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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNON BUII,DIIR DELCARATION
<br />I hcEby afiirm undcr p.nrlry of pctjury rhd I am excmpr fmnr lhc ft,nlmclois Liccnse Lw for rnc n,lb*i!G r.$on (sN 70:11.5
<br />Busincss ond PR 'c$b. Codc): Any Cily o, Counly lhich rcqutcs a pcnnir t, .onstu.r, ahd. inrmvc. &oDlhh o, repnn any
<br />d c!uB, p'iff ro ns isru,mc. uko rcqutcq rh. trmlic,nr rd such pcnnn h fit r si8rtrd sr cmnr rhor tr or shc h li.cn*d pu^uanr
<br />lo rne,,ovi\ions or rhc Cotrrrakn\ l-iccnsd lj* (Chlprcr 9, CoDftfti.! wirh s.ciio. 7ffx) ol oivhion 3 oflhc Busincsi and
<br />PrurcssionsC.d.)orrh h.or\h.iscxcmFrlh.rclrumandrhcb.sisaorlhcolkScdcxcrDtion.An,violnrionofscdb.T0.rl5hy,ny
<br />aptlicrnr aor o Fiinil subjcchlh. ipplicanl lo acivilpcnaltyolnot nnrclhan filc hundrcddolhr (S5m)
<br />L rs own$ol rh. rn,I.ny..r nryc.rtl.yr.s wth wn8.s,s lhcir vrc compcnrltiotr. will do rh. $ort lnd lhc srMu is a
<br />i,tcr& or olTcEn fo. eh {S( 70.U. lrusirc$ .trd Rofcsions C'odq 'l he Co.rrador'r Liccnse L'w docs mr arJ,ly lo !n o$ncr ol
<br />thc pmpcd! wk, tnrikls oi i'nEoRs rh.mn, and wlD dms su.h q,rk hirscll or hcnclf.r rhnt8h hh or l$ owncnDloyNs.
<br />[ovidc'] rhal ru.h impmunEnh m mr inrc Li or ofT.Erl fn $h ll h.w.w. rh- boililiflS or in{,mtmnl i\ $ld wirhin nf,c Fr
<br />of ronptrion. rnc owmr Buildcr will hare rh. hudcn of !rcvitr8 lhlr tE or shc dil ml hiu or nqr.rc rh. pn'p.ny lor d. Iiu4$E ol
<br />-1.
<br />!sowncr oirhe prcp.ny. a crclNilclyconrracriissirhlic.nrdconrldont,.onntu.rrh.nn)jccl(Scc 704,1.B.inr\\
<br />a l Pmldsi,iCodc:ThcCo.kd.roCsLi.cnscljwddstror.prlybrnotrncrolpiopcny*h,,l,uild\.rim|i.rcslhcrcon.
<br />und who .onrrocr\ri'!suchrmEcrswirhBContlck,ir lnan\cd po^uaii rorhcC.ntNttri Licctrs. L1w).
<br />-l
<br />rrrxcnrpr undcr Sccri{n
<br />Ouer:
<br />TAf,f,}:f,SIAITENSAIION
<br />Dlclt&LuQN
<br />I hcrc$y lrrfln unds p.mlty oa p.rrury orc ol llrc fol,owinB dtrloElions:
<br />-l
<br />h{vcudwill minrain rCcnirEdcofConsent ro Scla-,nsurc tu *orkdc .odp€n*drn i. as pmvidcd for bySclion.STlxJ ofrhe
<br />bbor Codc. ror rh. IE.lolmne of lh. mrt for *hich rhc pcnit h issu.d.
<br />-l
<br />haw and will mainlain worlcN comrcnsll ion insurarce. as ,cquircd bt Serion :r70o oI lh. tjhot Cadc, for lhc Pcrfomncc of
<br />th. work rd q hi.n rhr Frm rr F\ued Mv tr orlc' r c.mFn.lhn 'hu',a'r .m '.' Mn poh.y numb.r rc'
<br />."",",, V,rll,l' Atlw,r.r- C-sh i
<br />T9 NM 4;>1<.,1o1o.
<br />Ic.difyrhxr rhc lf,rfn nrRcolrhcroknrwhichrhl\pcflnil h i$ucJ.I shrllnoi en,plo,any pun inrnyr ncr
<br />$ slo lrconrc $h]ecllo rhc wo qscompctrsrrionr3wsoicrlinnnir,rndllrtdhIill(huklrt.otrrcsutjcclbrh.
<br />snrkcrs, snEnsrrion nrcvhi{in\ oi Sccri{'n .17{X) of rhc ljhn C,dc. l \hnll. rdrhs [h ..nIny N[ h lh,* pr)vnnnN
<br />WARNING t{ilurc $ scurc $orkc^ conrFnsrliotr .ovcnec is unh{tu|. ud shall rub)L.r r cnrf,oycr ro rinrinul Fmlrics,nd
<br />civil fincs uD ro orc huMrcd lhousnd dolhn ($loo.lx)o). in ad.iili{in t, rhc c.i or..nrr.nsriotr, datrr$cs rs pn,vidcd fot rhe
<br />Scdion 1076ortu hnor Codc. intcreslrtrd 0ltorncy s iccsD,,* , " 1018
<br />DECI.AMTCN
<br />I hcrcby rittflr lndcr pcnalrydfp.riurt rhdr I n'n lntna_d u.ddr pdvi\n,n orCh.prs 9lcomnEncins wirh Sccrion 7Im] orDivniotr l
<br />ol lhc Busitrc$ ond Prn'c$ioni Codc. Lnd m,licen\c is in tullrbreaJdcftd.r
<br />Ddar. _l
<br />\eo qlsAtl
<br />TlB
<br />(:(INSTRTICT(TN I,ENNINC AGENCY
<br />I hcnby sfirm undf r.ndly ol pcrjury lhal lhcE h. con(rudion lendirs rycncy r(tr rhc !.rlbmm. of$. eort lhr Bhich rhh Iicrmir ir
<br />is$cd (Scc.109?. Civ C )
<br />AITLICAII.D8.CI,AMUI,}N
<br />I h.1$y dim undcr Fnalry orri.rjury dk of rh. rollowi.g d<larilio sl
<br />Dcmlilion Pcrdls-Astrslos Nolilicalion FcdeEl Rc8ublions ('rilb 4(1, P!d6)
<br />-Rcquncd
<br />Lcllcr of Nolifiolion
<br />I..diry rh,r rh. tcd.ral Egularions rc8&ding asbeslos rcnrvtrlN nol artltabk ro thn pejecr.
<br />rft curiry rmr t Urc rcsa rns apdtarion en $arc rhar rhc ah,vc ina.nMibn k.omr. I lgE roomgryv'lh lrl ciry !d G,nry
<br />ordiMnccs tr.d Slrrc Laws rclaling h bu
<br />ab.v. nrnrn,ftd pr,t.dy ror insrc.tiotr
<br />olrhis Ciry md Cndnryb cdr$ upoi dr
<br />Appliranl or AA.nl Si*nnlufr
<br />D---i u 'o{'ffAY
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lighl 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 />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough </t,?l,t 9-E 4,ba&
<br />Service lvleter
<br />FINAL 4-n-tg J/"{oL (v/
<br />Notes, Remarks, Etc
<br />t ndcir Nlm
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<br />Lrtr.lcr'. d'Jrc*
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