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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS ( r'llNllR IllllLI)IR I)liL( ]lRrl l lON
<br />I herchy lifirm uxlcr Fmlry of Frjuly rhar I m q.frtr fn n rh. Conrl.los Liccnk LiN for thc followins r.N)n 1SB 701 1 .5
<br />Businc$ 0nd Prolc$i,'n Cixlc): Any Ciry oi Counry which toquircs a I'. mil ro conntucl- allcr. inrpn,v., dcmol,sh .r rcI\'n My
<br />{ru.rurc, pri.r$ irr hqu.nc.. rl$ rcauncs rhc ardicanr for such lErmil lo fitca silncd (arcft.r rhd rf,o. sh. is liccn.cd I,UrqJnr
<br />ro lhc I''ovhions o, tlE Conrrrcrois Liccnrd t2* (Chaprcr 9, Con rmin8 wirh Scction ?0Oo oi Diriqi .] ol lh. Btrsincs ind.
<br />Prorc*n,i\Code)drrh h. orshc f cxcnu rhcreiionrrnd rhc blsis ior lhe ullcscd .rc'nprnrn. Atry vbl.rion ol Sdion'7t).l l 5 hy rn,
<br />.prli.,nr iu r Frmir subjcchlhc snpliclntloacivilncnlltyofnor trcrhfltr fivc hundrcrldolt s(SslD)
<br />-1.
<br />{\ os'Erolrhc proFdy. or n\y cnr o}e\ wrh w,eN $ rhct v'lc compcnslrion. wiu do rle work ,nd rtf, (nr1uc is nol
<br />iftn|rl or oficrcd ror srlc (Ss 7041. Ausimrs lnd ftolcsions Codc: Th. Conrra.ktr s Liccns Ij* docs nor aPPly t, an osnn or
<br />rhcpmlrny who bnilds or in{)roEs th.Nn. ud *h das $ch wnk hinscll or hcrslf.r IhmDAh hF ot hc, owncmnl6r..!.
<br />prolidcd rhar suc[ impDrmtumfrn inrmlcJ orollcEd for srlc lL h.ucx., rlrc tlildin8 or i'rllturcmnr is$klwiriinoN )d
<br />olonph,trth.OwncrBuiltrsillh,vcrhcblrdenofptrNinErhrhcorsh.didn buikl or iq,m$ tnc nnpcny ror rh. purs* ol
<br />I. N owncr or rhc !ro0dy. u cxclusivelyconrrrcrinswirhliccnrd.ont,.ktrstuconsruclrrt,r'jcd(Scc 7lll4, Bu(iiL$
<br />ul ltDlbssi.n Codcr-t hc Conrhct, s Licrn{ L.} do.s nor alflyt, atrowncrol'tn)pc y{hobuildq.rnnrrovcsrhcrcon.
<br />rnil who .onrdc* ror such pmrcsts wilh a Conlrack{s) Itccnsd Dr uMr rorhdG)nlrNrols Liccnse t-usl
<br />I rncrcnDr undcr SccrFtr . B & PC nr rhn 'cr\'n
<br />()*n.r
<br />U0BtrIiSSll':llUtxNsr\.IIoN
<br />DECI.A.BAIIAI
<br />I hcr.by rfitn unJcr |r.rlly of pcrjury onc olrhe [irk,*iu dcch'rrnii\:
<br />-l
<br />nlvc and p ill ruinhi. . Ccnifici. or coisnr Io sclrlnsutu rrtr worksr conDensrlion. ss p!,vidcd ror btSccrion l7o0 ollne
<br />tihor Codc. for thc Frformoncc orthc worl for *hich rhc Pc..rir n n\,cd.
<br />I havcand will trrinrrh *.rkcrl conlltr.srlion insuraflcc. rs requircd hyS(ri.n37(Dofrhc tibor(bdc.l'o! rhc P.nnrtui.c of
<br />ihc wurk ftrwhi.hthi n nnir is nscd Myworkcn .ompc.slion in\urancccmis dnd Fni.y numhd $c:
<br />U-c)q
<br />o4 qa
<br />Icc ilyrhar inrh.l,crlnrmn colrhcwork rbr *hich ! hn l]tnnil is i$trcd.I\hrll or chr/oy,ny [l.non ir anynunncr
<br />s $ ri b.com suhjcd to rhc sorkcs .o'npcn\drion la*\ orCrlil{niii.,n,r 4rc lrar iil should hc(,m srhicd h i]a
<br />workcrs.ornpcnsltiotrnrovi\ionsofSccrio..lTU)olrhcLah.r(-odc.lshill.l'onhwirh.o'nplyRithrl'n,{P(,!rriotrs.
<br />IVARNIN(; Frihrc r, {curc *ortcr\ cotrrtrtrr.ri nr ..v.ruAc t unhriul
<br />rivil lidc\ oI k) onc hul|drc'l rhousrtri (lolhr\ ($l(D.ll(xr)- h nddiri,)n k,
<br />. and shall rubrd sn cmphrr lo rimiral Jf,.rhi.i dnd
<br />rhc.on ofconDcnsarbn. daroscs x providcd ln rhc
<br />--.-.--->Sc.riinr:1076 rlrtu Lrhr (t{1c. iN.rci urlrq1bild -4
<br />DICIAIAIION
<br />I hcr.hy sinnn undcr,,.n,hyorpcrjury rhar l,r lienscd undcr povhion.tChlprcr 9 (mnnti.ing virh sccrion TurO) oil)ivisn,n:l
<br />of rhe Busiress md PDfcsions Codd. and ny ticcn\. is in rull foft $rl cfltcr.
<br />4
<br />clu/ir ./.-
<br />COISIBIIqIIANIENDIIIi-AGENII
<br />I hcrchy offirnlndr pcialryofpcrjury rha! dnc is r onsrrudio. h in-q.sencylbrrhcp.irdrmn.colthcwoftforshi.hrhi\pcnniri*
<br />nsu.d (S.c lc9?. Civ C.).
<br />l.Ddcis A{ldrcs
<br />-
<br />APPLICAN'T DECI AR,ATION
<br />I My allim undcr !.nsxy orFrjurt onc of lh. rollowir8 dclarationsl
<br />D.nnlirion Pernrik Arbcstos Norificart,n Feddrul Rcguhnrns (Tirl.,1o, Pd6)
<br />-Rcquncd
<br />L.licr of Norifi clri,n
<br />-l
<br />cenif, thar rh. red.ral Eeulalions res.din8 sstEstos rcmvol rrc nol appliclhl. ro rhk !rcjd.
<br />I cnify rhll I h,vr rcd rtis omlicrrhn.nd srale rhal rlt at-k into@ri.n ii comcl. I .BN lo comply wnh !I Cnrand Counry
<br />ndh,ruc!andslar.tiwsElarinBr,huildinsmndddi.'n.andhcrebytxrhoriz.re!rcsc.livcsoflhnCil,Mdcou.ryloctrrcutotrtlr
<br />st v. trnhni.d FhFn, ror rtr.p.llion pq,"s -<2nrouu^*nu,r",r-ry,/ -*F -- - o"," SJ41(iL
<br />*^u* --.,,n"u,U 12;Yl a \hechctn'
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Condilioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />l\,4eter Belease
<br />Rouqh 4lafigfr rmo4z e)
<br />Service lvleler UI
<br />FINAL tolfrUltt'li--zrwr\<'f,+>, )
<br />Notes, Remarks, Etc.I lut
<br />Under Slab / Floor
<br />n/*/iq
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