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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />L rs o*mrorr[c pmFny, or nrycfl]plo]ccs $irh *!ges rs Ihcn sb comFn\ari.n. silldo rhr worl nl rM i'^-nrc n Nl
<br />inrtrdcd or oficrcd for $L (Sa.7(!.r. Busincs Md Prolessions Codc Thc G'hricktr s Li..n{ taq dGs trot lpply lo !n ow,tr or
<br />rhc rftp.n, sno hilds or in{ea r}Em..,nd who dr* (kh s.rk hnffcllor hcrcllor throu3t his or hcr own cnPloyccs.
<br />,'n,vidcd rhar such imptuknrnls nc nol ir .nddJ .r .ficrcd fttr s)c. Il hoscvcr. rhc ltriuing or in{rclcnEnr i( sU wirhin onc }t0r
<br />.fcomtlcriotr.rt Owrcr Bxikld will hnrc thc hordcn of lrovim rh{ lf, or shc did tror triLl or impmle rhc I'FIrny lor rhc 0uq!s of
<br />-l-
<br />0s owrcr of lhc Imr.ny. anrctchsively.onrracrins wnh licen\ed contkroN ro otrrltu.l llE trujccl (Sc( 704.,1. Bu{ncs
<br />and h,ftssbn Cod.: The Conkkkr's Li.c.s. Ldw d.c* n.r,tplt t, an osmr of Dorl:ny *ho builds or idpruv.s rhcr.otr.
<br />lnd qho conrmcls tor sucn rorcch wirh!Conhcrons) ltcnscd nufiunnr turhcC., rd.rors Liccnsc L0w)
<br />-l
<br />n cxcmpr un(lcr S(l
<br />laatrIBl!;llMtl:Ns rlax
<br />DLCLAEAUAN
<br />I hcr.hy rinntr uidcr p.mlryofp.rjurt.trc ofrhc tullosi ! d..hr.rio.s:
<br />lhrvcandNillnEinrrin,C.nifi.rr.ofcon\cnrr)sclalisrrciitrw.ilcn.!trDcn*iotr.rsF)vnkdntrbyscctionlTmolrhc
<br />lrtnr C.dc. l'or lhc n€rronhrcc or rhc work lar {hi.h rhe pcnnir i\ isd.rl
<br />! hav. a.d will nrinrain workcF comlrcnsdtt irsurnn.c. rs rcqnnd hy Secri,'n]70O ofrho t-'h.r Cid., r(tr rhc Pcri.Iruncc ol
<br />rn r nrocd My sorkos Nihn lnatrnmc.!tricr $J lx,lic) nunbLrdc
<br />-l.crrilyrhtrr
<br />ir rhc pcrforun.col'hc w.rk which rhis ntnnir k hnrcd.l rh0ll not .nrploy iny penon in diynMmr
<br />vrd\i,b.romsul,i..rt)rhcqo*d\conl|rctrsrrorliwrrr(rlil trir. rl.Ncc rhd ifInnnikl hcdnd \lhJdi rirlt
<br />tro'[cr\ co rnctr\ari,u fn)v'sn)tr\o, Sc.ri(r.]7U)ol rhc t-rhtr (lrlc.ld[]1. tunh*irhcotr,fl] * irh rho{ nx)vi\ trf\
<br />WARNINC: Frilurc ro scurc sorkcn $'np.durifl,.(LSc n r hstul. rnd nrll $btcr in cnrtloycr ro oininrl f.nalrir{ and
<br />in rdd nrn ro rhc co{ ol conpen\aihn. da'tulc\ r\ pn}vidcd for lhc.ivil itr.\ nn h otrc tundrM rhousrtrd d.lhrs (Sl(l
<br />Sc.ri,r .11176 ol rhc ljhtr C, r. i' c'.d n J
<br />/,-.=7-t-
<br />DECIAf,AIA!
<br />I hcEl,y uffi'm undcr Fnahyol Fjxry rhar I Mr li(ns.d u.dd rrovni.n olChrflcr 9 (omnErcins sirh Sccrbn 7000) ofDivision 3
<br />ol lhe Businc$ ind Pmfessions Code, ud m, ltens n in tull forcc dd .ffNi.
<br />7 0,r?t9
<br />7/z-'rt e
<br />g)NiIAICUAIiIINDINi.&AENCI
<br />I hcrcbyantrmund.r p.nallyof,Erjurylhlt thcrc n a conslflclhn lcndins uscncy fttr rhc Frf nrRc oirhc work forPhi.hrhn Fmn ir
<br />i\slcd (Sec 109?, Civ. C ).
<br />AITIICdNIDIiCI.AIAIIO!
<br />I ho$y,fmn x,l'l.r pctr,lry ol p.+ry onc oflhc f.lloring d.clai.rions
<br />Dcmolition Pcrnrils-Astr$s Nolificdrbn F.dcral R*ultrrions (Tirlc 40, Pr6)
<br />-Rcqutcd
<br />Lcttcr of Norificari0i
<br />_l ccditrhar rhe t deralrcllljrb rE.rdnrg *h.{os tunbMl .rc n.r rmli(ihlc n' lhn rreJc.r
<br />I .crrilr rId I htrvc rc0d rhG !pp]icnrion lid srolc lhlr lhe trhorc inlomarion n conccr.I rEt b.ompl, snh nllCil] and Couni,
<br />ordirinccs itrd Srlrc LiK rclarin3 ro fiuilding consltudbn. lnd hcrcbysurh.riz. rprscnrrtilcs ofrhis Cny oM Counry ro enrs uf.n rt{
<br />rl,)vc nr ioncd |)n,ltrny hr ir
<br />,\r'plirnnl !'r,\ar l sis nlrr.;,,, ,/<7)/&
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rough tu-2-{r fl.u|.\a
<br />Service lt4eter Y)
<br />FINAL lo -zt-ll h"w10
<br />Notes, Remarks, Etc
<br />Communications Cable
<br />Sub-Panels
<br />OWNER BT,ILDER DE!,CARATION
<br />I hcrcny nfirnr undc! D.n0lty of ncrjury rhat I !m cxcmpl ircn lhc Conlmcrod l-ic.nrc tjw f.r 'h.
<br />rolbwirS rcamn lscc 70315
<br />ausinc\s a' Prolc*i,,n C.dc)r Ary City or Cutrnry which r.qun { , Frnlir ro con$ru.t. olld. inr[ovc, dcmli\n or rcIl3t qny
<br />sl[crure. I,rhrro irs hsuancc- olso rcqlires lhclppliconl fu \uchncrnrir b filca sisned nd.'enr thar tEor shc is liccnscd ouruanr
<br />Io lhc povhn,ns oi d. Cotrlmckn s Liccnscd Lrs (Chq cr 9. aroma*ncins ,ilh Sccri,,n 7Un .r Divis n I ol rhc Businc$ rnd
<br />P,ohsbns Codc) or rnll hcorshc hcxcnut lhcrcfrommd Ihc basn torlhc !ll.g.dckmprion Anyviol.lionoiScdionT0ll5 bydny
<br />lmlican 'or ! pcrmir suhjsrs rhc lptli.anr ro r civ il prnslr y or i6r nM. rhm rivc hundr.d dollm (S500J.
<br />*,. 4zz/ t (-r
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