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ELECTRICAL-INSPECTOR RECORD
<br />OWNER IIUILDER DEI,CARAAION
<br />I hcrchy,fin undcr pcn0lly of p.rju.y lhlr I anr cicnDr ft,mrhc(i, n.r.n Liccnsc Law for lhc follo*ins.eNri (s...?0.115,
<br />llu\inc$ aDd Prcfc$i.n Cnlc) Any Ciry or Counry shich r.qui$ r ,crn lo .onslrud. rncr. idpnM, d.mli$ nr toFn rtry
<br />{ruclurc. prior ro ns hsu!trcc. aho rcquncs thc ofdicanl r'or euch pcrmil lo filc r silncd d cftnr rh,r rEor snc n licenrcd puruanl.
<br />ro rhc F,vni6ns ofrh. Co.rRirr\ Li.cnscd tnw tchdlr$ 9. CotrneknrS $irh Sccrion ?O(X) of Divisnrn I oi rhc Eusinc$ a.d
<br />nruh$dnscodc)o.rhdh.orshciscxcmrlrhcrctrorDandllFtNis[nrhcullcrcdcxctrrPriotr.Anyvirnriion.tSccrion?0.]l5by3ny
<br />nprlic. aorapcrm subjsls rhe trtplicanrlo,cirilpcnlllloinor x,to rh,n nrc hutrdr.d dollnm (5500).
<br />l.rsowncrotrh.l)n,tEdr,ornrlcnrtloyeswilh*!gcsasthcirvnccon{'en!urn,n.{illdorhcuorkaidrhc{frruEi\ftn
<br />inlcnd.n or ofilrcd lor srk l Sa 7(Br. Btsims\ and Pmlcsbns Codc: l hc conta.ktr s Lic.nlc hu docs nol ippl! ro ,i oq'$ or
<br />rhcpr,Fny *lb bnilds or inpors rh.rcn, ut who dcs {ch woi( hirscll'o! hcrcll or rhrough hi or ,rcr own cnllt,yccs.
<br />pmvacd lhsr such inuornEnlteun inlc .d oroltircn in. ek lr- k,$.rcr. rhr buildin8 or inprownrnr k$ld qilhinonc FU
<br />ol ollll,krDn.
<br />'h.
<br />owtrn Builcr sill hovc rlr budcn of roliry thal ic or \he did 0or hild or ifrIrok rhc pn,F1y for rtE puryh* or
<br />I. N opNr orrhi |)I)rny. n cxclu\ivclyconnnclins sirh li.enscd conrrlctr\ r, r.tr{ru.r ttr pmfd (Scc. ?04J. Bu\i,'c$
<br />x1 hDrc$ion Code Thc Contu kt s l-iccn\r Lsw docs nor rnply t' nn o*rr of thrrry qho bu ilds or inrprits rhcrcon.
<br />r qho d,nrr.rr rd sn(h pmisls wirh a CoM!.k)(sJ li(cnscd lunudr hrhc Co r&kn s Liccns.lnw)
<br />I amcrcmDr dndcr SNuotr .B &PC n{
<br />'hn '.r.o.
<br />Oxr€r
<br />rrcn&i&::laur[NtA.ItQr{
<br />III!:LAAAIION
<br />I hrvc nlsill mxinrrin rC.nific colC.Ncrl h Scllhr\xrclir workcr'.rnnncn\dn,n. r\ n(r nkd ntrhyS(rion.l?lx)ol rhc
<br />t-JhrCodc. i{trr1rc p.rtunnnftcofthc $ork f.r shichrhc lcnnn i\ is\ucd
<br />Innvcrtrdwillnuirhirworkcriconrcn\ari{{rin\uru'Ec.rsrcqtrndhysc.'iotr:17{x,ol'hcl,hor(it..nnrhcli'rormin..nr
<br />lhc sork lor shich lhh p.nnir is n\!cd lvly w. cs .l,mpcnsrrnrn nrur kc.rnicr i Flicy nunrhct !rc:
<br />I hc'chy.,r trMur lfnnltyolpcrjry onc.irhc fdlo*inr dcchrrlions
<br />_lccnilr rhrr nr rhc perfonfrtur.frhc w.rk tu which rhi.,rirnir is ksucd. I shlll nol cmploy rny pcron ii r] flrnnf
<br />c, a\ b b.roN subirr ro lhc so slc.mpcnsorion lawsolColilornh- and,sdihrr irl dbuld tr.offubicctlolhc
<br />workc( NmFctrsriion provnions oiScclion:17(xJolrhc Llhor Cr c.lsh l. i,nh$irh .on],ly rnh rlx)s F,vhii'ns
<br />IVARNIN(; riilur. n) {cur {orkc^ ronlltrtrt .n co\crrlc
<br />riv,l lin.\ ut t) onc l,trn,lr.d rh.trsnrd dolhr\ (51(xr.(xx)). I
<br />i\ unln*lul. und {tll \uhjccr rn ctrDk,tur io dnrin0! ncn.his und
<br />';:::."i/ir/4"inrcrcq.nd Morrcy s lirs )4IHl*''*"
<br />I hcftby rmrnundd Fn.hyofFtury lhit I aN liensd utrdc! tnovirii)! olChnpr.r 9(..mnf,ncirg wirh Salion 7O(x)) olDirisn[ -l
<br />of rhc Bu.in.$,nd Pmfcsions Codc. tut mylic.ns is ir r'u0 lirrccondcllrrr
<br />L
<br />atrl4 Crntmclm<
<br />I h.rby .inn undcr Fnohy of pe.july nd rh.rc n ! conslocrion Lndi.! ,ecncy fo, ltf, ,crfotmncc of rhc work ror ahi.h lhk Irnnir is
<br />hsucdts( :1097. civ. c ).
<br />Lc.dcas N!m.-
<br />APPI ICAN'I' DECLAII,A'TION
<br />I tmt'y ufirm undcr pcnah y of p.dury oft ofrhc a.llouing d.cldr.!ions
<br />Dcfr,lilion P.rhils-AslEslos Nolific0tion lcdeml RcEulalions (Tillc40. Pan6)
<br />Rcqutcd tlncr ol Nolifi carion
<br />_l.cniiyrl,rrrhc ltd.rrlmtuhrioh r8dlnr! r\b.{osrcnrrrlJc .r !Irnli.$|. t, rhis n.otcr
<br />l.cnil-vlh l [rvc rcid lhisoppli(rn'nud {!rerhll ltu rhr\c i r{trtr n is conccr lrgreroco'.ply*irhrllChyr d(1nd,
<br />ordnrn.cs rtrd Srrrc ti*s rcldir! loin r9n'\cnrirnc\ o,lhn Ciir iM C.un1!t) c rcr trB,nrrt
<br />rh,!c trr.trri{nr In)nc'ryi(r
<br />ADpli$nl.rArml Si[n lu
<br />APPROVALS DATE
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />,[t4lDlCeilings (Hard & Soflit Rouoh lo L7 LI *t)
<br />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service lVleter
<br />FINAL :*1f(
<br />Notc$, Remarks, Etc.
<br />/*.O to L $zy'/o a-<.r,*I
<br />",KtA d{ 8;"t i..!,"t,{ Av(. of ,to **-t /ept!L. at.+1;n",I L
<br />-)
<br />",," . 3/,,4r,
<br />ID/SIG.COMMENTS
<br />Site-Work II
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