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ELECTRICAL-INSPECTOR RECORD
<br />APPBOVALS DATE ID/SIG.COMMENTS OWNFJR BUIT,I}ER D6I-CAR,{TION
<br />I hcrchy !finn undcr Fn,hy {,r p.rjuy rhtrr I m excnDr rn,'n rhc Conradon Licen\c L,w fitr rhc ftrbwnrS erv;ll (s...7(,:il s
<br />Bu\i.css and Prof.\sn,n Codd): An, City or Coutrly which .dtuics n lcrnrir lo conid.r, rlrdr. inDnrvc. {.mohh or rctrt Jny
<br />sirucrurc. ttriffro ils issuaNc. rho rcquncs rhc appli.i.r for {.h Frin ro lilc r siBrrd srntcnE lhor h..r shc ir lkcn{d pursudnr
<br />ro rhc pnrvisions or rhc Conl&chls l,ienscd kw (Chrtlcr 9. Comrrcncirs wirh sccrn,n 7fiD of Division 3 ol lhe Brrnrss xnd
<br />Pmn$ionsCodclorlholh.orshe ncicdpltltretromlnd rh. blsh ror rlrallc8cdcxcmPlt'n. AnyvioldionorS&rhi70rl5byrtry
<br />rtplicanr tuatcnlir suhjsh rn rmli.anr k, r.,vilp.n.hy.rm' nrne rhar liv. hundrcd dollan (S5(r))
<br />I. { ownci.frh. pmlEny. o. trtycnploy€s uilh wrsc\ is rlrn s,t conrrn\rrnnr. willdo rlt work nnd fic slnLl!rc h nor
<br />irnc cd orofcrcd ld slc(Sa 7l!,1. Br\i,rs rnd Pn)fcsi,,n Codc IhccontrrclolsLic.nsct-oBdoesnorapplyt)anoqmrol
<br />rhc |Jn)Fny whohoildsor imtrct$ thcron, md *hodoc\ n'ch w)rk hnnsclforhdr\clforrhhtShhis or hcr own cnl'loyc*.
<br />p!,vidcd rhrr such in,pRrlcmnrs rr Nn inrc cdoroficrcd firnrL li ho$.mr. rlf, buildin! or nnprovc rir is sold *irhin onc rr
<br />or.on$hli{4 rh:Ownq Blikhl lillh,vc rh. t{,rdcn olroving rlra he or 'lr dil ml hoild or iryrorc rhc pnDdy i(" th. puln{ol
<br />Laso*wolrhcpfl,tory.r.r.hrncly.ontmh8*Ihli.cnscnro.rrackEroc.nitu.rrltrnttr(S.c.7(}l,l.ltu\incs
<br />. rhhsi,nCodc:rhcConrllcroisl-iccn\cl-awdoc\norat,plyi.mowD.t.fFoNnywhol,uildsori'ntrov*rhcrcotr.
<br />rnd lvho conrBk fff sxch !hlc.r\ wilh d Qrnlm.ron s) lf,cnscd lusu!trr to rlrc Contlrtn \ l,i.nsc l lw ).
<br />-lurcxcml
<br />trndcr sccr
<br />D.le O*r.
<br />woRxFRs' ('rwiFilsa'l (N
<br />DICI,AIAIION
<br />Ihcrcbyaflnmu crpcnnlryo,pc.r.yon.ofrhcfolk,wintd.cltruri(,n\:
<br />-lh.vc
<br />n$illnuniinaCc.lificsrcofco\cnrroScllhsrrcrortrorkcm.lmpcnqrior.aip(,vldcdturbys(tionr700.lrhc
<br />hbor Cod., rbr llr pcrfornurcc oflhe work for *hi.h rhc !€mir is k\xcd.
<br />-l
<br />hlvc rnd *illnuinrrin $ork.rJ.o rrcns id! i.turnn.c. r\ rcquiEd l,y Se-.r i,'n :17{X) orrht llhor cod.,lor lhc Pcriomun.e ot
<br />rhc *ork lor whih rhi\ Frnrir is nsucn. Myeotkc* conlpcn$rion inflm.cccatricr u{ Fnicy n!'nt rdr:
<br />-l
<br />ccniiy rld i. thc pcrntrmrn.c ofih. sork ntr whi.h rhis fnnn n i\{rd. I drll nol cmDloy un} pcr\n, i. nn, manNr
<br />v, Niob{d . nrhjcd r) r lr worksJ .onlc sdi hssofcrlilorni.. rnd ogrccrhol ifldnuld h.co,nc lxhlccr lollr
<br />(o c'i.omp.tr\ati,,npn hiotrs ol Scdiotr :t70O of r,r l-rta)r (hdc. l +rll. trnhwirh .o ,rly wirh ilx'* Ir.\ isi(nN
<br />WARNINC: Failurc ro Km work.rs ..mpcnsarn,n.o!cBE. is u.lawltl. !trd sh.,l suhjccr on cmplortr ro rininal pctrollts flrd
<br />ciil finc\ !p ro om hudrcd rho$and ddlles (Sl0o.0oo), rn rddiret rgrhr.os ol lompctr'.ri9n. .i,roB. \ .\ tnvnrcd tor lhc
<br />scc"on no76or thc llho' codc. 'md.{o.'l rtrormv g,c6 ,/,7 / ,,t/ /
<br />D.,e: ?-26-(g noo,*,,[ OA& fu-
<br />t t( rNsEn coNTMcT()R
<br />!EC!.dNAIJON
<br />I h.Eby firm u.nd p.nalry of p.rjury rhar I !m lisneal undcr pruvisio. orchdpru 9 (connmmiq wilh Sccrhn 7fix)) orDivision ]
<br />.r rhc Busin.s,nd Profcsio.s Codc. ud nyliccnse t in aull nrcc and cffc.r
<br />LiccoscClos:-
<br />COIiSIBUCIIIJNIENIIIIGICENSI
<br />I hcrcby !finm undcr Icnalirofp.ijuryihri rhcE is, $nsrDcrion Ltrding a-pency for lhc lcrfotukc orthu wolt for which lhh pcrmit ir
<br />iss,cd (S( 1097.Civ. C ).
<br />Y9"""""
<br />AITLICANIIIE(LATAII!]N
<br />I trt$y afinn undcr pc..hyoftxrjury om of rhc follo*ing d6.-lararions
<br />Dcnnirion Permih AstEsros Norific,'nrn F.dc0l Rcguldions (Tillc40, Pan6)
<br />-Rcqlncd
<br />Lancr oa Noril-srbn
<br />l.dlil-vthrlth.ltdcrrlr.suhri{,$r.!rnli'rsr\ta(o\'. nxrlxrc ornffrnrhLrolhnprojc(r
<br />-l
<br />ccniiy lhar I hou read lhisuppl
<br />odi.rrccsnnd Slalc Lnws rel(int r,,
<br />otrove nrnriorcd tmpeny Lr insoecr
<br />icrri, rid nrrdrhi rhcrh,rc nrronndim is cor..l litrelocomdr*ih.ll(-iryrnd(_ounly
<br />olrhi\ cirt d coxnlylo.trrcr upon rlrc
<br />Applit{tr1 or AE€trt Sian$n'r.
<br />l'.r itr'. nd r iprinlr:
<br />*t(flZly
<br />,**, Tzua
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq i UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit) q^* +- I 'ol<1n1tu,wa,4'zt )
<br />Walls (Rough)L U
<br />Ceilings (Hard & Solf it Rouoh I 1-\
<br />Ceilinqs (T-Bar Bouoh) rlz,r*rrlxTr{ ?r rtuari,l,e)
<br />lt/leter Release t u'\
<br />Bouqh
<br />Service Meter
<br />FINAL L7)i1-lN \lfuxn t<t /J> )
<br />Notes, Remarks, Etc I ()\
<br />at r
<br />(,I r-Nr/
<br />1-zt- ts
<br />trndc''i A,lJr.'s
<br />-
<br />Air Conditioners
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