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ELECTRICAL-INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcr.by ,lIrn und.r p..rlry of F+ry lh l am cxcnq 6orn lhc L'onluclorr License ljs for rhc lbllowinS ,.rsn (S.c 70rl 5'
<br />Ausiness rnd Pii'L$ion Codc) Any City or C'o!trr, which rcquirc\ 0 rErmir b co.{fl.r, 3lrcr. i.Drovc. dcmlnh or Eran any
<br />srrucrulc. prinh iI! h\uamc, dlso rcquncr(hc srplica r ror such pcrnrir b flc 0 siCncd sl0rcnEnr ltol tEorsfie i{ lice!{d po^oant r r
<br />ro lhc rimlhionr of llr Contrrcl{r's t-tcned ti* rchlplcr 9. C.ifti.in8 eith sccrio. ?u)0 of Divhion I ot lhe B8nrcs 3nd
<br />PFfcrion! Codc)orrhar ltorsh? is.x.mpr rhcr.rromand rh.basis for rhenllcAcdcxcrlplion Anyvi.hrionofS.criotrT0ll.5byrtry
<br />nfplic,nl ror n p.flnil subjNlsrhc lpplicanl lo acirilpcnall!olnot mrclhan nvc hundrcd d.llm ls50o).
<br />l. N ow.crollhc prorErlr- or nry cnuhrrcs silh $ases 0\ rh.ir v'lc.onrl.i$tutr. silldd rh.wo udrlEsltur!rci\Nr
<br />inrcdc\l orolttrcd for sle (S( ?04.4. Bxriftrsand Pn,f.*ions Cd.r Thc Co mctolsLiccrscL,owdocsnorrppl,r.nno*mrof
<br />rhcnn,lxny who hurlds or illltmvF rhcml md who dfts stch sorl hinscll.r hcrtlf.r rhn'ugl hi! or hcr own cnlloyccs-
<br />pruridcd rharslch nnpRrvcmnh dc rht inrctrd.d orollcrn lorsL lt bkvr. rlE hikliig or nqtmttnr tsUuirhinnDc,ur
<br />olsnnrkri,n. thc Opncr Blitld willhuk rhL hu(lt. olpnrvi'r! rh.r h.r \h. dilml huikl or imtmlc rhc I'n Fny for rh. puqnsc ot
<br />-t.
<br />rs owncr oIrh. l)r,pcny, amcrclu\ivclt.ontnding wiih lic.i{d.ontr.lorslo coNlrucr rtE rmjKr (s.c.704.1. Bunmrs
<br />md Pnfc$irn Codc Thc C.nracttr's Liccnsc l-.q des nor imly h m o$ncr of pFrcd y sh. builds or nnnilrcs lhcrcotr.
<br />nnd $ho .onrncrs r'or such nrcFcls sirh a A,nrmcrorl t licen\cd Frsurnr o rhc co mdois Liccnsc L!w)
<br />lrnr(rcrrl nftl.r Sc.ri,r .B &l'L-tu'rh^r.n*rr
<br />D.Ic: O{ner:
<br />woRl(xRs' coNIPFNsAT(rN
<br />DECLAEAUOX
<br />I htrcby rflir und.r lcnnlr, ofpdjuyonc ofthc followins delr0lion\:
<br />Ihrv.sfiiwillruinr r a Ccniftr.tc ol Cotrsnl lo Scltl nsrc fn wolkqr mn{k.\art r. n{ povidcd for 6y Sccrion lTlx) ot rh.
<br />lltrn C,dc, a.r rhc l.rrom,nc. or lhc so ior whi.h rhcFrnrn k nsucd.
<br />lhrlo rnd slllmiid.in wortcrs conllctrs i,n insurrmc. !\ rcquircd hy SNrim.lT(X)of rhc l-rb.r abdc.lirr lhc Pcrlonmn.c of
<br />lhc work for whirhthn pcrflnt is issucd. My*ortcn $mp.oelion in\tre c uni$ d noli.y Nrhcr uc
<br />,.,,,",, CrPrc53 -,^.,^*,*, L)cd)( 727547 .,n',..
<br />-l
<br />ccniiyrhor in rhc pcrlormtc ol ihc qork ror *hichrhis pcnnn is hstr.d. lshrll nor cnnl(,ytnyPcn.i intrnynunncr
<br />$ ,{ t, rr.oft rxhj.d b lhc so*c conrEtrsnrn ksrofcrlii{nnir. nnd qru hrr irl should b.cotrrc subjcl rolhc
<br />wolkd^ ompcn{rn,n lmvisions oI Sc.l ion lTOo ol lhc t hor Cqlc. I shrlL nrdhRnh c. rtly with rho$ I'lorh ion\
<br />WARNING liilurc h $ctrrc *orkcn $ il.ns,rion..\.tue. i{ lil$vful. rnd \hrlLn'$jccr u c'npl(Dn h oinriml |rcn,hts md
<br />civil fincs u! lo onc hundrcn lhou\rnd dolla^ ($lm.(xxD. ii drtirion b ihc cost oleonucrsniion. drtust\ rs f'orild tu
<br />'nc:"'::;/;w:
<br />Lt( ti\stt) (1)iit R,t( Il)R
<br />uicljaAuoN
<br />I h.Eb, ainrnlndf Fniltyorp$jurythll I a li.cn*{ lndcr lovnhtr olCh,prer9 (s'hmeing wnh scrion ?G)0) oIDiltn,n.l
<br />ol rhc Businc$ and Prolcssio'r Codc,0nd myli..nec k in tillrorcdtclttl
<br />.ZA 7 7?ac4?<
<br />C1)NEIAI]CUI}NIENDINGAAETCT
<br />I hcDb, amrm undc, Fnllry or Frjury lhar lhcrc is ! const ction lendins csen yfdrrht FrfornEmc or rh. work for otich rhis pcdir is
<br />ksucd (SN. 109?. Civ. C )
<br />AIILrcANUECIAEAIIO!
<br />I hsr{,y afrin. u ndcr pcnrllyofperjlry onc.frhc lollowins dsl,r,rn,ns:
<br />Dcmlirhtr Pcnnits-Ash.nos Notificlrion FcdcEl Resularions (Tirlc 10, PLn6)
<br />R.qnircd t*rlc. ol Norifrolim
<br />-l
<br />ccnify rhlr rh. fcncrll,crlhri.ns ftgarding Ntrs.s rcmolJ arc nor lPt'licibLro this pr+.'.
<br />I ccnilyrh l htrr. rcrd lhis lFplic0r ion ad sroldhlr rhc ntwc inlormrioi h coftcr I ag6 b ory,y wilh all City und Coonry
<br />ordinaeerandSlnrctrwrelniirglobuilting.on*flclion..nlh.rchyiurhtrrzcrclrc{nrslnc\ofrhhC Fnd Counr) lo cnrcr uPon rltil:,-:-ffi:::l*:%_ *,., z/zy'v
<br />Pemli@Ene(prlnu: @
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />I\4eter Release
<br />Rough
<br />FINAL Zhehq 1 irl*rl4 zD)
<br />Notes, Remarks, Etc
<br />Sub-Panels
<br />Service Meter
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