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ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNER BUILT'ER DELCARATION
<br />I hcrcb, artrD undcr p.nally or !.riury rhar I "m.xcfrpr rr,n rhc Co.lrN.is Lkcnsc bw ror rhc followinS rcN,n (Scc7011.5
<br />Busincs and Pdtsion Codc): Any Cily or Counly qhi.h rcqlircs a Fmil to cotrslrucl. allc.. implovc. d.nFliih or rcnat any
<br />ntodlre, rriorro irs issutrmc. a,s) rcquncs lhc aptlic0nr for su.h Frmit lo fiha si8trcd srlrcNnr th.t hcorshc h liccnscd pu,sanr
<br />lo th. pmvisions of rhc Contrh s l-i.cn{d I:w (Chdprcr 9. Commcocins wirh S.crn,i 7000 of Divi\ion :l ofihe Busi..ss rnd
<br />Eoltsio.sCodcr orlhal h:orshc hcxcmpl lhcrcrromdndrhchrsh ro hc rllcSd cxcnrrriotr. Any violationofSalion?011.5 byany
<br />{tlica.i fo' a pemir sohjNh rlr aprlicrnr ro acivilFnahyofnor mrc than iive hlndreddoll rl$50o)
<br />-1.
<br />us owrcr ot lhc pmrEfl y- or my cmployccs *irh wu8 s as I hcir ek comFosal ion. will do lbc work old r& srtulm n mr
<br />inrc,xlol or o6cr.d for eL (S( ?044. Bu\in.$ rd Pmac\{ons C.dc Thc Conrod.r's Li..n* tl* d@s tror .llrly ro in ownq ol
<br />rh. tmFny sho huildr or inpDvcs OrNn. ari wio di*s sNh sofi hims.lfor hcriclfor rhmu8h his or h.r uwn.nploy.cs.
<br />provi:lcd rhar such imrtuwnrnr m mr i cndct or olTced ror elc. lt trsvc( 'tr buildiry or i,rvnorcmnr h $U lihin otu )ttr
<br />or.!rq,kri,n. th. Owncr Buil:kr will hsve rhc hirdcn oa pmvin.c rhar lf or sh€ di] nor ltuiti or tnpmr rhc rel.ny f., rhc luqrs ol
<br />l. N ow crol rh. rol.ny. ad.x.lusivcly.oftrcrnrl wirh li.ri\rd.ont crrs k,..iefl.r rhc pnrLrt rScc. ?04-,1. Boiincsr
<br />ad l\of!:$r Codcr'lhc Conrr.crois t-iccn\c Lrw doer nor trlplr ro nn owncr olpro!.rry who huilds or inrplo$ rhcrcon.
<br />and *ho.ontrrkforsuchpRj<($irhaG,nrEcbdnli.cnscdtrFurnrrortcContak,sl.i..nsel-rw)
<br />ItaB(E&::rallfEtra.raN
<br />OEII.AIAIION
<br />I icEhy alltnr undcr pctrrhyollnrjryon. olrhc lhllowirS dNhrdnnr
<br />-l
<br />hrlc rfrlwillmlinl.ino Ccn ilralc oi Conrcnl bSclllnsurc r(tr trokcB conrtcn{lion- us frovidcd lor by Sccrion l7(xl olrhe
<br />Labo. Cndc, tor lhc p.rroirmrcc ol lhc Bork for *hth lhc Frfrn ( issucd
<br />illm.i ain workcs' .onrr.nl,k,n insuink.. a\ rcqutcd bySern :1700ofth. tjborC.dc,lor rhc lcrlolnstrcc .l
<br />hisFmril ie irsucd. M,wolkns ..nrp.nsdttr,n iNuhn...rrid ardF,li.y.unh.r nc
<br />t? t^l Jv(,otz\oao \.\.\1.U
<br />-l.cnily
<br />Ihit ir lhc pcrfonnJkc ofrft wdrk tu whi.h rhil tcrmir n is\ucd. I \hrll tror ctrd.y dtry Nr({ in uny mrnNr
<br />$ N t' h(o'E uhlcd ro rh. w.r[crs c.nDcnsarn,n hws ol C lihnrir. inn ur cc rh it Inouu tf,.onE \uh]ccrn,rhc
<br />workrn con,pcnsaln,n pmvhions oiSccli.n:17(x)ollhc l,!hnr o)rlc.lNhxlL hnhwirh con,Ilt sirI rlhr pn,viri{nr
<br />IVARNING] Failur. ro -_urc workctr mrpcn{lbn .ov.ngc is unhwrul. rtrd \hdl sublccl n cq)lorr to rimiml Fmhics md
<br />civil fin s up ro oft hundbd rhousnd dolldr ($lutmol. in addirion ro rhc c.$ ol comrcnelion. drmScs rs lrovidcd ior lhc
<br />Selion 1076 ofrhc labl, Codc, irlcr.i and artoirrr\ tsi
<br />il"AY+r ?Li$
<br />I hcrchy!lltnundcr p.nultyofpcrju,r lhal l.m lieNt undcr pmvist,fl ofCh!fls 9 (comnrcncina wirh Sc.1i,i 7lx)0) oroivnn,n.l
<br />of rhc Bu\nEs lnd Piofe$ions Codc. md my liccn* h in tull fora od clitct.
<br />v,
<br />*"fiA+1? I0tu ...'".",..f4ua,
<br />(atsrBlJsraNrilDluri-acirNcl
<br />I hc(by,fln'nuidcr pcn.lry of Frlur! rhir rh.rc i\ L L-nitucrt,n kndirr8
<br />"SCn.y
<br />for rhc prdonruncc ofrhc sork for which rhh lrmt n
<br />isslcd (Scc ,t097. Civ. C.)
<br />txndcis Name:
<br />-
<br />atfucANfl)Ert BAtroN
<br />I hcrd,y a8inn undcr ncnnlly ofpcrruryonc oirhc rollowins dcchmlions:
<br />D.nrniriotr Pcirnils-As6.sros Notilicorion lcdcrrl RcSulations (Tillc 40. Ptm6)
<br />Rcqrirud l-crrrr of Noii,icari,tr,
<br />ffidffi;;;ardin8 Ntrn.s rcmov.lirc not aptlicablcro lhic prorc.r
<br />xlnrrc rlrrrhrnh)vc inl{trn k i\romcr I r..o Dly wirh allCiryrfrlC.uniy
<br />rhil Ciiy dtrd Counry b ctrrcr urxn rhc
<br />,'\nnli.nnl or Aa€nl SiInHlrrrc
<br />I'rmrilc€ mnr (prinl):
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundino / UFER
<br />Transformers
<br />To rqueing
<br />Sub-Panels
<br />Rool Top Equipment
<br />Ectory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilin gs (T-Bar Rough)
<br />It/eter Release
<br />Rouqh gE vE tbr ,zfl+ *L
<br />Service lvleter
<br />FINAL b/x?/6 >b 1rd
<br />Notes, Remarks, Etc.
<br />APPROVALS DATE
<br />Under Slab / Floor
<br />Air Conditioners
<br />-l
<br />d .rcdp! undcr S<riotr-. B. & P.C. fot rhn @son.
<br />D.tq onner
<br />(n\,
<br />rhovr n{trri,nKl n.oli.n! r{tr insp..rioi
<br />h,"t
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