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()l\NtiR tiI' _I)tiR t)t.l_(.tR,t1 rrN <br />I hcrcby rfiinn undcr Fcn.,ry of pcrjury lnal I .rn cx.nrr fmn rhd conkrlm Liccnc L.w l'or rhc lollosing rersi (scc.70.ll t <br />Btsinc* sna Prcfe$ion Codc): An, Ciry or Counr, whicn rcquircs a lf,rnrir t, $n{tu.i. alrcr. inpovc, dcnrlnh or EPat ooy <br />qrd.rur.. Itrn, ro irs isurc.. al$ Equirs rhc rpplk,nr lo s ch Frmir tu lll.. ri8n.d {ar.mn' rhar ncorsh. h liccnsol ru6uanr <br />ro rhc povnions of thc Conrr0ck,\ Liccnsed l-ow (Chsrtcr 9- Conn.crcinr sirn Secrnr 7(xlr ol Division:l ofttr susincs rtrd <br />Pturc\si{nFCodcl orrh h.orshc i\.xcnpr rhcrcrr.d!.d rhc hasi\ r{xrhc,llcg.d drcmprion. An} violarionofssrionTOll5 hyany <br />appli.dnrrd,pcmirsxbjc.hthcnpplicrnrtor.ivilrcmhyornormoolhMfivchnndrcddollois(1500) <br />-1. <br />!s owNr of ll* polcny. or.rycmployccs *irh erScsaslhci sLconrpcnsrion- *illdo rtr work !d rhe srtrim n nor <br />nn.n&d or ofiered ao. qlc lsm 7014. Burinc* rnd Prorc$trns Cqle: Thc G)nrmcrrtr r Li.rn* tjw rlrr not .p/y ro !. owncr ol <br />lhc pmtf,ny who builds or iqmrcs rhc@n, a.d *to dtu\ such wo,i hins.laor hc^.lfor rhmu8h hn or ficro*n.hpl.tc.s. <br />,rovnbd rtutr soch imprnvoftih m mr inr.ndcJ or orc&]d f.r {lc la hwcw. rl* huikling or in{)r,vcnEnr is hkl tr iriin nm ,ru <br />ol conltrion. ltE Owrcr Buildcr willhlE thc t{dcn oipmvirs th hc or shc dil nor huild or impmrc rhc InrrErly r{, lh. puqns or <br />l. !\o$ncrofric propcny- !'.crclusivelyconrra.rin8 wirh liccnscd coniocktr\ bcoDdtuci rhc pRtcr (sc.. ?044. Bu$trc$ <br />rtrd Pi.fL\si,n Codc: rhc Cont0ckr\ Liccnsc L.w docs nor apply k, osnrr.tp()I)cny who huild! or improv.s rhcr.oi. <br />$d sho.ontnctslorsuchnnJcd\trirhnConr.scr{r(nliccnscdl)u^urnrhrhcConta.ror'st-i..nsdtjq) <br />-l <br />snrcxcmpl under Scclion <br />ZZ-r-2.,".- <br />Vr4oIECLASAIION <br />Ih.r.hyriilnrndcrpcMlrrofpdruryoncDfrhcfollosi'rg c.ldrri(trr\: <br />-l <br />hrve dwillnEinrrinaCcnilEarcorcon\e ro Sclf lNure hr worte^ on'pcn\dion. as Fovidcd lnr by Sarion 3rtx) ol rhc <br />bt$r Cdc. for th. pc.loinutrcc orihc wo* lor which tlt p.nnn i\ issucd. <br />rlt sork lnwhich rhisllnnir i\ isul{. Mysorkor! con,Fn\xrn,n n,\trrx .c. rirr nNl polryrutrthcr rc <br />Poli.yN!nbcr:- <br />l.cnllirhr inihc |[ifonM.cc oithe work hr shichrhn p.nnir is isucd.Is Lln.r cnuloyrny!.rcn inrny mdif <br />qi xsro bc.orrc suhjNr ro rhc workcs cohp€nsdn,n hwr olCtrlifooin. rnd +(. ihrr ifI shDuld b.()nf, $rhFrr ro lhc <br />*orkcF conDen\nrion pmvisions otS.crion 1700oIrhr l, orCode.l shf,iL tunhqith.omfly s i'h rtu\. F)visi.ns <br />WARNIN(; I,ailurc ro ccurc srkcn' N'rycnq(ion covcRsc is unlN,tul. r \hrll subJccr a. cmtl.rcr k, mnl'ral Fmlril ond <br />civil fincs up lo o.c hundrcd thouslnd <br />Salion 3076 of lhc Lltor Code. inlercn <br />Drt.:_ <br />I ktby alfirmhdcr t.nohrolFerjlryl <br />of lh. Busine$ arn PofcrsioN Codc, <br />dollxr\ ($lix).lx[)). iI iddiri,, r r) rh. .on coop.ourtr dnrugcs as Fovidc{, fosrhc <br />hi I u liccr$dundcr F)visionof( l |r1.r9 <br />Md nry ll.cf\c n i'r fulllnrc dcllicr <br />LiccnscClsss:- <br />CoNSTRU(:TXIN I NND!N(; A(;ENCY <br />I hcrcby ilitnr undcr Fnallyolrrjurylhal thcrc n a constNction tndinB rscmy Io, thc pcrfdmnce ofrh. wotk ror whi.I lhn Fnnil !i <br />irsucil (S(. .r097. Civ. C ) <br />d.TIUIANI.IIIII;ITISAIIQN <br />I )ra$y llinn undcr pcnalryolp.rjury onc orrhc tulkwn,r d..larrinrds <br />D.mlirion Pcrnrih Ashcsros Notilicariotr Fcdcral Rcsullrions ('lirlcl0. Paa6) <br />-RL.qu <br />ncd hno nf Norili. hn <br />-l <br />ccnilyihil rh. fedcrrl rc8ullrion\ E8ulirg $h({os r.nFval are mrtlPnlic$h t, rh( rrcj.cr <br />Ir.nityrh lhrvctoadrhilrft,li.trriotra strr.rhrrrlrrhvrilannxriori\..trcd IrBrccrorotrUlyair[!llCirylndCotrnry <br />ordinnnccsr Srar.,-rs\tolringbbuiunrg.otr{fl.rnrn,ndhcrcby rhorizcrctrc{ alivcsoflhnCilyitrdCouniyiortrrcrtr|rnrh. <br />H:-^Jil:"'#Z <br />APPROVALS DATE ID/SIG.COMMENTS <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Satety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Bonding / Groundino / UFEB <br />Transformers <br />To rquerng <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soflit Rouqh <br />Ceilings (T-Bar Rouqh) <br />Bough <br />Service ltr'leter qw*tilrFINALI1zoh9'li.?9) <br />Notes, Remarks, Etc.VTI <br />Pcm ler ninr(prinl): <br />%e6 <br />ELECTRICAL-INSPECTOR RECORD <br />L.ndd\ AddrE$: <br />- <br />Site-Work <br />Under Slab / Floor <br />Meter Release