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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueinq
<br />Air Conditioners
<br />Rool Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Rouqh
<br />FINAL lo-0-tr D"\4.j0)
<br />Notes Remarks Etc
<br />OWNER BUILDEi DELCr\&,\TION
<br />I hcrcby affiro Lnd.r pcnally of Frju.y rhlr I !o cxcnpr from rrr Conlrcron Liccn\. hs fot lbe tolloeinS r.rsn (Scc ?03 1 5
<br />Bxsincs\ nnd P.ofcsli)n Codc) Any Ciry.r C.unty which rcquncs r lErnir h mnsdcl, iltcr. iqrnrvc. &mlish or rclnt anv
<br />ntudurc. priorlo irs nsuaN. !h. rcqutcslhc aPlicml fo! such Pcmir b lil.t si8rcd starcmnl rhl lror shc k ltcneJ nu^u,nr
<br />ro rhe Eovirn,ns ofrh. Conka.lors l-ien\ed tiw (Chaplcr 9. Corurencirg wirh sccrion Il0O ol Di!isn,.I .r rn. Bu\incss $d
<br />Pmfcsnrns C.dc) or rhar hc o..h. is crcq, rhcrclrorn nnd thc b.sis i'or rhc allrgcd cxcmflion. Aoy viohrionolScclion 70:ll5bvanv
<br />applicanl lor o r'4r6ir xubj(k rhc enlicanl lo!.ivilpcnsllyofnor nbarhm fivc hlndEddollds (5500)
<br />-1.
<br />as o$neroi lhe pmpcny, or nry cnDloyccs,ith wsgcs as lheir solc ca,npensrn,n. willdo rh. $ort,nd rrE dtrluE n mr
<br />inrctrhd or ofi.rd fir elc (Sc.7M4. Busine\s dd Profcssiofi Crdc: Thc Cbntraclois Liccisc tjs docs nor !nn!v ro di osn.r ol
<br />rh. popcdy wtu hilds or iqmws rhe@n. sr*l *ho des su.h qort himsclfor h.r*lror rhmuBh his or hcr own.mployecs.
<br />orovidc{ rhar sucn imlFvcrnk m mr i find or .ffcrcd nr sh. ,l l[wcrcr. rhc huildinS or imProrcnur t sru wirhin onc )tat
<br />.f comphlion. rhc Oqrcr BuiEs wil n \t Ih. ttrnLn of pmvint rhar tE or \hc d'd mr brild or inlhE rh. p$p.ny fin rhc l qi,* of
<br />-1.
<br />as o* mr o hc pnrpcny, nmcx.lusirly.onrraclirslirh liccn{d.onr,cro$t'condtucr rtf, rmitt (Scc 7(}r'r.8u$ncr(
<br />und }bli:\\irnC.dc: IhcConlrocrois Liccn\c Lrw do.s nortfPlykr own$offnrFcdywhobuildsorimnrovcithcrco..
<br />ud who c.nl{cls ror su.h pmi(h wilh a C'onlrldo( 9 licn*d lx u.nr tolhc Conr,ocrois l-iccn\c Ltw).
<br />-l
<br />amcicnfl !nd.r s..rion-. B &P.C rn this rcason
<br />Ihi€: OPne.
<br />womrns ttitrPrxurrtrtr
<br />DFCLA IIATION
<br />I hcrcby amflnundd p.nalry ol pcrJury orc.f lhc a.llosinE d(lMrbns:
<br />I hnvc flnl {ill mnrlain ! Ccdifi.dc of Co.enr ro Scli lnsrrc lq sorkcN .onwnsarion. rs Fovidcd for bv Sal ion l7m of rhc
<br />tjbor Codc. for rhc p.:lormrcc oa rhc woik for whi.h lhc fEnnil is tsucd
<br />-l
<br />hnlc rnd {,ll rntrdir $orkcr'coa,pcn\rrn i'surid..,n(rcqutcdhyS.rrionlTLnolrhcLtbor(odc,f{trrhcl.rl.nurcc.I
<br />rhc aork for whi.h rhi( Dcrnrir is ilsucn My*ork.ri.o ,prnsrri( irr{uran.c urricr itrd |iricynrntbcr nc:
<br />cam'-
<br />Polic, Numh€r:-Exptcs:
<br />I c.ditythll ir lher.rfnruEkcofthc *.rk f.r ehrllhis pcnnil is hsucd,I \htrll.ot c,ryloylnyF6on nranymMncr
<br />$ $lo bcco E suhJcd b lhc workcr omPcn\arion lo*s oaC(liaor.ir. md a8rcc rhar ifl \tould ttcom subjcllo Ihc
<br />wo di conD.nsflriontrovisionsoiScclio!l?lx)ofrhcL,tDrConc.lshall.forrhwilhcon,rlysiihrhr*pmvhions
<br />WARNINC: Iiilurc l{, sccurc w.rk. compctrsrrion colcrrEc i\ trnh$tu|. rtr(l shlll luhjccr rn cnill,)ycr Io rimirul Fnrhi.\ Md
<br />ciril lin.\ un h onc h!tulrcd thous!trd dollln (SllD-000). in lldiri(r t) rhc c.s of conrP.nsarn,n. drnBtscs is lmriiqt rtr rh'
<br />:::yJ62y
<br />I hcrebylmrnrundcipcn,llyof,Eriutyrhor I a licdn*i undei pnrvkion ofChlplr 9{conmn.ing silh Scclion 7000) ofDivisian l
<br />of rhe Blsitu* and Phrc$ions Codc. and mrlicci* k in full rorcddcficcr.
<br />'felt:./?
<br />CONSTTTU(]T!0N I FNDIN(; AGEN(IV
<br />I hcrcby affrf,und.r pcnah, ofpcrjury rh rhd. icn oNruclhn h ins a!c*y Lr $c p.l.onlEme ol rht work ror rhich lhh pcmir i{
<br />issucd (Sec.3097, Civ C.)
<br />-l
<br />ccnifyrhi rhc rcd.rnlrtuhlion\ rcganln,8 a\hcno\ rc hvrlrrc nnlrPnlic$lc k, rlris Pn)ju.r
<br />I{dilrthdlhrvcrc rhi\atpli. ion riqrlcrh rltfi,v.inlni,n ri, r\.otrccr llgrl{t).o rt'lyBirh !ll Ciry rtrd cou.ry
<br />ryafrlCoonryro.nrd uB,nlh.onl'nrturs !nd srotc L!*\ El,hns r. hurlcinEcotr{9tr
<br />.hr.
<br />'tunrtr,ncil nmn nylor in\nftlion rdrF\.r /-/
<br />Appri.anror^.enrsrs..rur. \//
<br />P€mll* mme iprint,r I
<br />ion. oln ncrchyaurhorizc rcp,.rcnrdi
<br />74@?S
<br />Sub-Panels
<br />Meler Release
<br />Service [t/]eter
<br />txft.is Nernc
<br />-
<br />A?ILICAII"DECLAXAIIQN
<br />I h.Eby ojlm undcr ,.nall, of pcrrury orc of rh. lollowing ddlual bns
<br />Dc'nolition Pcrnits Asheslos Noliricarion F.d.ral Rcsulalions ('Inb40, Pan6)
<br />-Rcquncd
<br />kllerof lLriatarb.
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