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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER OILCARATION
<br />I hcrcby artr6 undcr r.idr, of pcrjno rhd I u, cicmpr Lonr rhc Conrradon l-i.en\e tjw ior rhl nrbwing rca$n (s.. 70.11 5
<br />lrusincs snd Profcssior Cod.l Any Cily or C\utrt, which rcqxirs n Fnnir ro corrru.r. trli.r, if,provc. dcmlish or El[ir 0ny
<br />(ruclurc. prior ro ils hsuoncc, also rcquncs lhs alplicnnt lor su.h pcnnir ro 6lco si8ncd (nrcmnr lhll lEor shc n liccn*d pu'suanl
<br />ro rhc I,hviqi.ns.rrh. C.nrmc(r\ l-iccns.d hw (Chiprcr 9, Coft.ENins wirh S.dion 70(D of Divis6tr I ofrhe Bu\ircs ond
<br />Pmicsions Cod.l or rhar hc or sh. is cr.mlr lhc..fronra rh. tu\is fin rhc allclcd cxcnrption. AtryvioltrlionofSsrhn?031.tb,lny
<br />applica n, a ncrmir sunjcch rhe lpplicaor lo !civilpcn0hyolnot nuclh!tr 6vc hudrcd dollln ($5OO).
<br />-1.
<br />as owNr oa lhc pmltny. (r ny cnln,!rcs wirh waB.s rs rh.r $lc onDcnsdion, will do rhc suk and rhc srruclurc is rer
<br />inrcnd.n or oliarcn for s,c 1Se.7044. Blsircss ond Pn(c$ions Codc: ahc Co ruclnir Liccnsc La! do$ to, 3l,ply ro an .wnd or
<br />rhc pmt rly wfu) blilds or i@owr rh.d,n. aid who des sEl *('rt himlrlf or hc^clf.r rhbugh his or h.r orn cmtlorccs.
<br />,ovidcd rhrr srct improvc'ftirs aE hr idcn,h or oftqcd nr slh lli ho*oq. rlf, hoikling or in{mw'ftni h sld wilhin onc F{,
<br />or.o,phrion, rhc ownc! Builds will h.rc rhc burdcD of pn'vnrs rhd rr or \hc dil mt hitl .r nlll)mrc lhc Dmncrly lor rlrc rrurrnr ol
<br />*l- rsoancror rhc nnFny. trflrcxclu\ivclyconlrrlinB wilh liccfl\eJ conlr(ntr\ t' .on(ru.r rl[ pnrccrlscc 7044. Bhincs
<br />,nd tbli:si)n (ndc:1hc Conrrrxtr'11-icctr\c l,trw doc\ nor lDrly l. itr ownq ofpr.pcn! sho huikk or iflprovcs rhcrcoo.
<br />!M who c. nrrs f(tr su.h ,)n)jRrs Rirh r Co.tr.kr(\ ) lircn*l pu^utrr r. rh. CoftNtr's Li.cnk tjq)
<br />I rnrcxcf, trnJc' Secriin, .l' & P( n! r[n r..N.n
<br />I)or. lrrrncr
<br />]l!3x,}lBs:!auru$^I1l!
<br />Dl;lJ.ta ro!
<br />I hc'chyr,lntr,tr {l.r ncixlryof Itr,My.ic,)f rhc n)ll)sia! d..hrrri,A
<br />-l
<br />h!rc md will nui.roin a Ccn ificare ol Concnr ro Scl nsurc lor *orlc6 compcn\.rion. as I/6vid.d rd by s(iion l7lx) ol thc
<br />khor Codc.lorrhc p.rlonmn.. olrhc wo r.r which rhc lcnnir hhqucd.
<br />I hrvcrid !illnri'rlrin workcrr .omllrn\rr i.n in\urimc.6 r.qtri..d hySccri(r.l7lx).lrhc tlhltrCoJc, ror rhc lcifonnrd.r ol
<br />rtu sor[,nr *hi.hrhi\I[rrnir i\ i\{ul Mysork.rs onlnctr\rrnn, in\urrnc..]nio' rlt'li.yiu rbcr rc:
<br />_l ccnilr lhat ir lh. pcrf.nurcc of rhc lor qhi.hrhi\ l.rnrir h issurd.l shrllnot cn{,loynnypcron inrnynrm.cr
<br />{i rsh hc.om {'hlccr t)rhcaorkcr\ conrnctr\ari hs\ oi Crlilhnrir. rnd$ruc ihri ifl sh)uld trc. r \uhl.. o rhc
<br />*.rkc^ co 't sJrn,n!n,visi(ilotSccri(ilTlrOofrltrl.rhtr('{nl..l\tu'll.lanhlvirh.onrply$irhrho{lfr)}i!Dn\
<br />.ivil nnc\ un kr onc hundrcd rhoo\rtrd dollnn ($l(X).1
<br />Sc.ri( 1076orrhc tjhrC(xlc. i cr.i rtrd fionrt t li
<br />i'r n dirnn, h rlr co{ of c.nrtcrsrrnnr. dnihScs 0\ pr)vidcd nr thc
<br />,,,,", LqTlT)//E ^,
<br />ln.( t.,\k \ u{)l
<br />I h.Eby aftrrn undcr pcnally ol rcrju,y lhal I am liccnsd undcr povision oaChatler 9 (onmEins sirh Seri.n 70(D ofDivkion l
<br />ol lhc Bu\incss and Prolcsions Cod.. .d my liccnso h in full fom and .ffc.t.
<br />-R 7o /E-ffii/p
<br />CANEISITCUOIiJ,ADING.{GEAII
<br />I hcEby aflnm undcr Fnalty ol lxrjury lhol thcrc k a const clk n LBli.g rBcncy lbr thc rslbnemc ot lhc worl ror which lhis F,nI n
<br />isucd lS.. .1097, Civ C.).
<br />AITUCAIfDICLAf,AIION
<br />I h.ir'tyafiimund$ tcnalty oapcrjur, orc oIrhc follo$ing dcl.r io!s:
<br />D.mlnion PcrnrirrAch.slos Notilicrlion Fcn ill RcAulrrions (Till.40. Pan6)
<br />-Rntuircd
<br />bt'.r or Noifrolion
<br />-l.cnil,
<br />rhot rhc rcdcrul rc8uhrions ic8rdilr3 rsncnosrcDnvrlnrc nor lllalicdhh ro rhn rtujer
<br />l.cn'rirhd I hr'c rc J rhn pnli.rridr rhrr rh. Jlx)!. n,r.i,n rtrnr i\..r(r l.!r.c k).r dy sirh ill ( iryrf ,l (ir v
<br />coh{rudt r s.d hcr.by,urhoarc rcrcknrarivcs ol lhit Ciryand Counry ro enrcr upon rnc
<br />t'hfu nrc rnnrd pn,tx'r! r,tr
<br />l{ ,.,v tr:f=*.r 1/2il4
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Salety /Low Voltage
<br />F ire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bo nding/Grounding/UFER
<br />Transformers
<br />Torqueing
<br />Rool To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Rough lt -2-tr Y\btu
<br />Service l\/eter U x
<br />FINAL h-26-tq,v.\t/.{tr,)
<br />Notes, Remarks, Etc v ,\J
<br />l{' L1 ( AJJi$
<br />onlimr$ rtrd Si.rc lrq\ rchrnB
<br />-..--\-
<br />Communications Cable
<br />Sub-Panels
<br />Air Conditioners
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