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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DELCARATION
<br />I hercty !m,m undc! p.nrh, {,f pcrjury rhDr I d c&ntr rmm rh. Co.tdom Li.cne ljw for rhc followin3 Eas. (S€c.r031.5
<br />Busirr.$ trnd Pror.xsion Codc) Any City or Counry which rcqnies ! F.mit lo connrud. alrcr. imrovc. dcnolkh .r rrun d, t
<br />siru.rurc. I,nor to ns issuancc. also rcquncs rfie applic!trr for such [Ermir h nh a sismd (dce
<br />'ha!
<br />h.orsh. is li.cnEd l,ursor /i
<br />ro rhd prcvhi.n1ofrh. Conrra.bls l-i..ns.d bw (Chdpr* 9. Connm.i.B with Sc.lion ?0(n of Divhion 3 oflnc Burii.s{ and
<br />Prolc$ions Codc) or 'h{ rrorsh. is cxcmpr thncfroo md th. bas( ior lhc allc8cd cxcr.llion Any liobr bn of Seri,n T0ll.5byany
<br />spplicanl for a lEr,.il subjNts lhc lpplica lo !civilpcnlhyolnor rmrcthdn fiv. hulldred dolhr (55m).
<br />L as oukr ofuhc pmFny..r nryr l|)loysr wirh urlcs as rh.n qnc comp.n\dion. villdo rhc wtrk and rhc (nr1orc i\ ftn
<br />inrc cd orofcr.d lir slc (S( ?014. Busincs a.d Prcfe$ions Codc: Thc c-onrrucroi s Lic.n* tie docs ndr ardy h ,n owncr ol
<br />rhc pmpcdy *ho huild\ or inpmvcs rh.r!n, dwhdd{ru.hsrlthnn\rlforhcFcllorrhroughhisorhcrowncnfk,rccs.
<br />providcd rhar such nnJtrorcnFnrs arc mt ille cdorollcBllor$L lli hof, dkr rht hxiknE or hrgs\ cnEnr is sold Birhin ,Inc rr
<br />orconpLri,,n. rh. ownf Buil&r will h,v.lhc tDdctr oiti{'vin8 thd kor shc did ml build or impmw thc omlxny ror rhc flitx,s.r
<br />l. nsoqmrofrh. |)roJ'.ny. amcxclu\ivclyc.nlrrcrins $irh liccn{dco r.b^ t, condnc' ihc pn)(...r ( scc 71}1,1. l]uiirE\\
<br />aid fi.tu$irn Codc lhECo rtrnn s Lic.n\. Lrwdods nor rlplyl() rtrosoq ol'Impcny*ho huildsor i'nFovd\ rh.rcotr,
<br />!trd who conrmd s rd such prejcch ,irh ! Conr6do( 9 licctrscd
<br />I o'ncxcmDr undcr S(tr"n . B &
<br />DICIANA.IION
<br />I hcrh, nltttrr!ndcr I{nrhyofr.rjuryo.d orthc followi't3 dt.hrdrirnt
<br />-l
<br />hrvc mdwill mointaina Ccnificatcol Consenr ro Sell lnsu,c aff worlcn .orrycnsnriotr. !s rmvidcd lorbySc.lion]700oirhe
<br />bb cod.. ror rhc prforromc ol rh. wo ior *hicn rhc pcrni is hsEd.
<br />IhavcandwillD0n ain workcrl compcns.tion insur.ncc. as rcquircd hyScdi.i l?m.rrh. Llhor Codc. rbr rhc,Erlonurcc oI
<br />rhc work lor whi.h lhis I'ctrtrir is nsucd. My *orkcs conucnsllt,n iNurant .add dd Fli.y numb.r rc
<br />I .cnili lhnr ir rhc pcrlornnrcc ollhc w.rk tu which rhh p.rnrn n nrrd- I \hru ndr.ry'k,y rn, !.rrutr ir tny ntnNt
<br />so N ro hc$nE suhFlr ro rhc soden' conpcnsdk,n hwr of Crlirornir rnd rsnc rhd il I sh.uld hNonr {hjcd ro rht
<br />w.rkc6.onrF-nsarionF)li\ionsofSccrionll?tDofrhcl-trtrtrGxL.l\hrll.lonhqirhonrlywilhrho$pornion\
<br />$ARNIN(; l.rilo,. r) {.tr. $,nk.$'.. rNn\Itrrr r,tr.!rt. r rh$u \hrll srbrccr an d'npk,ycr ro diniml JtMllic\ rtrd
<br />.ivil fin.s ut b om huMrcd rhousand dolhr (Sl(x).fiXJ).
<br />SA1r,n x'7Aclrh. L'l$r Cndc. 'nr.rc( 01d ou.nf,, \ fe..
<br />da [g.s as providcd lor thc
<br />I hcEb/ otltm undcr FnrlryofF Jury rhar I am liccnkn lnncr p6vnio. ofchryrd 9(co
<br />.r thc Bu{in s\and Pma.siorN codc. uxl my lkcnsc is in lull lore dnd ctbct.
<br />sirh sNri0tr 7(xx) orl)ivi\nnr:l
<br />Liccnsc c lassr
<br />-Licc
<br />nsc Numh.r
<br />tu|. Cotrlmclor:
<br />CONSIII]EIIOXIDNDIX(].ACEN(I,
<br />I hiEby rflirn uMcr lEmlry of pc,Jury lhal lhsc n a con(ncrion bndins tscfty ror rh. !.riorNMc of lhc wort ao. which rhir Frnir n
<br />ksucd (S.c 1097. Civ. c.)
<br />APPLICANT DECLAITATION
<br />I h.rby rIIm un L, I).nrx y or prju.y orc or rhc lolhwinS d(laral n r:
<br />Dem'irnrn Pcrmih A\hc(os Norificrrion Fc&ral Rcgnlrrions (Tirlc40. Pan6)
<br />-Rcqutcd
<br />Lcrrerot fiorificario.
<br />l..dirr rhdr I hnvc rcnd rlns amltll
<br />o,tinrnccs and srtrrc tiwsrchrin8 ro tNi
<br />$ovc 'Rdnnrd prop.ny lor inspcrliotr
<br />ini(,mrrionircomd IrFrNro.ondyqnhollCny!!dcornry
<br />( of rhir Ciry {nd (i'unry t,.nrcr ulrr rhc
<br />,{poli. nl or A[utrl Sirnrluro
<br />hcnby rurhtrizc rctrcsctrl
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service IVeter
<br />FINAL l 1\\v /(,11U(19.
<br />Notes, Remarks, Etc.
<br />Translormers
<br />Policy Nunbcr:-Erpncs:
<br />_l orr ifr rhll rhc rcdcBl dsuhr i. r rgrdire r\h.{os mnn'ril .rc nor !!Dli.ahlc lo rnn preFI
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