|
ELECTHICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATloN
<br />I hcr.by rltrfl undfi pcnrl.y . r pcrjury rhar I m eicmpr from rhc Gnnrackna Liccnsc Lrw tu rhc followins rcuq,n lscc 70.115
<br />Busincss lnd Prclcssnnr Codc) Any Ciry or Counry whi.h rcquims a l.nnn i. .o.stu.r, trlrd. imlrok. d.mkh or rpat nny
<br />slrucrurc, riff ro ts i3suarrc,,ko rcqun s rhc applicur lor {Eh p.rmir lo filc a \isrcJ srsicnEnr ihat tEor shc is liccn{d pumuant t
<br />ro rhc pn,vhbn\ orrhc Contncn,\ Liccnrcd ljw (Chlprcr 9. Commcmin8 Nirh Sccrt,n 7l(D ol Dirhion I ofrhc Businc$ and .
<br />Pmlcssi{NCodc)orrh0rhcorsfuhcx.Fptrhcr.frooandrhcbn\ilI{xihcalhgedercryn,n Anrviohrn,nofs ri,nT0ll5byDn,
<br />aprlicad lhrr pcnnil subjcch thc attli.onltua.ivilpc.axyoffr isr. rhM uv. huMrddollri lS5lD).
<br />I. .s owrcr or rh. rreNny, u n'y cnFloyees *ilh wases $ rhcir nnc co'npcnsatnrn. will do thc tort and lh. (ulur js noti cndd or ofltrcd for sk (Se.7{r,t4, Burincsr and Protcsshns Codc Th. G).ts.ktr \ I-i{nsc Lrw dtxs n, dl)dy b rn .wmr or
<br />rh. rrcFny who builds or iq,rorcs rhcmn. aM qho des such uork hi,nsclror hctrcllor throuSh his or hcr own cn,l.yccs.
<br />rnvidcd 'hir
<br />such inlpmwnrn( rrc tur inrcd.d or olrc'ln n, sb ll tDM. ltE huildins or in{rorcmnt h old *ith'n .m ,tr
<br />of conrrlcrion. lhc Owei Brildcr will hdh rh€ hrdrn of pnvin3 th.t lL or shc dn d hoi! or inuro( thc pmpsty for rhc nlrFE of
<br />_l- ns ow,cr oi rtu pmlMy. ain crclusivcly ..nrfr i'rr wirh li.ensc.l .onra.roN ro c.nsrtu.r rh{ pmjc.t tS( ?0.r4. Buinc*
<br />Mrl Pnfcssion Codc: 'l he Conracrols Liccrsc Llw docs nor amly ro 0n owkr or pror.ay who builds oi nnpovcs rhcrcotr.
<br />rtrd who mnrn.rs fttr su.h pn,Fck with r Conhdo(n itensc{ I'Ursu r ro rhe Conrra.&, \ Liccne bs)
<br />-l
<br />rcxcnrU ufilcr sNr
<br />O*&r:
<br />]laatrr&i-c{rufENtAr0N
<br />DICI.A&IIION
<br />I h.rchy atlirnlnder !...hyof Frjuryo.c olthc i.llosirg dc.lar ions
<br />l hr!c dqrllikir{rinr(tnitLrrcufCoi\cirk)Srlrltr\urntr\yor[.^'.omlf,nsinrn.r\!r'rnkdfttrhySccri{,n]7(X)ofrh.
<br />I- rtr Codc. lnr rltr t '
<br />lnnMncc ofrhc $orh f{x lhi.h rhc p.nlir i\ isu.d
<br />_l hrvcand *illiminriin workcG ..mFnr iotr insututu.. rs nquicd b) S.crn,n]T0Oofrhc tjb.r C.ilc. forrhc p.rronun.c of
<br />rh. s.rk li,r[hichthis pcanil h MyqorkcA ..nDcis,im'n{r .c.r'rifi nnd |[lk! trunhtr c:
<br />€-s o g
<br />-l
<br />ccnilithil i.rhc pcrlilirm ceol rho work ror trhi.I rhis p.rmit ( ksu.d.l shallmi cmployany pc^oo in,trylm.rcr
<br />s n\b }f,..ft sutrccl b rh€ wo*cF conDcn\alion l.ws olC.lifomir. nnd n8rcc Ihal if I shDld Lronr subFI k' Itr
<br />work.s.!n1J,.\!ri.npmvki{)n\orSccrion.lT(xloflhch}inC(nlc.lshrll.lbnhwirhco'q,lywilhlhoBpr,!isirns
<br />WARNINC: Failure ro scurc
<br />ciil nncs !p to onc hundrcd I
<br />:::l'<lTif
<br />$.rkcr' L!'nl)etrsotiotr c.vca.ec is trlawrul, ..d shall subict in cnDn',tl h aimin.l F.alrix ..d
<br />iin)tr Io thc cosl ofcomlEtrs0lion. damgcs,s [ovidcd for th.
<br />lll n*
<br />lll(]r!!tll!1
<br />I hcEhy ilfirmundcr pcnalryol Erjury rhtrr I gm liccn*l undcr EovnionofCllnplcr 9 (comntrrcing wnh Sclio. Tux)) olDivhtun -l
<br />ol thc BusirEs! ,nd Pofisions Cod.. dld ny licci* h ii full t{rrt ldi cfr.*
<br />D \00uq"5
<br />ade>
<br />AfILIT:AILIIEII.AEAII!}N
<br />I hmby .rm und.r pcnalry of p.rjury om or rhc a6lL*ing deU.lrionr:
<br />D.turirion Pcmtu A\l,cnos Norificarion Fedcml Rcgubrhtrs (Title41r, Pan6)
<br />R.quind lltrer .f fLrif.dion
<br />-l
<br />ccniiyrhurthc |cdcrul rcBu hr ions rghling $h.sios rcnDvil .rc mt lpdi.lblc to lhirI)n,F.!l
<br />I lcnilvrlln lhrr. r.rdrhis inrl st0rcrldlhcatnvcinfornmrioDis.om.r laELrroconl,iywiihollCitylndCounty
<br />iirdiriNcs rna Srntc Lrqs nhrinS ddion. ril hcnby rbrizc snr,r ivcs o f lhis Cny md Counr, ro cnlcr uron rlr
<br />ahorc NnlioRd ln)rcny ror
<br />ilApplirsnl or A*ent Si*nslr El3 IK
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER 7 -l (-l'1 A,I tua
<br />Transformers I \7
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />C eilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release 7/Wt*'
<br />Rough
<br />Service IVleler 7il-t1
<br />FINAL 1-3t^t1
<br />Notes Remarks, Etc 7V
<br />Lioht Standards
<br />/n\
<br />!r.
<br />- . Jr\\
<br />X"\+FJ1
<br />Y,\lsl/
<br />SONEIBUCIION.LEIDING.A{iDNqI
<br />I hcEby nffirm under I'cnlhy oI lcrjury lh lhsc is a onrtudion lcbding trgcrcy lor $. pcrfornffic ol thc work for *hich lhis pcmil is
<br />issucd (Se 1097, Civ C.)
<br />l .nd., . \,mc _
|