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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDDR Df, LCARATION
<br />I h.rcby rmnn u.dcr n n.h, of pcrjlry lhal I m cxcmrl amm Inc ConhcroF L&n* t2w foi rh. rouowinB rcasn (S.c.7oll.J
<br />Busincss md Prof.ssion Codef Any Cny or Colory $hich rcquit s a pdnir io oNru.l. !hc, imPrurc, dcmlth nr rcP,n m,
<br />srtud!.c. prior lo il\ iqsoakc, al{ r.quircs rlr .mlicmr aor \uch FmiIo filc a s4ncd stolcmnl lhal hc or ihc k liensd flhuMr
<br />lo lhc pmvisions of ltr Cootls.lols Liccnscd tiw (Chaflcr 9. Commncing wirh s.crion 7Oo0 or Division.l oattE Busincs rtrd
<br />Proitss io.s Codcl or rhor L o, shc is dc Dr rhcftfn,n ad rhc bsri\ r(tr ih. dlcBcd .rcmtlion Any violorion of S(lion 70.115 byd,
<br />aptlicr forrpomn subjdh lhc appli.rnl lo r.ivilpcnahyofnor morcrh filc hundred dollffi (15(xl).
<br />I. * ovmr oi rhc pmtErly, or my cmplo)ccs wilh wo8cs {s ihcn sb co'nrcnsal ion. will do
<br />'h.
<br />}ork rlthc sltrlw is ml
<br />inlcnd.d or olTc.ct for $le ( 56 704,r, Busincs Md Profcssions Codc Thc Conkr&, s Lic.n{ tjw docs not 0ptly lo m owm, of
<br />rhcrmFny who hoilds.r inlpo\u ttEN)n. &n whr des Mh N* hmsclfor icr{llor rtmngfi hir or hf.*n cq)loyccs,
<br />pnvidcd rhtrr so.h invroknEnrs d fr inrdd.n or offcE'd for eh. ll. h.wv.r, rtr tuilding o, inrrowmnr ir $U wirhin rft yaa
<br />ofcofl!,krion, rtE Osm B,i[:kr will hnr rh. tturd.n or thvi.g rrd h. or sh. did ml bui0 or irymtc the IrFny ror rtE puqt$ oa
<br />_l. rs owtrc! ol rh. rordy. a .xchrsivcly.oitrcrnrBwirhliccn\cd.otrtrcrtrsl(i.or(ru.rlh.ntr!.cr(Src 7(!*1. Bu\irtc$
<br />dxl Ph),tsshr C.'lc ThcCorrrcxr'r l-i.(n\u us (l.cs n.r rDfly b trn osi.r of ProFny {h. buildsot nnPmvcsrhcrcotr.
<br />atrd who conrNr\ f{tr surh pntcc( wirh r cotrh.k 1\) li.cnscd tursurtrrrorhc conrracroi\ l,iccnsc t.rw)
<br />-l
<br />a'nc&nrtr ridcr S.cri.n .B.&PC lor'his!ca$n.
<br />Dol.: Osn.r
<br />woxru,Rs' cotrIPElts,{Tl()N
<br />DES/AAIIO!
<br />I hcreby rfi,hrndc' p.nalryorpcrjury orc orrhc rouowinS dNlrarn 'r
<br />Ihnv.d sill'nri'nninrC.nifc.rcolConscnfoScli.lnsurclorwortcr'ompctr\ i.n.as ptuvidcd forhyScclion]TLOollhc
<br />l-atxtr CDde. tff lhc lrraormancofrhc work lnr which rhc tdnit is krucd.
<br />Ihc {.rk fitr \hichrhn prrmir ir is\rd Nrys.rkcr'.o rIctr\rrnr ir!urnfl.conicr arylpolicynun,hcr r'.:
<br />co lr a (
<br />l.crrilrrhrl inrhcFrlornrn.c.frhc work lnr rvhich rhi\ lcnnir n i\\ucd.I nklltrot ctrlpkry dny pcr\,o irrny n nmr
<br />{, a\b hccotrf, \uhjccr k,rhc work$(..rnNtr\ nr hwsofCnlifuirii. trtr(llarclhrr ii I \houkl trconic suhl..rrolhc
<br />sorkss.on,Fn\arn,nF)visn,sulsc.rdr:lTmofrhcLatxrCodc.ln l. t)nh*irhc.nulr$irh rhoefn,virions
<br />WARNINC: l,rilurc ro sccurc $orkcn compcn\lrn,i colcrlcc is dilrtrtnl, rtrd shdtl subjccr 0n c.rnlo)cr lo ri'triml rf,tulris rnd
<br />civil fincs up l. onc hundrcd rholsnd dolhs lSl{D.rnO). i! ddirio b rh..on of cotr!.n\rrion. drnu8cs trs nn,Yidsl (n rh.
<br />Sc.r im 1076 ol r lr I rhn t-odc inrrr.n nD{l rrtn'r\'\ Lc\
<br />'",",512JJ+
<br />I hcrbt rl11, m tr crNnallyolpcrjuyrlrrIrmI
<br />DES,ANtrIION
<br />undcr tn)ri\i( ol( hr|,$ q(connncf.ir! s rh Sccli{nl?(xx))olDlvnior l
<br />of ihc lnr\nr$rtul Pn)f.$idNC.dc, ud nrr" li.cnsc i\ ir lullLRc indcllc.r
<br />f)t,za. z' .a a -X)F ) / >1)
<br />o^. {/Q 7(t
<br />CANEIB]JCIIONIENDING.{AENqI
<br />I hcEby dflir rund.i Fn,hy ol t rjury rhd IlE.c n ! construcriotr lcndira a!cr, ftn ihc pcrronn,N..lrh. work for rhich lhis Ernril is
<br />isucd (Scc 3097. Civ C.)
<br />APPLICANT DECI ARAII0N
<br />I )*rby dinn unddr l)cnrlryorp.rjury onc of'hc (nlowing dcclonrn'ns:
<br />Dcmolirnnr Pcrmirs A\Esros Norincartun li.d.rul Rclnhrh.\ (Iirlc 40. Pd6)
<br />-Rcquncd
<br />klrcr of Nolificdhn
<br />_J t cr y rhlr rhr ri{., al .rlldrhn. ft8,d'n8 rrh.no. rcm\ rl Jru nor 0rflt ohlc h rl'tr pmjccr
<br />&/* ny ,n, , t'
<br />"
<br />."0 ,n^ amlErt nn !,d {o,c rhd rhe lbovc inrbrmr ion is cotrecr I ag@ ro .omply wirh all ciry and counry
<br />ordi.ares (d sr,rc taws rcLling to building cotrnrudion. !,ri hcrcby autlnrizc rlrceordivc\ orthieCi!, rnd Counly ro cnrq upon rhc
<br />uy'
<br />obovc rmnh',md p'nncn) fin in.rdi nrlrnqr <
<br />Applicont orAs6! Sls@luft
<br />Pqmi,eenam.,n.rn,,: "fta a !<<-f h MT,A
<br />1l t?
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)() ,o''Y . \.q'P
<br />Walls (Rouqh)E.J0'(4{.)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)S-2s-t0 J ).9&U1 I
<br />Rouqh
<br />Service l\ileter
<br />FINAL 4- q- /8 J).,{*,
<br />Notes, Remarks, Etc.
<br />ltleter Release
<br />c_
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