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ELECTRICAL-INSPECTOR RECOHD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DELCARAIION
<br />I hcrcby afli.n hdcr l].nalry of perjury rhar I am ercmpr from rhc Onrracrui Li..nse hs ror ihc following r.nn'tr (Scc ?011.5
<br />Businc$ ann Protcssn,n Cod.)r Any Cny or Colnr, which rquncs , p.rmilo .onsld.l, .116. inprovc. dcnmhh o! rcPIt any
<br />(tucrnrc- lri, rr irs issurmc, ,lb equns rh. arpli.,ni k,r su.h trr. ro nlc i si8rcd nurmnt rh3r h. or rhc h li.cn*d pur$,nl
<br />b rhc previsiotrs of rtr Co"rrrcttr\ Liccncd ljw (Chaprcr 9, co,nncfti.! snh Scclion 7O(n oi Divhion :l orrh. Buti.c$ and
<br />Pmr.s\i.nsCodc)orIhrlh.o heiscxcmplrhcrcnomandrhcbtrsislorlhcallcscd.ictfln,n Anyvidl ionorscctionT0S,.5byrny
<br />appliconr lb! a pemir sul,j(ls rl'c applica.r t,,cililpcnalrrofnot dr. rl'an nvc hutrdto{ dours lS50O)
<br />-1.
<br />$ oqncr ol rhc pnrpcny. or my cnulorcs + ilh wqcs rs thci. dc conrpcnqritr. will do rh. work d ltE(nIlurcn nor
<br />inrcflkd or oflircd for $lc (S( ?04.t, Brsincss and Profcssions C{xlc Thc (})ntrndois l,iccnse lls dms hor arply ro in owrcrol
<br />rnc lolEny *ho huilrts or inpmvcs rL6n, aJd wk) dt8 luch uuk himscllor hclsclfor rhmugh hh or h.r o*ncflnloycc(.
<br />ntuvidcd rhnt su.h nnflovcmnh @ not inrcrdd or o|IeNd ,nr ub lll ho*ckr. rh. hoildirS or imPmvcmnl h\oldwnti"nnc Fr
<br />.rrnnokrinn- rll Ownd Builihr will hovc rhc htrrdcn .r lrevirg rh,l hc o! sh. did ml l{iu or iqmE rhc rmFny for ttE Nrlbs ol
<br />I. 3i owic' of rhe ln{r.ny. a r cxclunvcly co,rrdinS wirh liccnkd coMado6 ro co!{tucr rh. Pn jd (sft 71x4. au\rtrcs\
<br />lnd ho6ssion Codc lhcContractors Liccnse l-a* docs nol lnnlyro anosn$orrrorc ywlD builds or imlDrc\ rh.rcon,
<br />trnd whu onrmch tn srch Eojc.h wnh , comncro(, li.cn$d puEutrfl h rhc conrracrols t,i.cnrc l-r*).
<br />I anrcknrm uMcr S(Lotr . A. & P.C ror rhn r.n$r
<br />D.le: Ownerl woR(tfs coNlPENSArIoN
<br />IIECIATAIITIN
<br />I rf,flbyrfllr Und$pcnalryof p.ruryo.cofrhcli,llowirgdcclar nnF:
<br />-l
<br />h.tc lnd wili nuidain r Cen ificrrc of Conur b Sclf ln\urc trtr *ork$f co.qrnsd ion. as Fovidci ,,,r hy S..rio .lTm ol rhe
<br />l- r Corlc. hr ltu pc htrmtrcc olrhc *ork fq which rhc Frmir i\ iss!.d
<br />/xcand will
<br />'nainrrin
<br />wort.r\'.omp.ns.rn iNuran... a( rcqlncd hyS(lnr 3?(nolrhc lih.rCdlc. hrrhcI. ot.unccot
<br />"'Btl$l ?'^ *"P.{Ufi::*il i'}'HI?H*fr,:,"J ""' *
<br />rlzStgt
<br />l.crrilirlrrr irrhc|Eitumimcollhc$orklnrwIi.hlhi\pcflnir is i\str.d.I n]rll orcndoy
<br />ri s\ k, hcom rhJ.cr t' rh. $orlsi .onp.n{rn,n h{rorcnlitunir, an{la8rcc rlmr ifl sh.uld bcco'E uhjcd 6 rrk
<br />worlcn conrrrnsrrnnr rtuvisn,ns of sc.r im l?m or th. ljhtr Gxl.. l choll. lnd hwirh comply sirh rlx^c ptuli\ions .
<br />(ivil
<br />RNINC: kituc lo securc *o!k.n con,Fnsllt'n corcrasc i\ otrl r m cnDkDlr ro sirinal ncmlr
<br />lilr\ up lo oflc hundr.(l rhonsrnJ d.llJs (Sl(x).(xx)r. i'r
<br />:::e/I+i inrcrc\r and urr(,rcr's lUs
<br />I hcrhy,flt'n md.r Fnrkyoipclury thol I am licctrst undcr pmvGbn ofCtuprer 9(contufti
<br />ol rhc Businc$ad Pn,L$n,nsCodc. md ftryli.cns. h in futlforccmdclfccl
<br />(irh S..rnn 7l)1){)).r l)nni,',.r
<br />i:::9i2ffi CtorS Q<() .)
<br />,K
<br />I hcE6yallrm! s pcnoly oa t c4ury lhat thse is ! snnodbn lendins !g€n.y fo. lh. t rlolmrcc of lh. atrl fo, *hih rhii Frmt G
<br />hsucd {s*. 3097. civ. c.).
<br />AITUCANIDICLAAAIIIJN
<br />I Mry |Irm undcr p.n{hy of pcriuly ore of rhc followin8 dahr ions:
<br />Dcnnirion Pcrmn\ Asltrtos Noliilc ion Fcd.r,l RcBuLtions lTnt 40. Pan6)
<br />-R.qni..d
<br />larrcr ol Noiifralhn
<br />/.cnilir[xrrhcndcrrlrcrrl,rionsrcBtudi'r8Nhi(nsrc hul &c ror rtflicrhlc ro rhis pnjccr
<br />I crnilvrh lhrLc rurd rhi\ lpfli.rriotr nnflyqnhrllCnyrndCourl
<br />o'dnrn..\xnd S,rrc I a*\
<br />'rlxrnrp
<br />b hn1
<br />rhrlr trrnii{nEJ lm|xny ntr i'Np..r
<br />\pplicinr 0r .\tcnr St*n$tur.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Vollage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / 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 />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service lvleter
<br />FINAL ,p1, tt cf&'2')\
<br />Notes, Remarks, Etc
<br />tD/stG.
<br />lvleter Release
<br />Z
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