|
ELECTRICAL.INSPECTOR RECOBD
<br />APPROVALS DATE IDiSIG.OWNER BUTLDEN DEI,CARATION
<br />I hcreby allrn rndcr ,.nrlly or pcrjury rh l d .x.npr rhm rhc contr,.lrc LEcnsc t w for lhe lollowins Ea$n (sc.7o:rl t
<br />ausincss ad Proic$ion Codc) An, City or Counly which rcqutcs { Irmii r. con{d.r, nlrc, idprov.. d.m,nh ot rcFrn lny
<br />srtucrurc. prior ro its n{anc.. aho rcqutcrrhc amlicur f(n skn p.rnir ro fiL. riSn{ $ar.mnr lhol lEor shc n liersed l,urtu8nr
<br />ro rh. pmrisions ol th. Contrcrols Liccnsd L,w (Chnllls 9. Commencins sirh Scclion 7(x)O 6, Divki.n I orrh. Busincss.nrl
<br />Prolcsions Codc)orrhll lrcorshe h cicnul rh.rcfromlnd rhc bash ior rhc lllcsc{ crcnflidn ?\., viohtionofSetion?0115 b} rny
<br />apttic.nr iora pcmir rubr€cc rhc arpli.anr ro acivilpenrlryolnor nncihrn fivc hundod dollas {$500)
<br />-1.
<br />ns owncrofrh. DroFny. (nnryc rtt'yccs rvilh *.Scs .i lhcir v'lc comp. {rnn,. willJo rh.\ k.rdrhcnnrrurci\ n.r
<br />inlcndLn orofitrcn fu slc lS( 7ltr.r. B!\irf,s\ 0nd I'n,fcs\ion\ Cod.:'l h. (i)nttrtr \ Li.cisc l-aw docs nol alply ro rn o*mr of
<br />rhc ptuFny who bnilds or inlttrolrs rhcto\,n. dwhodoc.su.hqo*hinrscllorhcrcllorrhrourhhhorhcro{n.nfk,ycc\.
<br />provided rhsr uch impmvc'mnk ,m nn inknd.d or oflbrcd tor \rk ll hotrchr. rh- i^rildiu or in{no\rmnl is s,kl s'irhin onc ,tr
<br />of.omplction. tl[ owrcr auilds will hrrc lhc hurdcn of rrovins rh hroshcaid nor hoi or irfn,c rhc prepcny iorrhcl)urlnEol
<br />-1.
<br />ns owtrcr or rlE fm|[ny, inr rxcrusivc ly conrrocriry wirh licctrrcd conrru.n,n lo con{rucr rhc F,j..r (scc 7t44 8nnrc$
<br />anl ftofislbn Codrr Tlr. Cotrrdcror's l-i.cns. t-rw do.s n.r q)/, to trn owncr olproncnywho huilds or nnlolc\ rhcrcon.
<br />lnd $ho coor,arh lor such pojccr\ wnh a Contracrorl, lten*d prrsud h Ihr C.nt r.r'sLi.etreljw)
<br />-l
<br />am cicnlpr undcr Ssln)
<br />tll]BKli&5lAUfEN$AlION
<br />IIECI.AAAI]ON
<br />I hcrchy aflim un.lcr rcnllly ol JErjury om olrhc r'ollouins dcchruin,n!
<br />-l
<br />halc snd will nuinrain 0 Ccn ifurc or Con*nr t, SelH nu'c r'or workc(' c.mFnsar ion. os Frcvtcd ior hySccrion:17( otrh.
<br />L.bor Codc, iot rhc ncdonutuc of lhc work for wfiicn rh. pennil k n\ucd
<br />lhxlc n d sill ui'trri'i sork.rs .oupctrn nnr iDsuraif,c..( rcquircd hySc.li 37(x)olrhc lnborCodc. nrrhc p.nnnnxm..r
<br />rh. qork for qhich rhis Firnir is ilsud. M!$orldi.om!.i\ ri insurrtrcc crrid rndFnicynuflrhcr arc:
<br />Ir{,licrNun,hcr ErDrc\
<br />--l
<br />ccdifythar inlhc pcraorNncc otrh. $o aor *hich rhi\ Pcrnir i\ i\srcJ. I rhrll nor umpk,y rny F.rsotr nr rny mrn.r
<br />v, Nk tr.nft subirr hrhd warkrn .onrrcnsartun ldws or crliromil a |3elhal ill should h(ro'm {h,cd rorhr
<br />uorlcn'comp.nsdn,ntovnion{ofSstir:l?0OofrhcLaborCodc.lsh.ll.n'nnwirn.onr y wirh rhos lr.vhions
<br />WARNINC: [lilurc ro scurc $orkcn
<br />(nil finc\ uI h ryr hundrcd rh"u\ond
<br />srlhn x,^ of'',}fi fod. lnkr(,"," 4L'-!Ll)
<br />!n cnvlo'€r ro diminrl Fnrhf,\ ud
<br />tnr. drnr8es is prov cd lu lh.
<br />I hcrby arnrn undcr lc dry.I!.rrury lhd l,m li.cn*l uMcr pnrvision or Clu|]lcr 9 (commminE wi'h S(rion 7(xJ0)olDrisi$ l
<br />oi rhc Busincs od Pnn'csionsCodc, drd myli.cns is i'r tull f.r.c lctlccr
<br />(
<br />lolsmueuoNr[lDllcaa[Nr.I
<br />Ihcrcbyifii,rntrndcrpcn{llyollErjurrrh lhcrc h rconsrruclhn hndingascky forrhc ptrf*nrdkc olrhcwotk ior*hichrhi\ pcnnir ir
<br />irsu.d (Sc. 1097, Civ. C.)
<br />I ccniiyrhar rtu tcdc rll rcSu lar io n s EgardinE osbcsros nor qrplicrhlc n' rhisl,ntcr./
<br />-l
<br />ccnifythar I larc rcsd rhkupplicarion !d \rar9,61rnc !b.rc flnii,r '\.om.r l rg(t k,.o Dl!
<br />;'li"H*"-
<br />.dinrncc\ nlSiire l:rw\ rchring r, huinting cn6rrudion. rnd hyxurh.r 7c rcprc\.nrrrrr\ ol rhr\ C-[)
<br />rtn\c ntrnrioncd prcr'crty Im nr
<br />ADplicnnt or AEenl SiAnrlufr
<br />a
<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 />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Fouoh)
<br />It/eler Release
<br />Rouqh
<br />Service I\,4eter /1
<br />FINAL /t/tvl/ -M1-4-/I
<br />Notes, Remarks, Etc r<
<br />COMMENTS
<br />APpI ICANT DFCLAR-{TION
<br />I herhy alIm xnd.r p.n,lry.rtcrjury on. orrhc f.llowin8 ddclmlions:
<br />Dcnrclirion Pcrinils Aslrnos Norillc,rion Fcd.rrlRcEularions ('Iirlc 40. Pda,
<br />R.qui6d trncr of Noriff, ,rior
<br />r
<br />--------T------
<br />I
<br />F
<br />I
|