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ELECTRICAL.INSPECTOH RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER BUII,DER DELCARATION
<br />I hcrchy lrfiirn undcr pcMlty or Frjury rh{ I am .rcnpr rrorn lhc Con! rck,6 Li.cnsc bw fo, rtc foltowjns rc$.n (sN ?0.1 t 5
<br />Ilu\inc$ nnd Prorc$ion Code): Any Ciiy or Counry whic[ rcqun r a pcrmir ro cotrjru.r. atrcr. inptuvc, dcmhh or rpnn ,
<br />srucrtrc- !.ior to irs issuatuc, nno rcquiEs rhc applicanr lor $chNnnir ro fitca signcd d3rcmnr lhal hco.lh. n liccnscd purqad
<br />ro rhc prurisions olrhc Conlmcr.ls Lic.nscd ljs (C[,/..9. Codncrcin-! wirh Sccriotr 7000 .r Divisior ]t ol rhc Busilcf mi
<br />Pftnasnrns Codc)orrha, heorshc is crcnrlt th.rcfrom anil thc ba\is tur rhL dbgst cicmpr ion An, viot,k,n ot sccrid 7O:I.5byony
<br />0trlicanr tnr ! Fr.rir subjccrs rhc applicanr to a.ivil pc !ky!, nor nnrc rhin nvc hundrcd doltas (55uJ).
<br />l. rs own.r olrhc por.ny, or
<br />'ny
<br />emtlorrcs *nh oascs as rhcn $t comFnsarion, witt do lhc work a,r lh. slfrm G bri cnd.d oroficrcd for slc (Sc.7u4. Aosinc$ otrd Pror.$i.ns Cod€: Ttc Conrmdm\ Licns tiwdocimt Eplyroanoqffiorrl{ rmtEny ebhoildsor irfrercx drNn.oJd who d@s su.h s.* hiEs.tior hcrstforrhDueh hn or hc. owi cfrpk,rE:.
<br />Pr.vidcdlhat such iml,okmnh m nor inlcndcn o, oftrcn for sL. tr. thec& rh. huildins or in!6wmnr is sH withn o,rc )tsofconrrlclirn. rh. O{ncr Buildcr will hw rhc buden of rrovi.g rhai hc or sh. d d nor blitd or imphle $e poFny for rhc FurrD$ or
<br />_1. !s owrcr oh lE f6tcrty. am erclusivcly .onr,cring with li.ctr*d .ontr,ck,6 b o nrud rhc roj.rl (scc. 7014, Buyncs
<br />0M Pturd\t.Codc:ThcCont,.ror'sl-icenscL{wd.cinollptlyro.nnqocrorptu|f,wh(,nuiBsornnprolcsrh&.oi.
<br />rid who onrnck ao. slch pnjccls wilh 0 Conrrlcn'(s) li.cn.cd pu^Mm h rhc Co racrors Licctrs rjw)
<br />_lr cxcnU ulldcr slrrirn__ IJ & p.C. rorihirr.an,i
<br />Dale Oer€r
<br />woRxERs C(|NIPFNSA',T()N
<br />IIEII.AA{ITON
<br />I hcrcb, a0i,m und$ p.trrhyorrdjuryonc ollhc lalbwins .lcchrariotrs
<br />I hnv€andwill nBinr.in rCcnificolcolCo.scnr roSeta-t.surc for qor*cr' sdprnsarion. as pmvidcd torbysdn,ilTmolrhe
<br />Lnhor Codc. nr (ht n rrormne ol tic wo.* ror {iich rhc pfml n kqx.d
<br />-l
<br />hrvc rnn sillDainIlin workcB .ofrpcnsltiotr n$urrncc, n\ rcqlired hy Sccrion rr(x) .r rhc lnhor Gdc, lnr thc ncdonMncc or
<br />lhc work r(r which rhis I,crmit is issNd M y *orke6 conrl.n\arion insurqncc caEi.r od potkt nxfrb.r !
<br />Poli.y Nrmhcr:_
<br />-l
<br />cdiry$!l in lhclcrfoirrEnccofrhd wort lor whichrhis pcrmil n hsucd.l shaltn.r.'npt.rdnyI{.$n inanyaurncry, Nro tieonE sxhrc.r h rhc wo*er ospcn{ion laws.ic.litornin,.6d lsrcc rhd ift should h.\.onr subjd r. rtr
<br />wo.kcs compctrsrrt,opmvnirn\ofSc.tionlT(xlofrlttrt,Codc.t\hdtlronhwirhomptywirhlho{pmvhionr
<br />WARNTN(;: Flilurc ro surc sorkcA conD.trs idr cor.ra[c is unhwtn]. n shrtt sDhjscr 0I cmptoy.r to dimin ! FMhics a.d
<br />civil nn.\ ut ro onc hundrcd rhoDs,nd dollln (Slu).ffxt)_ in ridnion to rhc con of.. rt i drtr'i!.\ , \ J,'!tr dc,l ktr rlr:';;E)t
<br />DEII.AMtrQN
<br />I hcrchy afrm uniL! Fnlllro{pcryury lhal Lh liansd utrdcr ptuvisio. olCh,pter 9(.onrrcmine wilhS&rion 7fl)O) atDnhion l
<br />ol lhc Busimrs ad Pmf.$ions Cod.. ,rd ny liccnsc is in tutl ro,cc srd cfrel
<br />e{ ft'/l conhc,c}l
<br />C(TNSTRIJCAION LENTIIN(: ACT'NCY
<br />I hcshy amrm ufldcr Fnrlry .a p.rjory lh.t thcrc h a d,nneriofl lcndinB .8crc, aor rh. l,ffo.mre of lh. work tor shi.h rht rErm is
<br />hrue.l (S(. 309'7. Civ. C,)
<br />APPI I(:AIIT DECI ARATI(IN
<br />I tl{h! l8im undcr pc.rhyoflcrjlryone oilhc,nl[,uins dcclonri.trs:
<br />Ocmlirion P.irnns Asbcdos Notificarion Fcdfial Rqulaliotrs (tnb{0, Pff6)
<br />Rcquired Lcllcr of Norifi .arion
<br />-l
<br />c.niry rhrr rhc iedcnl rc8llalonr rsudin8 ashc(olr.evatarc nor anfticabk b rhk pbjftr
<br />l..nirvll r lhr\( rcirl r[nrpfli.diru d ndr rhxr rlt ]tnc ifnr hr otr A.or.cr t)
<br />ordinarccs md Sldc hqs rcLriig b bu ild inA coniflci i.n. a hcrctr) rur
<br />Ay\€l- ar.l.-e ,w
<br />gc roconlnly wirh dllciry snd counry
<br />::;/zur
<br />Site-Work
<br />Li ht Standards
<br />Life Salet y /Low Voltage
<br />Fire Alarm / Dam pers
<br />Communications Cable
<br />Bu ild i ng
<br />Translormers
<br />Sub-Panels
<br />Air Conditioners
<br />Roof T E ut ent
<br />Facto Wired Unit
<br />Ceilin s Hard & Soff it Rou h
<br />Ceilin s T-Bar Rou h
<br />lvleter Release
<br />Rou h qlzaltfr r{q )
<br />Service lvleter I ',l u {'\
<br />FINAL Ir*l$-,K K.\4TI
<br />Notes Remarks, Etc.
<br />Underoround
<br />Pole Bases
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Under SIab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueinq
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Li.cnscclrs:
<br />-
<br />Liccn\c Nuarhcr
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