|
ELECTRICAL.INSPECTOR HECOFD
<br />APPROVALS DATE ID/SIG.COMNIENTS OWNER BUTLDER DELCAf,ATION
<br />I hcr.by trmlr utrdri pcMlry or Friury rhar I am cnmpl lbrn lhc ConlrucloB Licensc bw lor Ihu folhwillg rc$on (Scc.7oll 5
<br />ausircss Md P.or.sio. Codc): Any Cily o. Counly phich rcquircs ! pcrmir ro ..trirucr. all6, imPrclc. dcmohh or rpair My
<br />(ructuc. Driotro its Gsulmc- sho rcqutcs rhc applicanr ibr r&h Frmn b filca si8trcd slslcmnl lhlr lrcor lhc n lianscd lurs t
<br />tu lhc povnbns or $. contactor's Licc.sd tjw (Chlplcr 9. Comocnci.! wirh sccriotr ?fin ol Divnion :l ofihc Buii.c\\ ,id
<br />Pn,icssiotrsG c)orrhlthcorsh.is.xcdprrhcr.iionundrhchasirri,rhcallcscdcxemprion.Anyvn,hrionofscrbnr0ll5hrlny
<br />uprlicanr ri, ! tcnnir subF.h ih. ryplicont ro acivilpln,ltyolnor mrcrhon filc hundrcdddllaB{$50o)
<br />-1.
<br />rs owmr ol rhc pFI.ny. or ny enplorr\ wirh wagc\ N rh.n vr. .omt'cnsd ion. \'i,l do ttc sqk tnl rh. nft1urc s nor
<br />i cndrd or oflcEd ror elc lse.70t4. ausnBs aM Prolerrions Codc'Thc Contacttr s l-ic.nt ltr* dor nor alply ro an o{icrof
<br />r hc pmrcny wln) bu ds or inDnrvcs rhemn. md ehl) dcs suci m hnnscLrorh.FcllorihmuBhhkorhcrowncmpk,t.cs.
<br />proviJcd rh"r such impmwftnh d mr inrcMcd or olLNd lor snh ll lnwcvc'. rhc huildinE or i'npmvc'fttrr is srld wirhir onc )tr
<br />ofclnlplclion. rhr (rncr Buils will hvc rhc bordcn ofp()in! rhd lf.r sh. did nol lrild or imProk rhc pturtnt for Ih. Puqnc of
<br />l. owncrofrhc pnrpcdy, rmcx.lurivcly cotrtrcrir3 s(h li.crrcd.onrtu.roAr,.lnr{'u.(h. tn.lcd (Scc 70{,+. Bu\itu.t
<br />{Rl F\oL:$irn Codc Th.Cofrrrcrols I-icrn\r I-aQ dods noramlyr. oNmrofpro,l.nytrho huildsor i'nPtuv.sthcrcon.
<br />rtrJ who .ontl.h for su.h |]mF_F wili n (bnlrucr.n sr lEcnscd puFurnr rorh. A,.tr.kn'!Li...sc tiw)
<br />I Jn.xc rt, nidci Sc.rn)
<br />Dnle: OPn.r:
<br />woRKFis'ci) rmrrsATlot
<br />DIgLABAIIAN
<br />I h.rcby rrfirh r.d.r Fnalry or p.rFry onc olrhc followi.S dccltrlrions:
<br />-lhrv.lndwillmint,inrccnific0lcofConscnfoSclilnsurclorwortcr'R,frpcn$rhn.aspmvidcdrbrt'ySccrion:]7m.lthcLat$r C.dc. lor lhc pcrlomne or rhc worl lnr Nhi.h rhc t nnir is issucd.
<br />lhdvcrnd will rinra'nw.rk.r!com!..srrioninrurancc.rsrcquircdbyS.ctnr]TID.frhcL$irCdc.lqrhtrrrormn...t
<br />thc work f(tr whi.hrhi{p.rnnl is hsucd. My*orkcr'otr i'ntrrrn(.rdicr dklNli.y nuhh.r rc
<br />-lccnifyrhal
<br />inlhcperlb.nx,nce.f rhcsork *lrich rhisFirnil h isrucd.l shnll nor c'!nk'y 1i, tc^otr in rny mrnncr
<br />{, \t)bcconr \uhNd k) rhc so'kcs..nr|rn\rrion h*olCriilni,rir. rftlr8'rcrhr il l sltnrl(l ltcoDt suhicd hrlf,
<br />sorkr($trrtxtr\xri(nipn,!i\i,)tr\olS.di,3?mofrlrcLhtrCod..lnll.tunhtrir[.o]dy!irhrh.scIrovision\
<br />WARNNC: ltihtrc k' $!rc *ork.6' c. rN snr .ovcrr(. is utrlislxl. ntrd rh!ll strhFcr rn r Pk,ycr b dimirnln!mlric\ rtr(l
<br />.ivrl lim! trp n, onc l,unllrc,l rhotr\r (l lolhrs ,(,1[)r. i'r addirir h rhc .od of confcn\ari(nr, d rgcs r{ ttovirlcd hn rhc
<br />S.crhn 107r, ofrhl lnbor Codc. inrcrc( Md
<br />"",", -?/v/e: ^
<br />:Ea4<
<br />DECI.ABAIION
<br />I hcrcby affirn undcr p.nalry nl pcrjury rhsi I ao liensi xndci ptuvkion ofChrpls 9lonmrcing wnh s..iion 7000) olDilhion:l
<br />or rh. Busin.s md Prcfesions Codc- Md my licent i\ in full tod snd ctIcr. /
<br />/o /00b62-D
<br />CONSTRI(ITION I NNDING AGFNCY
<br />I hcrcby alfim udc, IEnah, oa lerjlry rhdr rhcE is a .on{ .rir lcnding .Bcry ior lhc pcrto.r@e of rh. work for wfiich lhn pemn t
<br />issu.d (sN. .1097. civ. c.)
<br />AfglsrtNfllEClAAAIIoN
<br />Ilrrbylfllnnunddr p.nrlry orpcrjuryonc ollhc lhllowinE ncchrart ns:
<br />DcnDliri.n Pcrmirs A\lrdos Nolilicali.n lcdcril RcEUlations (].n]c.&). Pk6)
<br />R.qutcil I.tr.r.f Norilt.tiotr
<br />I cc,lilirhrr I harc rcad rhi\aprli.,riondrxl{ar.th,r rhc ntsvc inn)i.Mlion h corar I agr.r k,.onDly with rll Cny lnd G'ury
<br />oilimnccs ind Sr.rc lj*s rclalins ro prcs.x(ivcs ofrhn ciry,nd counrt to cntcr up.n rhc
<br />nbvc nrtrrnnLa, prorcny lor
<br />Appli.nnl.r,\,r.nl Sitnatu ".,"f./:2tr8
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFEB 1/ tolte 2D 6b
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />l/lollt 5\>G\L#ll 7/ttTt<4i)4$
<br />Rough
<br />Service lvleler
<br />FINAL \^n t$aN6S
<br />Notes, Remarks, Etc
<br />Ivleter Release
<br />I ccniiyli lhc iedcrrlrcsuhrn,ns rgnnli',! r\h.sn)\ rc d rc trol rtyli.rblc ni rhi\ p'oic.r'
<br />I
<br />----+---
<br />F
<br />lt
|