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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcr.b] rmrn untLr p.n.lly ol Frjury lhal I n crc!ryl from rnc Co rnctun Ltcn* Llv tor rhe foUo*ii8 rcn$n (Sd.7or L5
<br />Busincss a Prcfc$ion Codc): Any Cily or Counry which rcquirc\ ! Frnir k, snnrud. d6, imProvc. dcmolist or EPlt lny
<br />nflcrurc. pri,b irs k!u.ncc. 8ko rcqu ircs lhc ptlta.r ror such pcmn to filc a si3ned (alcmnl rhlr h€o. sh. n riftnsd pu(umr
<br />t, lhe pmvnions or rlrc C. E.rofs Li.cn*d ljw {Chaprd 9. commcncing wilh Scction ?000 oi Divnion I ofrh. Bu\in.s Dnd
<br />Prorcssbns Codc).rrhar h.orshc Ls cxcmpt lh.rcfnm alnl rhc b,sr forihcnllcScd cicnrrlbn. Arylt,ldri.norSNlion70ll5 hyrnl
<br />applictrnl tbr I p.nnil subiccls thc appiiconlto0civilpcnrllyofnolmrclhanlivcnhdrcddollm($5(10)
<br />-1,
<br />$ owncr olrhc pn)lErty. or mycmplorcs wilh *0Ecs ns lhcn sob smneosuridn. willdd lhc wdk 0nd lh. slutuE h ml
<br />inr.'dcd or olttrcd &r slc (Se.7{)44. Busi,rc* rnd tt{,t san'na C.d. Thc Conhhr's l-iccnE ljw des nol,0llr ro oo*ncr of
<br />lh€ poFny sho tnild\ or in{mEi rtF@.. sri qho des sxh *ort himsclf or h(tlf or rhrouAh hh or h.r own crploycc\.
<br />0rcvidcd thol such iDpmrcmnh m mr inlcnd.i or olrs.d f.tr slc. l( hosvs, rli huilding or irqmKftnt is s*l wilhin orc ytu
<br />of smnlcibn, rlE O*ncr Buih.r will haE llE burd.n of pnving rhar h. or shc dt mr buiH or nr{mE lhc tmFly tor r,r purl[r of
<br />L is ow.cr uf rhd Frlxdy. r.r .xchsnrly coftn.r ir8 wfh l,ccns.n conrrrrors lo con(rucl rlE no]ccr (Scc 7(}t4. Bunncs
<br />and ltolssion Codc:'l hc Conlruclor's l,iccnsc Lsw docs nor applylo mowns or prorcny aho l,uilds or in{rovcs rhercon.
<br />,nd *ho cr,nhd.h aor iuch polccls wirh r C.trltu.l${s) liccnscd lunu$r to lhc O'nrrxcxtr \ l-i*n$ tjw)
<br />I ancx.nrpr undcr Sc.itrnr , A & PC hrlhis rcrnn,
<br />D.t.: Orrcr:
<br />IIAXX,EBS:I:OMIINSAIIIJN
<br />I}EI;IIISAIION
<br />I hcrciy rfi rmund.! ncnalryoipcrinryonc.arhc lolh*n'[ ncclararions:
<br />_l hevc annwill EinrDinaCcnificrreorCon(nrrosclrln\rrcrorworldacompctrsition.0s prcvAed for l,yS(.'in,n:1700 orinc
<br />L,norCodc. forlnc pcrformotraof thc qork lo!whichlhc pelmil n nsucd.
<br />I havcri will mri' ai'r worlcri conrFcn\di i,n nsurr cr. rs oquircd by Sc.r idr lTlX) ol lh. tihor Cd.. li,r rhc |,rrom-nt hr
<br />rhc work for *hich rhi\rcnnir is *\ucd Myworkc^ .o rFn\dion innrnncccrmcr d Flicynumberuc
<br />-l
<br />ccnify lhnt ir lhc n rhrfluncc ollhc work lirr whicn lhn pcrmir is isrkd. t \hallnor.nplD! an, pcson in ony mlnncr
<br />$.sroh.6m hj(r t, rhc workn\ ontctr\diotr l ws urciliromia, lnd aBrcc rh(t iil snouE hcconE \ttjl{r k,rhc
<br />wod(r.onlxnsarn,nF)visionsofs..rionlTfi)olrh.tihna'odc.ldull.fonh*ihcomplywirhihoeprcli\n,ns
<br />WARNINC li'ilurr, krurd sork.ra..n,t^-n\xri(n,.ov.rrg. i\ ! hsllrl. x dnrll {rhl..r rrr cml,loycr k, .riDinxl n nrk r\ rid
<br />".H#sl
<br />Codc. inrcrsr and r orfty s le\.ls
<br />DESIAAA.IIQ!
<br />I hcEby omrmundcr I'.Mlly of pedury ihal I dn liccnvn lndd polision ofchdpr$ 9 (commftin8 vilh Scclion 7$0) ofOivision l
<br />of rho Burircsrand Porcssbns Codc, {n my liccnsc is in fllllbra and cficcl.
<br />Li.enreClass:-t
<br />'".-sJ l
<br />CONIiISIJqI]ON.LINDINC.ACDIII
<br />I hcr.by afllnn und& Frrlly oi pcrjury lhal lh.rc C , constdclio. lcndins asctrcy for rhc Frfomftc of rh. *otk for whth this ll.r h
<br />hsucd (Scc 3097.Ci!. C ).
<br />IP]UCANIDECI,ASAIIIIN
<br />I hstyotrnnullcs Fnally olFjury orc oflhc lollosins dchr ions:
<br />o.mlnion Pcrnrns Asbcaros Nori6cr'ion Fcdcnl R.3ubrions (Tillc40. Pan()
<br />Rcqutcd lxtr.r of Notiaslion
<br />I ccnityrhar lhc ltdcrrlrc3ulalions rc8nnlirE !sh(nos rcmoval{c nor apllic{blc t, rlri\ porc.t
<br />-l
<br />ccrrilyrhd I lnvc rclnr[i\ lpr!ori{r nl{dcrhrrrh.xh)!c innn ]rri(ri i(.oft.i IrsrccroconrdywilhrllCiryxndCouiiy
<br />adinrnccs rndSr.tc l-n$sahringbbuildingcon{tu.tn,n- md h.r.hy rurhori2c rcprc{trrdtl!$ r)frhisCity.ndCounryt,q,i.r
<br />'x)nrhc$nrr mnrioncd pm,t.ny ntr iNp..lio
<br />Appli.{nl or \t€n( Si!rllure
<br />(.)
<br />sl ,*
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rouoh
<br />Service lvleter vFINAL 9/h
<br />'-De
<br />ll,oN+<l
<br />Notes, Remarks, Etc
<br />Policy Nrmb.. Expncs:
<br />tJnJ.,' . AJJrs
<br />r a L S
<br />:
<br />I
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