />odinamcs.nd Srar.liws rcl0rins ro buildins c
<br />is..ncct lige toomplt sirh all Cnyrnd (r !
<br />r.prcs.talivcs ol lhn Ciry
<br />ihnc N rirlrcd nn,Dcnylor ir\n$r
<br />,\prli trror,\xrnr Six trrorr tl t-
<br />[i;*r"
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Bough)
<br />Rough
<br />Service [tr]eter
<br />FINAL 77*//?h446/Z . tazz:--
<br />Notes, Remarks, Etc.tl /-I
<br />Site-Work
<br />Meter Release
<br />vV-l/\
<br />c'ril fir\ rn t,.N htrndrcd rhou\!trd dullir\ (Sl(x).(rXr. n
<br />I hcrchy affimundcr pcnrll] ol p.riury rhal I an licctr*d under pmvision orChuflcr 9(.omnrn.in8 rirh Sstion 7OO0) ofDivnnnr l
<br />ol rhc Buriftssa.d Pmf.sions Codc- and my liccflr n in iull lorce md clltct.
<br />IOISIBUEIII)NIENDIIG.AGENII
<br />I nerc$y trfltn undcr pcnalryofF.juryrhar rhsc is tr mndncri{)n knding rgcncy f.r rhc p.rlbtmtrcc ofrhc work for which rhis Ftmlr is
<br />hsucd iscc.3097. Civ. C.)
<br />tr1'Jc,'\ Nrna
<br />bnd.,\ Addre$
<br />-
<br />tt
|