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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUILDER DET,CARAIION
<br />I hcrcby alfi.nr undcr,Enlll, oi pcrjury rh I am cxcnDr ri.n rh. Conhdo$ Liccns t2e r.r lhc followin8 rcomn (SN70315
<br />Busincs* odl Prolrrsiun Codc): Ant Ciry or Counry which rcqlncs a Fmir h con{tocr. alrq, i6pmvc. dcmrish or rpln ,n}
<br />stucr$.. prir ro iis issuaft., alb nluns ttu arpli.,fl lnr su(l pciini ro nlc a si8Rd raEmfl thor hc .r shc i\ liccnscd puruant
<br />ro thc pmvnn,ns olr}r Conrr..rols t,iccnrd L!{ (Chn s 9. ConnENinr {irh Sccrion 70(n of Divhion I ofrhc susinc$ and
<br />Pmrcsn,nr Codc)o,rhar hcorshc is crcnllr rlrrclroh6d rhchusis ior rhc all.scd cxcn1trn Any vi.larion ofsktion ?031 5byatr,
<br />applic0nl loraFcmit subjek lhc lmlicanl ro !civilpcMl'yornot nFrcllEn livc hun<lrcddollutr (S51x)).
<br />-1.
<br />.s ourcr oi lhc pmpcrlr, or rny cnplorrs w h pnScs !\ lhcn qrc .orB-trsrriotr. will do the work ond lhc sln{1urc n nol
<br />idcndcd or oficrcd i(n elc ( 56 70!u, Blrims\ and Prcfcsbns Codc: lnc O]nrrackr'{ Lic.nsc rrw docs n.r ,mly ro trn owtur ol
<br />rhctn'Fny wh. build\o. imp(,!cs rh.mn, ntul wlrr &a \uch sii himsclfor hcn.lfor rhmuBh his or hcr own cmtloyccs.
<br />providM rhr su.h nnrmvcnf,.N m nor imcnd.d d olt!ftd tu sab lt h.{ctr. rhc hoildirS or ioproRruN is soh wirhin onc Jrrr
<br />orcunrlk'nr. rhc O,ncr Buiuer will hik rhe budco of,,rcvinr rhd tr or chc dir lxn nrild nr ifllmlr rhc pmpcny for rhc I]! po{ ol
<br />-1.
<br />$ owtr.. ol rh- ,tuttlny. rtrrciclusivcly.onlmLlinS wirh li(n*d .onrrack,n ro con\rdcrrhc rotcr (SN 7rH.r, Bu\i[r\\
<br />tud Ptuf.s\bn C.dt: Thc Coitrcro"\ t-iccns. t-r$ doc\ nor rlply io ui owncr.l ltupcnywh. huildi or nnprovcs rhcrcon.
<br />and qho co.rrrlis l'or such Drojecls * ith r Contrudo( s) li.ctrkd nurua rorheConrld.as Liccnsc ltrw).
<br />-l
<br />amexenrnl undc! Secrion-. B &PC lorlhtrcay,n
<br />DlI. ()*n.rl
<br />UOBtrEAIL.cOIIIENIAIAN
<br />DII:IAXAIION
<br />I hc..hr!lfinnuDdcrrD0lllolpcrulyon..lllrclollowirAd(larIiotr1
<br />-l
<br />havc md will roinrain o Ccrr ifrarc .l Consor ro Scll'l nsu.c r'or qorter' compcn\orion. as povidcd ld by S&'iotr ]7m .r rhc
<br />khor C'odc. lor thc lcrforMcc of lhc work for which rhc lcrnri( is issucd.
<br />lha!c rnd sillnEinran, *orkcrs onlPcn\rri{,n in\trrm.- rcqun.dbySccri,nr:17(X)oftltLrborC.dc.furrhcp..lonniNc.l
<br />rhc *.rk,nr whi.h rtri\ p.nnn il nsuel.
<br />^ly
<br />workcrr .o'nr.i\ari,,n i'n.rrdc..nni$ dxl |)olicy truDhcr ircl
<br />I0licyNumhcr:-
<br />I ccdi! rhd rhc r.rtonnrmc ofrlf woik ix $hi.h rhh lrrnir is issucd. I sh.ll nol cmtloy rny p.rsn in lny nranncr
<br />ssn,bc.onrcsubJc€lrolhc$od(€n'.onD.nsaiiotrh*solCrlifornilmdlsEclhditlshouldhc.onrsuhj.crrorlf
<br />wo*en compctrsorion pnrisionsolSdion 37m ofrhc Lnhor CoJc.lshlll. fonh{ilh compl, trirh rlb* pr.vnion\
<br />WARNINC Failurc to sm *ork.n onp.ns.rio .ovdrlc is unlrwrul. and shall subirl .n crnplorr! to niminllr4rulricx lnd
<br />cilil nn.s ut ro orc hxndrcd thouirnd dollrs lslo0.fiXr, in rdditio. kr lhc co{ ofcompensorion. d.mgcs as proeidcd tu rhc
<br />Sc.lion 1076.trhj L:bor Codc, inrcmsl ana arlormy * ltcs
<br />Dole: Applionl:
<br />r rr:errsr.r. corirneiron
<br />DES,Af,AIIO!
<br />I hcfth, sflirnondcr Fnalry.ap.rjrry rhd Lfr li.:nel undcr F.rirnrn 6rChtrpr.r 9 (onxrf,n.ir8 wirh Scdiotr 7t{)0) ofDivision 3
<br />oi lhc Busincs lnd Pdtsions Codc. ud my liccnrc h in full iorce ud eltar
<br />C(INSTRUCTIoN LFNDIN(; AGT\CY
<br />I hcrchy !finm trndcr lcnllly ol p(rjury lhai lhcrc is a onsruclion kndio8 asenc, rd rhc prrrormtut.rrhr *ork lor vhi.h thk lEnnjr h
<br />hsucd(Scc .109r.Civ C.)
<br />L€adcls AddEsr
<br />-
<br />AfzugANfDEl;I,AXAlIO!
<br />I holty anim undcr pcnallyofpcrjuryom oithc following dcclodn,ns
<br />Dcmli'iotr P$nnF^sb.{os Noriar.ariotr Fcdcnl Rc8ularioN (Tnk 40, Pan6)
<br />-Rcquircd
<br />L.ttcr ol Nolilration
<br />lcur,lrrhrr r1[ ,i,[rrl rclrld i,)n\ rrgrnlng r({{.\rctrrul ,c f ,t rt]t)li.nhlc b rhs |n it .r
<br />lcrn'li rhd I hrvc rcxd rhi\npfliuin)n rid i cthd rtu rhrr inr(trtrdi,n, '\(oirc(l I r!ii\ k
<br />[d[::il#%?
<br />l hl hv lilir,e r. fi.|llliv.\.I
<br />) conlly wirh ollCiry 6trd Colnry
<br />rhtCity!nd Counr) h ctrrcr ur'n rhc
<br />^,. Q(z;Jtr
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondin g/Grounding/UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service Meter /..-\
<br />FINAL '1*27-11 \M\Y-t(,)
<br />Notes Remarks, Etc.
<br />COMMENTS
<br />c{no
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<br />Site-Work
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