|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUIT-DEN DELCARATION
<br />I herchy uffirm hder lcnalty or p.rjuiy lh lan.xcm, fromrhcContrackniLiccnscLasforlhcnbwinetlsn(S.c70lls
<br />Busincss ,fiI Prurcssirn Codc) Any City or Counly which rcquncs u Irc nir lo co.(fl.r. rh.r. inr ov.. dcmlisn .r rcIrlt !n!
<br />srrucrurc, prk r ro irs hsuanc€, dl$ rcqunssrh. applicanr f.r ruchFhiirto ilc. sismd ststcmDl lhal tEorsfic i\ liccnscd ptrsumr
<br />lo rhc Fovhions olllE Conrrncror's l-iccnscd ta* (Chrprcr 9. Co'nmrire wiih Sc.rion 7000 of oilision 3 oa rhc Blsincs nnd
<br />Pnra$i,onl Codc) or tlui lE or slrc is cxcnDt thcrcfrumMd lhc hsis lor rhc lllcgcd crc'npiion. AnyviolarionofS.dirn?0ll5byany
<br />npllicrntlbrupcrnirsuhjdsrhd.mlic,nrt,rdvillcnlhyorno( ror.rhm livc hrndrcd dollm (S500)
<br />-1.
<br />as n*rcr of rhc prolf,dl. or nly . rrloy.N wilI w.!cs rs rh.n s,b conrrr\ll i.n. lill do rlE sork lid rh. {d.rm is .ol
<br />i. cd or .ftcrcd lnr slc ( SN 7()4,l. Busine$ lnd h'olcsiotrs Codc 'l hc Conrrrfi s l.iccnr hu d..\ ior rplly r(' nn o*rcr ol
<br />rhcpml8ny Nho brilds or intov.s rh.E n, and who dds su.h $o* hnnsclf.r hcr{lfor lhrcugh hn or hs.*n cnpk'yc.*.
<br />nruvidud rh.r such inDhenE.h d. nor irtc(hd u offcr{t fi klc. Il h)rBcr. rh. hoiklina or iq'mvc.rnr is $ld sirhin onc }trr
<br />of.o {rLr iotr. rh. olrnn Buikls sill havc rhc h{dcn oa ptuvin8 rhal lE or she did nor huild or iopnnr $c tmFny frtr rhc rulxN. ol
<br />I.6s owErolrhc rolcny. a'ncxclusivclycotrrrffrinE wiih lirenscd contlctn\ h.Dndru.r rh. Frol.l (SN. ?Oaa. gu\inAt
<br />o{l Eni$shn Codc rhcConrrucroi\ Licen\c l-awdmr nor upplyro M.wtrcr oi nroFay who huildsor nnpn,!.s rhcrcotr.
<br />rtrd uho conrE.r*fitrsu.ht,mic.ls wirh n Cotulclont li.cnscd l)u.{u!nl lolh.Conlructr'r l-i.cn\c tjw)
<br />I nmcxcrn undcr Sc.r
<br />D.le: ' oamr:
<br />rvoRkElts coitPf, Ns,iiloN
<br />DECITIaA.IM!
<br />I hcruby,ffinn undcr p.MrryniFrjuryonc oilhc l{lllowir8 nshmrionll
<br />-l
<br />n.vc adwill m0id0in !CenificalcofConrnt r{r Sclllnsurc tff w.rk.r' ..mp.nsl ioi. as pmvid.n ror bySdt,nlT(I)ofrhc
<br />ljhtr C.d., f(rhc p.rlormm. oflhc w ror ehich rh. Fnnit ir isucd.
<br />-lhovcrndwillmi nir worlcn con\uilrion insurancc. r\ rcqu tu,l h! socr iotr 3Trro nl thc litror Codc- tu rtc pfirormrn.c or
<br />lhc work for whicnlhhrermil i\ issucd. Mrworksi q,mpcnsarion in\ure_..micr ddtricynu.rhcr c:
<br />I'olicyNumhcra
<br />I.cniryrlii!irllhcI'c'o.aurccoirhcsorklbrwhi.hrhnIcmil n issucd. I rhrll nor .nrk,y rny pcN)n iratry Dinncr
<br />w s ro bsorm subjccr k, rhc *orkc6' comFnsar ion hws ol Crlir(rnir. rnd 4ec rd il I rhuld bcnnrc lub]cd t, rh.
<br />workcN compcmrrion pmviions olsffrnrn l7(x) ofrhc hhor Cd..l \hrll, roirhtrnh co,ntly eilh thoc Prcvisions
<br />WARNINC: Faihrc b $cuh worrcN ..nEns,rion.olcElc,\ unl.*lul. and rhall slhjccr m snloycr h dilnjtrd PrD ics ind
<br />ciril liic\ uI b oic huhdrM lhousand doll*s (Slm.Un), ir rddirior ro lhc cod oi corlpcnvrion, d,tugcs trs Imvidcd lor thc
<br />s..r otr 1076 orhc lf,lxn codc. ir crc! ldr
<br />t)t( !.,\RAt toN
<br />I hcrcby trfllrm undcr I'cnolry ofperjury rh l am liccn(d undcr ptr,eisionorChaprLr 9(.onrmrcirs wilh Sarion 700{}) orDirision l
<br />or rh. Busincs Md Pofcssions Codc. anl nry liccns is ir tull ftncc ad di..r
<br />I.cnilirh rhclid.ralrcguLrri.n\rc8rr'linE \hc{o\r.nnxlrr.n,trtplicrhlct)rhirt)n,lcd
<br />ri, . " rrr,r r L1 rl r, r rl.rr , t, r r, ..
<br />u.rpfri, ,{ ^rd'r\irn,'rtrrrf r!,,rc-x
<br />llhnntrnxtrrtsrrnnlr / \
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER t4 tCl(g /,@1fi )
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bouqh)
<br />Ceilings (Hard & Sollit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />lvleter Release r4Plt$ ,</r1 E (D
<br />Rouqh t4tlltg .<.a.q@
<br />Service Meter
<br />FINAL r z-l tqlt6 lrqA
<br />Notes, Remarks, Etc CONiIf,!CIIONIENDI!].4IiENq
<br />I hcret y !fifl, undq lcnllry or ri.rjury Ihar rhcE is a .onnd.ri(,. lcndi.S .8..cy for rhc !.dffmance olrhc sor* ro. whah rhh lErmi h
<br />nsu.d (Se 3097. Civ C.).
<br />I cnd.''r Numc
<br />-
<br />t.trJr'\ AdJ,.s
<br />ATILICAILD!(LABAII!}N
<br />I hsrby dflim u nd.r ,.n,n, oa lcrjury orc of lhc followinS dclml ions
<br />DcflDlirion Pcrnirs Artrctji Norificalion Fcd.rnl RcSrlarions (Tillc40- Pan6)
<br />-Rcq!ircd
<br />lrncrof N.rilicrlion
|