|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DDLCARATTON
<br />I hcrchy aanrm lndcr !cnal', of pcrjory rh l m cxcnrfl fmm rhc ConlracloN Li..n\c tiu ror lh.lollowir8 r{son (Sc..70.11.5
<br />Busin.s uRl Pr.rcsaion codc): Any Cily or Counry whi.h rcqutc! r pci,nil ro onsrrucl. 0her nnprole. dcuhlirh r rcN; rnl
<br />srru.lurc. prior lo ns issuane. aho rcquncslhe a,plicanl for such!€rmir lo file E sigicd sidrcftnr rhdr hcorshc il li.cnscd lunu{ni
<br />ro rhc r.visions.f(h. Co.racbis Liccnscd tj* (Ch,pl..9. C.mmncing qilh Scction 7(llo of Divnion.l orrh. Buiinc$ rnd
<br />Prclcsions Codc) or rh.l hcorshc hqemrr rh€rcfrom,nd thc hNh for rh. alkEcdcicdprioo Anyriol,rionorsccri.nTlr-1l.5hy.ny
<br />applicamtorapc,nirsubj(krhc,ppli.antroa.ivilpcnahyotturmo6rhannvchundr.ddollnrs($500)
<br />-1.
<br />N owncr of thc pmtEny. or my eryn,yes wilh sagcs as thcir sle .ompcnsalion, sillrnl lhe soik dd.{mtEkmt
<br />inrc lcrl or ontRt lo, sk (56 ?Or4, Blrn'cs lnd Imrc$ions Codc, Thc Coniin ttr s t-ic.ns bw docs not rylly ro !n owr oi
<br />lhc pmicny who brikjs or inrpmvcs tll]mn. n who dts such wol* hnnsclf o! ncrcll or rhronen nis or her own cnyloyccs.
<br />tmvidcd rhar srch in{mrmnB d m( inrcrdcd oroffcnn f.,qlc.If. hoa.hi rh. bxiUi.E or irpmEmnt is sll wilhinorc )nr
<br />oicon{rlclion. thc Owncr Builds *ill nlvc lhc ttrdcn ofprovins tllll hc o, \hc dtrl n,l liiki or irl[m*c th. ln)thy for E !uq,coi
<br />_1. tr\owmr olrhc pn,pcny, smcxcbsncly roairacring *irh li.cnscJ contr.tr^t)..n{fl.r rh. pmrc.t (Sc.. 7(!-1. Bunn.s
<br />itrd ltsli\sinrcodc:1h. Co r.cror's Liccnsc tjw d@s nor rl)nlyr. anotrncrnfrropcny$h. huil&or impn rsrhcr..n.
<br />rnd sho conrrrcr\lb, ch lr+ck wnh r Contmbn n ltenscd prrunr b rh. G)ntdcr, r Li.cn$ lr*,
<br />-l
<br />m cm undcr Scdon-- A. & P.C. lo rhis @so
<br />Drler Ot,.r
<br />IIABT.E8.ICQMIENIAII!]N
<br />OECI.AAAIPN
<br />I ncrchy ofirnr uDder pculi, or rsjury onc ofihr rollo*ina d.clar{n,ns
<br />Ihrvc$d*illmoinrainaCf,nirtr.otcirn{nrt,selflnsuea,rworkc^con.nsarion.,snmridcdlurbyScdnnrl7(x}orlhe
<br />l,bor Codc. ior lhc pcrloflrurcc oi lhe *ork for 'fiich lnc Fnnil h hsucd
<br />! hart dnd will rinl.ir workcrC co,ncnsrlion insuran.c, a\ utuncd hyScchon 3?(X)olliE lihorCodc, f(trrht pcff.hkk. of
<br />YI,l ir h hsucn. Myworkc( onlp.nsarion insur0trcc cnricr offl Flicy n,mhcr rc:
<br />I. r. rq,fi, yy,.t vttC-o rffi)?-
<br />-l.crlilyr[d
<br />in lhc pcrrorrtr!.c ollhc solk tu wnich rhn rcmril n nslcd. I shrll ior cnfk,y eny pdri,' n' rny D'uncr
<br />{, ^ k, turo'rc {,hjd
<br />'o
<br />rhc wo*c6' ..mf.nsdim law\ or Caliiarnil ,nd rgc lh0l il I shoukr tEconE suhjccr ro rhc
<br />{orks\ contpcnglion prcvisbn\ ofSc.rioi:17(Dofrhc lihr Codc.l \hrll, fonhwnh.omply wirh rho* Jrlovhions..
<br />civil fincs uI k' otrc hudlcd thousond d.llln I Sll(),lxx))- in {ddirion Io
<br />Sccrion -r0raolrhc Lrtn Cndc- inlcrc{
<br />".,..LJ-. tet
<br />I hcehy dmnnxd.r p.mllyorp.rjury lhd I trm
<br />_prcr
<br />9 (comrncins eirh Sera,.7un) olD,vhion l
<br />ot ih. Busimssrtul Pi.itcrsi.ns Codc. fuld my lkchsc is in tullf.r.cmd.ff.cr
<br />LecY76'2,
<br />1.t ts cooro"rn"
<br />CIINiIS,UCUQNTTNDINC.ACENCI
<br />I hcrhy !finn undcr Fnrll, of p€iury lhal thcrc is a .onsldclbn lcndiflE rscnc, for rhe Frfomncc or rh. wo.k for "tich Iht lEmit is
<br />hsuud (S( 3097,Cir. C )
<br />AIII(AXIDEII,ISAII!}N
<br />I lENl)y anj r undc! rcnllty ol pcriu.y om otrhc nnb*in! dshralions
<br />Dcrmlnion Pcnnits.AstE(os Norificarion Fcdcnl Resularions (l irlc 40. PM6)
<br />-Rcquircd
<br />l.llcr ol Norifi cllion
<br />#."""1*lum;r'^,hi\ orplicdiotrand icrhar thc a
<br />of'hnCny,nd Countyro e er uron llE
<br />xhorr ririinrd pn,t0rtf.r \tf,.l
<br />Apt ll@nl or AAent Si*n,lor
<br />P€milee nonelprint):,a L^c-'2..[r'
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueinq
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough 6/s /ta
<br />I
<br />FINAL +/ Al$?u6r
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />WARNINC t'nlluc k, sccurc worter compcn{rion mvcmsc n !trb$t!j. ond shlll \uhjr.r an cnlpkrycr t) dirir.l Fnnllics r
<br />l.rdilyrhrr rhrf.dcrdrcSulrri(,ns r!rdiri3 d\brsosrc x)nl,rcnurippli(ihlcn,lhir!n'j..1
<br />Sub-Panels
<br />Service Meter
|