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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER AU[,DER DEI-CAR-ATIoN
<br />I h.icht afiiin und$ Fnally or p.rjury lh,r I am cx.mpr rmm rhc confutoB Liccn* t{r ix thc Lllowins rcayJn {sc.70.11 5
<br />Busincs and Profcssio. Codc): Any Cily or Coumy whicn rcquncs . rEmil ro ondncr, ah.r. inftuvc. d.mlkh or Epat 8ny
<br />ntucfurc, ri,ro irs issraBc, d$ r.quncs rhc amli.anr for su.h Fnnir b liL r sis.cd s.r.'rctrr rhar tr or shc is liccnscd 0uNlnr
<br />ro thc pmliions of rl* Co"lnctois l,ienscd lj* (Churlcr 9. Commncins sirh sftrion 7{r)o dr Drvision I ol thc Eusincs 3nd
<br />Pfurcsn,ns CodcJ .r rhar lrn,rh€ n crcq)r rh.ftfod rnd rhc hnsn ror rh. alk8cd cnmpr ioh A.y violario.olSecli{,n70.115 hya.,
<br />rpplira.' ror n perfrn suhjdrs rhc appli.anr ro rcirilpcmhyurno' nor dan rivc hundrcd dollns(S5(nr.
<br />-1.
<br />own toirhcpmpcny.or y c,nphrcl wil h wnlcs !s rhcir sle com,)cn$r i.n. will do rh. uo* n d rh. nnrturc k mt
<br />i'id tcd or .ficrcd tor \rlc ( S( 704:1. Br\i.d$ rnd Prrnasi,,n\ Cods Thc C.ftacrol s Li.. \c tnw docs nor mply lo !n o*mr oi
<br />rictmEny wh. bnilds o! inDtoEs thercn. a wtx' d@s $ch wolk hinxclf o' h.rrll or rhn,ugh hi\ or hcr own crfloyccs.
<br />pn)vidcd rhat sxch i,npiolonn6 crDl irtctrdcd or olLal ror rlc.ll la)scElrhe lDikliuor i,rrruwmni is e'lJ wirhin,& ictr
<br />olcotrqrcrio.rh.O$ncrBlikhrrillhdvdrh.huddnolptulin!rhdhrorshcdidnortrildorirpro$thcnmrslylirlh.purgxc.f
<br />l. ,s owtrcr or ihc lturMy. rm cxclusivcly conrncrir8 rirh li.ctrscd .onrnEros l{' c.nslrcr rtE DmFr (Scc 7014. Bu\ifr,]
<br />a.d h.i6sion Codc thcConrrncroir Liccn{ Llw dis\ Doramlyro ano*ioortn,r.aywho huildsor infmvcsthcreon.
<br />0trrl uho (, D.N ror such toj.cts wirh . conrmcro(O ltcnscd tursuonr to rhc Conretoi ! Liccn\c li* )
<br />l,ncr.mfl undcr s.clk'
<br />gaBtr[&5:!!]llSENSdrION
<br />DEg,INtrI['tr
<br />I h.r.hy llTta\lndcr p.n lry of l{rjuiyonc of rhj f(rbwlrg d..Lrnri,,ns
<br />Ihavcmdwillfri rir a Ccni6carc ofconrcni to Sclfltrsur.lor workcs conrpcn\lrbn, ar polid.dforbySccrionl7O0oflhc
<br />ttrbor Li,ric, r(, rh. l).rfonuncc of lhc work for whi.h lhc p.mir i\ hsucr,
<br />zEt rro," ,nt "itr ,n,ln*in *oricr' conll,cnroltun insurancc. u! rcquted h, Scdion 3?oo of rhc Ubor codc. ror lhc Fronuncc o!
<br />rhc work for which rht pcmir is ilscd. My wortcn c.mFnsur io. insurance catrtr aJ'd Flicy nxmb Nl
<br />3+qj< {:\}J
<br />qzl\ 35 5l2b /18
<br />-l
<br />(crriiyrhar rlrc rEr{ornEncd ofrh. work fir which rhi\ pcrnrir i\ nsucd.IdrlltrorcnDk)t {ny p.rwn in uy nunncr
<br />s Nt,h.d,m sxbFc r ro r hc wolk.6' co nr!,cns0r ion lowsorcaliLari( ond asre lhal iIl sholld tEcoru ruh]cd k, rrt
<br />woikcri comlcn\srid ptuviqi.ns of SNtrn l7m of rh. trhrr Cul.. I shrll. tonhwirh o,nply sirh rhos pmvtn,.s
<br />Wr\RNlNCr Prihrc k, krurc workcB conDctrsstion covcmsc h unla*ful, und \hrll suhjccr dn crdor.r Io dimirrlrnahics and
<br />.ivil lincs un ro drc hundrn rhousnnd dollatr (Sllx).uro). ir trddiliotr lo rhc cod.rcon'pcnsrrion. d0mgcs as Providcd lor rhc
<br />Scctiotr 1076 rirhc ri&tr Codc. inlcrc( and arrnrcy\ ltcs
<br />""", 5/l t'Itl,
<br />DECIAXAIION
<br />I h.rcby a(firn undcr Fnfiy of Fiury lhlr I 0,n lien*n undcr t,llisionotChatl6 9 (otuftri.r silh Sdrion ?m0) ofDivtioo l
<br />of rlE Blsinc$ ud Pmf6sioos C.de, and ny ltcne k in tull aoN lrl .ffRi
<br />5 /t)//r ."","".,,
<br />I!]ISIBUCIION.LENITINGICINCI
<br />I hcrcl'y rmrm uslcr pc shy.fFrjury rhar thcrc h..onitu.liotr hnding.ecrc, {or llt Frtornrancc o{rhc work ior which $n lrnni n
<br />nsucd (Scc.109?. Civ. C.J.
<br />ATTLIIANLDECIABAIIO!
<br />Ihort'ylnimundcr I'ctrrlly oipe4ur, one ofrhc a.llo*ine dcclarllions:
<br />Dcmoliri.6 Pfmn* sb.nos Norificarion Fcdchl ReEUlari.ns (TnE r0. PsO
<br />R.qtrir.d l.cnf rl Norillc i.n
<br />I c.niryrhlrrhc ltdcBl rclnl,rions rug dnrg Nsh.{os Enr,vrl ,rc norrfplic lclo rhh I]r.}Tr
<br />?4 ccnlty rtrar r travc rct rnG applic{n,n and sr0rc rhar rhc rbovc inhrnDrn,n n..md.I dgr.c r. cotrplt wilh trllciryad (-ounr,
<br />ordinanccsnndStorcbwsrchrinsrobuildinsconsrrucrion.n hcrcbyourhonze rcpr€\cmdi!.s orrhh ciry otrd Counly ro cnrcr nponrhc
<br />,t v. rnr ion.d F)pcny fdr iNf(lion
<br />,\pUliffnl o.,\sdl Sixn$toft:(&1 d.(5/to/lZ
<br />I'(nnit.. nhr.lprinlr: qv /i lr..llo
<br />I
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lire Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Air Condrtioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />l\4eter Release
<br />Bough q.t/fs 9. i}/Dl;:i**
<br />Service Meter
<br />>AFINAL tlv \ at Rt'rs>4
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Sub-Panels
<br />lol1q.7 L
<br />Irnd.l{ N!@. _
<br />t ndcrs Addrc(
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