|
ELECTRICAL-INSPECTOR RECOBD
<br />COMil4ENTgAPPROVALSDATEID/SIG.
<br />Site-Work
<br />Unde round
<br />Pole Bases
<br />Li ht Standards
<br />S FountainsasPool
<br />monumentSiNS
<br />Lile Safet /Low Volta e
<br />Communications Cable
<br />Under Slab / Floor
<br />7.1 (
<br />Translormers
<br />To uern
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To UI ent
<br />Facto Wired Unit
<br />Walls Conduit
<br />Walls Rou h
<br />Ceilin hSHard & Soff it Rou
<br />It/eter Release
<br />Rou h
<br />t ,Service lvleler
<br />FINAL /-
<br />Notes, Remarks, E1c.
<br />(,\\ NT:R III II,I)IiR I)IiI,CARA'I'I('N
<br />l hcrcby.lllrnr undcr Fctr ry (,l pcrjury rhlr l m cxcmPr tom rhc ConlrocloF Li..nsc tiw hr lnc rdllowiis rc$ntr rstr7orls
<br />BusiDcs a8l Pfl,rcssiotr Codcl: Any Ciry or Couory which r.qutcs I !€rdir t, .onslrucl alrd. inrrrovc. d'moli\h nr mFn Jtrv
<br />dru.rurc, piitr ro iis hsuanc.. ako rcquircslhc aPplitdtrr ror such Irerdir ro ulc o skncd (rr.mnr rhal hcor\hc i{ li'cnscd puruunr
<br />rorhcrmlnnrsorrhcConrrucxtil-iNnscdLaw(Chafl.rg.comnrncingwiihScclion?off).rDivision:lorrh'Irtr{in'snnd
<br />Prolts\ions Codc) or lhrl tu or shr is rxcrnPt lhcrcfronand$c btsis for rh.allcgcd cxcmrrion Anvviolarion'rS'crim Tl)ll 5 hFnv
<br />rpplic.nl ittr tr lcrmir sxbjftc lhc lttlicanr ro ucivilPc.alryofnor $rc lhnn five hundicd dollm ($500)
<br />l, !s ovner of rh. r,sl)cny. ot my corloyes *il h wlses sr rhcn sk omp€nqdion. will do thc $'rt ond rhc slrldm n nor
<br />itrrcnd{d or oflcto'd fo; slt (Sa 704.a. Busincas .nd Protcsriom Codc Tlc Cinraclols Lkcn* lrr docs nol aPplv ro 'n osncr 6r
<br />rhc p$tEny who ttilds or irpmlcs lh.nn, urd wh. dG Mh wolt himgclr or hcr$lf nr rhmuSh hk or hs own cmnloltcl'
<br />pr"!id.d rhar $ch imlrewmnh drc mr inrctued or ofieEn for sh ll howfti (lE buiuiog or iq,6Emnr is v'ld wirhin om vts
<br />;fcontlcrion. rh. owNr BuiBcr sill harc rhc l,olicn ol Pmling lhar hc or shc did fr, blik or i'qk,rc lh. ,mFnv ror rlE t'urlFs o'
<br />-1,
<br />Nowmr.f lie pmFdy, a cxclusiEly contocliB *iln lian*d .ontnctor ro con(ru.t th. tmj€cr (SN 7o4'l- Bu'i"cs
<br />and Aotcssir codc: ih; Conkkror's Liccnsc Las d@3 nor npnly to !n o{nd ollropcnvqho builds or iDpdvcs rhcrcoo-
<br />$d sla, .o.rsckror suchfllid(wnhacomEro(s) ltcn*d puisunl rorheCodEctoisLic..k rlw).
<br />-l
<br />a'n.xcmfl !nd.r S..rio
<br />Drr.:
<br />B & t'C r.irht rcr$n
<br />woRl(Flls' collPB{sartrN
<br />DECI,Af,AtrON
<br />I hcrcby afirm undo p.Mlry ol p€dury oft of rhc rbllouins d*l,ralions:
<br />-l
<br />hav. arid qill minllin t CcdirEorc of Con€ ro s.lf lNurc {or srk s coryc.erion. as P,!!idcd ldr btSalion 17fl}orrhc
<br />Lrhor C.dc, toi lh€ FrfonEtuc ofrhc ao* aor *tkh rhc pcrmir is L$ued
<br />-l
<br />h6v. nnd will mainlsin workcB com!€.slrion insuiarcc. !s tcquncd bv Sslion l70o ol lhc Lrbo! C'de lor thc I,crromncc of
<br />rhc work lor {hich lhis Fmn is n$.d. My sorkds ompcnsrrion insrrame 6nier aid Plicv numhd dc:
<br />-t
<br />ccnify rhar h rhc r.ri.nunc. of6c *ort r'or which rhk pcrmil h hsred. I shoil nol c'nplov anv Pc6on in snvmnns
<br />s, dr h bccom subiccr ro rhc soricF mmpcilut io laRs oI Caliromi,. dd a8rec rhar ir I should lE otu srbi*i x' rh.
<br />*ork.B coqrcnsrionrovisionsofscclion]T0OofrhctitorCod.,sh 1. tbnhwnh .on$lv wirh rhos provisions
<br />WARNINC: Ftriturc ro scurc wor kes' co nDc nssl ion covc.,gc is unhwful. dnd shall suhJ&r r!1 cnrplorcr b rininal P'nlllk$nd
<br />civilfincsutidonchundrcdrhousaoddollffi($lO0.O(r)),in.ddilionrorhc.onofconrp'nsalion.damscsss,'rovidcdrorlh'
<br />S.( ir, loll, ollh. l.iri{ (i'(1.
<br />'^,"=4ADlJtl $*ori
<br />IIECI.6XAIIA!
<br />I h.rcby aflnm undo r.ndlyofpcrhry rhd I m liEnsd ondc. r.vliionofCh,ptcr 9 (conrruncing with Sath.7000) 'rDivhion l
<br />oa rh. Businc$ and Pof.rsi.ns Codc. ud ny li.cnsc ir h tull lord a*l .dsl .
<br />',**."r*.(') o'c-4b 1 4_{260>
<br />,",., lhF? /f ,orz&*,
<br />qONIn!]CIIO!i.LAiUNC.ACINCI
<br />I hcrchy oafiro lndcr ,,ctr!ll, o{ tcrjrty lhtl I ho! t a consrrudion h0dins tg.ftv for llE pcrfomftc ol lhc work for whkh lhn Frmn 'n\u.d(Scc 1097. Civ C ).
<br />Lcn'ic' "Nanc
<br />-
<br />l,.dfl s Addrc$:
<br />APPLICANT TTFCLARATION
<br />I hcr.Sy amm lndcr n nrl y of pcrjury orc or lh. folloBin8 d<lmrions:
<br />Dem ion Pcrnrirs-Asbcslos Nolificslion FcdcEl Rcgularions lTille tlo. P.n6)
<br />-R.quircd
<br />LcrlcrolllorirEalbn
<br />Iccnilyrharrh.rcd.rdlnsuliri('n\rc8,rditr8rshc{osr.n$!rlffcnlrmli.iblcrolhnPr+'r
<br />_l c.nify rh.r lh.vcr$drhi\rPp )
<br />.' rrrr\ rlsrir. lrw\ r.lari')
<br />itr\c nrnrnnrd popcny I'or
<br />LLl-4...)-
<br />*,:a(y'42t\
<br />Fire Alarm / Dampers
<br />Buildinq
<br />.t(lr(/q,Bondinq / Groundinq / UFER
<br />Ceilinos (T-Bar Rouoh)
<br />-il?r')b\J6r
|