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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.Bby dlfirm und.r lcnrky or p.riury rhol I om cxc,npr rtufr rh. Ci,nta.ron Ltccns trw ror $c follof,inS rc.$n (S( 70i1.5
<br />Businesr o Plorcssiotr Codc) Any Ciry or Counry qhich rcquircs r lqni Io con(ruct. alrcr. impFv., dcmlhh or ftlai ey
<br />irtucrurc. pnor b ns nsuane. ako aqotca lhc apliclnr for su.h pc,nir b fik ! si8md n cftnr ,1h.' rE or sh. ir lic.nsd puisudnl
<br />b lhc Folisions ofrh. Conhcror's Li.cflsd tjw lchal'Er 9, Comncmir8 *ith Seclion ?OOO of Divti.n 3pfrh. Budnds and
<br />Pmfc$ions Codc) or rhnr lrc or shc is crcnfl rhBcrmm and rh. lEsir for rh1 allcged cxcnpri.n. Any violarionofSccrhn 7r).11.5 hy 0i,v
<br />aprtic,nr ld rFrnir {bjc.k rh. applicanr ro acrvilpcnal'rornor mrcrhan fiv. hundrcd dollais (3500).
<br />L a\ owmr of rhc I,oFny. or ny enDl,ryc.\ wirh *rgc\ a\ rhct $h co'np.n\ bn. will do rh. wfik arxl rh. (Mm k d{
<br />i cnddl or olIcrcd tnr st: (Se. 70.1,1. Busim$ and PrcLsio.s codc: Th. Conta.kn r Lncnsc tjw d@s nor appl, b m os ncr .r
<br />rhc pDrcn, wh' builds or in{,n,t\ itum(,nd wh) d,Es slcn q,* hinrclfor ttr^clfor Ihnlsh hh dr h.r ow.c'nproyccs.
<br />providcd rh, {.h i'nptubnnh aE mr inr.Mcd or ofi.r.d for $lc lll howclrr. ih. hoildi'r8 or imfiolc rtrr is sold *ilhh onc ]ce
<br />or.of,llkri{,n. rlE Owner Btriucr will hnvc rL hddcn olprovin8 rhar hc o! shc dil nn blilt or ir\Tok r,hc pR,p.n, nrrlE pu4$s or
<br />Laso*ncrolrhcpopcny. .xclurivclyro.tncringwirhliccn{donk t,^ io $.{od rhc poj.! (Scc 7l)44. 8uiincs
<br />lnd Prn6sk n Codcr Thc Contracto.s L,iccn\c L{* rlocs nor lt,Dly u rtr o*ncr olnrop.rlywho nuiB\ or i'.pnrks rh.rcon.
<br />and *ho $nkacc fr !u.h ln,j.cB wnh uC(, ra.t(,li.cn{dprr\urnrrotlf,Conkmror'sl-iccnscLrw).
<br />I n.xr.rnr und.rs(rion .B & P.C. fdrh6 rcdson
<br />Ir . O*n.r
<br />u.0a$i&tro!ltE!,ra.u9N
<br />DECI,ASAIION
<br />I h(rcbynlnnnutrdcr pcfuhyol Jrrlury onc ol rhc lalk,wiri! d..lnrdn {
<br />-l
<br />hilc.nd sill minrain a Ccn i&arc of Consnr toSclflflsurc for workctr .ompcnsarion-xs pr,vidcd r.r ily sc.rio.37m ofrhc
<br />Llbor Cdc. ror rhc pdlormncc oi rhc work for ahi.h $c Ffril is issucd
<br />_lh!v.rnd*illmrinrlinworkd^.onll.n\arn,ninsuHmc-0\rcqrndbrSdrionlTmofthctjborCnd..lorrhcp.rlornunce.i
<br />thc rork l{r rhih rht pcrnrir i\ i\\ucd Mt n i'aunnrc crrirr n lfiliry.u rhd rrc
<br />\e--\-E
<br />I cdnily rhrr in rhc pcrrblnuncd olrhc qork tu which rhi! Frnrir k h$d. I \hall nor cmploy trny pcNon in !n, manncr
<br />s) .sh bccom suhjccl
<br />'orhc
<br />w.*cn' cnn{ensiiion lrwsofCdlihnric rnd.sElhll illshouldhccoatr slhjcd t,rhd
<br />*oltcB.onrpcns.o.npn,vnionsolSccrion:lTmofrhctitErCodc.lshrll.r'onhwirhconrdywilhrhosrorisions
<br />WARNTN(I: lxilrrc t' $ruru qorkc^ c.nDcn\ nnr ..vcrr8c i\ tr lnqlul. trd \hall suhjc.r 0D crphycr ro rinriml |ttrJlris ud
<br />.ivil ni.\ xti b dnc hututr.d rh.usrDd doll rs (SllIl.(XXr, i. nddnion r) rhc.os ol conrp.nsdi,,n. drnE8cs !s Irovidcd lnr rhc
<br />Sc.riir, .1076 or rhc l x&tr Gxtd, ii drc{ md dnonry\ lccs
<br />I hcEhy 0fttm undcr rcn.hyolpc,jlrylh.r I ah liensrl u.dcr rolision ot Chaprcr 9 (.ormming *nh sc.lion 70001ofDivtion 3
<br />of lhe Busimss dd Pmlcssiotrs Code. a.d nry ltcns t in rill foe atd c|Id
<br />Lic.n\ccra\! Cao o73-lq(J
<br />o",., b2rq-tg .."*,..{
<br />co$irBlcuLtNL[Ntuclli[!{;r
<br />! hcth, amr.r ond.r Fnrlry of pcijury rhar rh.6 h a 6n{Mri6n Ldlin8 lgrmy for lh. Frformrc ot rh. work for whth rht Fmir ir
<br />ksucd (ss. 3097. civ. c )
<br />ATIIICANIDEgI.A.IAIIOI!
<br />I hcr..by affim undc. rcn.lt y of ncrlu,y om ol rhc ,ollowits dc€hrll ions
<br />ocelilion PcrnnsAsbeslos Nolific.lion Fc&nl Rcgul.rhns (Tillc 40, Pan()
<br />-Rcquncd
<br />Lcllcrol Notifi di,n
<br />I ..rtiry rhar r h. tad.rul rcgu[r ions rcBardinS $h.sros rcnnvrl rrc not rydtahh to rhh pmJc.r.
<br />l.dlilirhd I hNr R.lln rhisnnDli.r ti,Dlnd (arclh{ rlEnh)r ir,nrn i,!riscomcr I aArcc r. con,Ily wirh dllCiryind Coufry
<br />ordimtres n Srarc tiesEbrin!ro buildina rcnrcsctrrrrik\ of rhisCiryddcoxnryt,.nidu,n rl'c
<br />ove nrcnrioned pm!.ny i{n insllccr
<br />ApDlicnnl or AEcnl Sisnnlure
<br />a-,ltq
<br />Site-Work
<br />Underoround
<br />Pole Eases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service [/eter
<br />FINAL Y \\\ \c )lfit('7)
<br />Notes, Remarks, Etc.
<br />l\ileter Release
<br />,*. lo-}Io -[t
<br />,",., te 2le-K
<br />I
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