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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIVNER BUIt,DF]R DELCARA'TII)N
<br />I h.rbr srllrn undq pcnllr, {,f Frjury rhal , on crcmDl Imln rhc Contra.lon Licetr* Las,rbrrhc foll.$ir8 rcr$n lscc.7o.ll.t
<br />Busircss rM Pnfcslnr Cdc) Any Cny or Coutrry which r.q!ir$ r Fnnir kJ .on{ru.r. trlr.r, nupn,vc, dcnhll\h .r rqutr Jnt
<br />dtucrurc. prior ro iIs nsuana- oho rcquiEs rhc 0prli.anr ror such Ffln ronbrsiencd arcmnr rhdhcor.hctli(n{d Nisu0nr
<br />ro rhc lrovi\ion\ or rht Conhactn s l-iccn*d ljw (Chaplcr 9. Commcrcins *ilh Scdion 7000 of Divnion :l o{ rhc Bt\ines ud
<br />Pmfcsstunx Cod.)orrhnr h.orsh. iscr.mni rh.Efroda rhchasis ttrrhc dlcaed cicmprion Anyliolarion.lSccri.nT0.ll5hydn,
<br />{ppli(rtrt li)r o lxtrrir subjc.h Ihc aprlicatrr to r.ivilp.tulryofnor nxr.rhm fivc hundrcd dollus(S5ml
<br />Lasoemroflh.ro!.dy,ornlycoplorrcs*irhwascs!slhcn{'bconpen\alion.willdolhsfku dcnrl!ren n
<br />intcndcd o. ofcrcd for elc lsc.?()44. Busincs Md ftof.$nnr C{xl. 1hc C.ntuc(tr\ t-i.c sc tiw docs nor apply ro otr osrcrof
<br />rh. pmFny who l,nilds or iqrck rtFmn. rxl who dms sch\rr{ iin\clfor hcRllor rhft gh his or hd o*n cm!loy..i,
<br />rrovidcn rhll su.h imflo!.nEnls@ nor inrcnrlcd or oftEn ror ulc li bwcrcL rhc tliidir8 or inrprovcE n snd wirhin onc y.ar
<br />of c.ry,txion. llr Owncr Build.r pill lllvc rhc hordcn or tmvine rhd lr or shc dil nor huild or itr{trow thc pmFny for ItE pu{ns ol
<br />l. r\oNicrolihc proI.ny. m,crclu\ivclyconti.lirg *ilh liccn$d cofiacn$ h .onnrucl rlt pr+cr (Src 7(l{4.8u\i'iL\\
<br />anrl l,lnlc$irCodc: Thc C.nrNrors Lrcr\c Lis d(r( norrtplrt) iforncr or,,nipc ywhr tulkls or irnlovcs llscoo-
<br />rid sho .ln rrcr\f{tr\rchnn&crssirha A,i
<br />'
<br />a.k( 9 licun{d l[rsunrbrhcConrr .r, \ l-iccnlc l-r*)
<br />-l
<br />r cremrl !trder Scdiotr-. B & P.C. r'o!l[k rcason
<br />1yjIBAI'&I.CANTI:NIAIII]N
<br />I)E!;IAAATUN
<br />I h.thtrlltrn,!nd.rNulr\ol n{ru4on..lrh.la l,NiDg,l..Ir]ri,nr
<br />I.rl\, Cirtc. l(tr rh. rrlitrir r.c,)l rh. \rik ln' \[i.h th( prnn 1'\ s{].d
<br />*orkcr'o'nnctrsirion nruru.cc cr cr rn
<br />ob
<br />-l
<br />.eniiy lhrr in lhc pcrloflMncc olrhc work lor shich rhir I'cnnf r is{rcd. I \hrll nor cnrploy 0n, pcrson in rfy n]Mmr
<br />vr 1\ k, h.(nrc \rbj.rr t, ihc *orkcr\ comp.n\dn,n l]ws ofC3liiomi]. rnd +rcc rhrr ifl \houkl hcconr \objccr k) rhc
<br />sorlcr\ co rl)ci\ari{nr pmvirb \.fscrrn,n.l7tx)ofihc ljhn (i)dr.l \hxll lnnhlvirhco Dly w irh rho{ pnr irnnN..
<br />WARNINC l,lilurc lo scur! worker\' conrEn\nrion Ec n unhrvfirl. d shull nrhFcl cmnl0)cr lo.ri'niNl lrrlric\ rtrtl
<br />ciril firc\ up ro onc huodlcd rholsnd
<br />::-'tik[tg:
<br />&'rirse
<br />,/yn
<br />I hcruby rmrm und.r l).Drlryol no.irrr llrr I rn li.crwt io.tChrprcr q lc.nnncncin8 trirh Sccrid 70fi)) ol Drisnnr I
<br />01 lhc Busincs ann Pmtu$ions Codc, trid my liccns ir tu full lor. rxl cfiL{r
<br />cq ,c/o,c3g
<br />I hcrby alfirh undcr Fmlry of p.rjury rh,t $m is . mn*tuction lendang !g.n.y lor $c p.rfomn* ol rh! work for wnich lhn pehn is
<br />hrucd(Scc. 1097.Ci!. C )
<br />AfILICANLDDIIABAIII}!
<br />I lLniy rfliiin u.d$ pdnrlry .f Frjrry om olth. following dcclrturtnN:
<br />txtu irioo Pcrnir Ashesros Norilicarn,n F.deralResularions (1ir1.4.0, P0n6)
<br />_R.quncd lxrrcr ot Nor ifEa'ion
<br />I ccnilyrhir rhc lcderrlrc8rhrn)m ms ling bcnosEn$vllrrc norrpnlic$h n, rhi\rmFi
<br />-lccniii'hal
<br />I la'vc rcM rh^.pfl
<br />ordinrn.csrnd Sl.lc Lcws rc|fi.a Io
<br />tr d {orcrharrlr ibvc inli
<br />ir8 mnsh(rion. Md hcrcb,
<br />i\ .onc.r LBiN r. conlPly r irh ,ll Cirr otrd Counry
<br />I Ihis Cily rl Counryh cnrcr up.n llr
<br />rholc m.'mmd lmp.ny lut ln z1rlo
<br />Site-Work
<br />Underground
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh) fffi 9t
<br />lQqilings (Hard & Soffit Bouqh
<br />Ceilings (T-Bar Rough)\<11.,{--tl/*hq-t.,
<br />IVleter Release I t
<br />Rough
<br />Service lvleter
<br />FINAL zlilt'l lu 1,./
<br />4,4
<br />*/6_c
<br />l-r 8.
<br />^,0
<br />Pole Bases
<br />Under SIab / Floor
<br />Notes, Remarks, Etc.
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