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ELECTHICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNF]R AUILDOR DELCANATION
<br />I hcr.by dnrn undr p.nalry or Frrury rhd I anr cxcm Eonr lhe ConradrE Liccns. I.w rd rh. rollowins rc.q'n isc(7ujl.5
<br />Businc$ and Profc$ion Co<lc): An, Ciry or Coutrl, which Eqrncs I lfnnn to conrru.r. 6llct. imPto!€. dcmlnh or rnrn 3n!
<br />strucrurc. priff h ns isquancc.,ho toquircs lh.,mlic r ror su.h lEnnit lo rih! sisncd sldcftnr rh,r htor sh. t In.Fcd I1uFUJn'
<br />lo lhc provGions olrh. CotrlEtoi\ l.ice!*d hs (Ch!pr( 9. CondcNin! wilh Sc.lior 70(D ol Divhi{,n I or rhc susinc$ and
<br />Pmac$ions Codc ) or rhll hc.rshc kcrcdpr rhcFrr)hand rhchds( ld Ihc.llcscd cxcnution. An, vi.llri.norsdionT0l! 5 6, itry
<br />aptlicrn! nr a Fnnir subj(k rh. lptlicrd tr a .ivil pcnalry of .or mrc thun filc huidr.J dollnn l$tfi))
<br />-1.
<br />as ouner ol rhc Forf,ny, (tr nry cmrkrr.s *i' h sas$ ,s rhcir $k comll.neti.n- sill do rh€ *o* aJ*l rtr dMm is ml
<br />inrcndcd oroffcrcd for sh (Se.7(,4, BusirE$ o.d Pmlt$ions Codc:'I'h. G).tucknl Licc.s bw docs Nr alPly ro bn own$of
<br />rhepmFny sho builds or inuro(s rh-Nn. u wtF &f,! \Eh u)rl hims.lf or hcsclf or rhmugh hh ot hc, own cmplor..\.
<br />,,ro!A.n rllll such impmbmnhftmr inicnddl oroficrcd for$h Il horcrcr. rh.hiHiry or inpmw,n h$ldlilhinorc $u
<br />or.orpblir lh. Owncr auiklct willhlvc llE hlrdctr ofp.ovins lhal he or \hc did mr boill or imrovc the Inr['cn, i.r rht N4b{.1
<br />L.\oqncrolrhcnloncny.!merclusirclyconracrinssirhliccied.onti.to6lo.onslrucrrh.Ix,jcd(5..71!ll,Busircs
<br />lnd hlrcsi,n Codc ]'hcCoitttrkr'sLi.cnscLlRdoc$nor{pllyroanosncrofpn,nr yqho buildsor imtrorcs rhcEon-
<br />and who co.trk ir such t,ojNlr wirh s Conrracbn, licc'Md pursrnnr ri,lhc conrodois l,i.cnE ltrw)
<br />I a .rc'bfl utrdcr Sc.l
<br />]!!Bf,!BS].]I!JtrITDNSAIION
<br />DECITTIATN
<br />I hcrcby rrftn undn Fmhyolncrjuryonc ollhc folk'*ins declnftrbnt:
<br />-l
<br />hnvc d*illtuinrri.,cLnilkrlcorcotr*nrkrSclf'ltrsurchrsorkcrrc.n,!.rsri{,r.rsroridcdlirbySccri{,r.170{}orrhc
<br />tihor C.nc. lor rhc ncrforromc .f rhc *o fr *hi.h rh. p.r rir n nsu.d
<br />I h.v. lnJ s irl trminrunr *orkcra co rp.nssrtun i'xtrrrtu., a\ rcquncd by scdrion l?00 of rhc tlhor Gdc. rd rhc dlonNE oI
<br />til:r,l.r
<br />tr,ir i\ i\sud My$orkr$ conrFn\rrn ir{trrtr.c crricrr policy nuNhrr rr.
<br />Ms ? (y'Sh av\a-
<br />'I vl Cor D
<br />-l
<br />ccnily rhlt in rh. pcrlornunc..rrhc woik ror qhi.h rhis Dc.nn h isucn- I shlll Nr corpby,ny r.r{n i any mJnrcr
<br />$ dr t, b..o'm (uhjc.r ro rhc wod{er' comtanel ion lass of Crliforn ud,!Rc rhd ilI should b$om subjcd hrrh
<br />work.r c.nrFnsrlion ,rovisiotrs ofSarion 3?OO olrhc Llhn Adc- I shrll. r(nhwnhcomply sirt thot povi\n,n\"
<br />WARNINCT Fdilurc tu scur. $orlc6'conD.nsalion cov.rlSc n unh*rul nnd sh ll hFcr 0n cmplorlr ro niminnl tf,Nlri.r and
<br />.i!il lin.s np ro oft hundtod r
<br />:II'N\r"'t7"?0
<br />hous.nd dollotr ($loo.(xx)). nr addiri.n ti rh. ..s ol comPcnsrian. d!,usc\
<br />lqc$ o,r !num/.
<br />lrEctJSaullN
<br />I hcEb, atfi,m lndcr p(nalryof,rrjury thnt I am liccns.d undcr pmvht,n otChaprd 9 (co'nmming wifi Scclion 7()()0) ofDivasi.n -l
<br />ol thc Busircss atrd Pmac$io.s Codc. ,il my liccisc k in rull roc .,i clLcl.
<br />3.
<br />-l-iccnsc
<br />Nr rh../oag,o.G
<br />r:aNSrBrJcIloIi.L[NDINli-trcENct
<br />I h.Ehy rnim undd Fn,hyorpcqurytha hcrc h a constructbn bndins agenc, ror rlf r.rrornrncc oflhc e.r[ tui whi.h rhi( |*mir is
<br />ksucd (Sc. .1097. Civ C )
<br />AIILICAII.DECLAAAIIQN
<br />I ho!,by drm ud€r Fnrhy ol F.jury om of lhc foltowing delaar i,n$
<br />D.mlirion Pcrmik-Ast8sros Norific,rion Fcd.nl Rcgul,ri.ns (Tillc 40- Pan6)
<br />-Rcq!ncd
<br />lrncrot Nodfkdritrl
<br />-l
<br />ccnify rhal th. f.n d Esul,iions rcE&ding asb.nos Emv.l m nol alr,lic.blc to rhii prcjc.r.
<br />4.l sniryrhd lh,veEtrd rhir opdtolion{d srIlc rhar lhc atnE inrnmrio. h comcl I .8c lo mq,ly wirn all City snd County
<br />oidin n .s Md sur. uwsrcLtinn ro buildina connru.lion. !ftj h Cnt snd Countyl0. crur.nIt{
<br />ltx)rc rmnriomd I(,ncny frtr i'r(txctiotr purBxcs
<br />,lppli$nt o. A8tnl SianaluR
<br />IenNte n nre(pnnl):h,i f'
<br />Site-Work
<br />Underqround
<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 />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilinqs (T-Bar Flouoh)
<br />Ivleter Release
<br />Roush 2+U fik
<br />Service lvleter
<br />Notes, Remarks Etc.2C 4-
<br />J
<br />FINAL {fA lht ?t 6Y
<br />\ \. \q.
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