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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNEX BUTLDER DEI,CA RATION
<br />I hcrcb, aflnm und.r nenlh, .r Frjury rhrr I r cr..rt, li.m rhc Co rador' Licc.sc lis tu rhe folk,*in8 r.obh (Scc 7031 3
<br />Businc$ rnd Pror.\\bn Cod.) ny Ciry or Counly whicn rcqutcs r lErmir ro con{ruct, ulrd. in mvc. &mlish or qot lny
<br />rrudur.. prh. ro ns issuarcc. .lm rcquircs llB applicanr aor such pcmir b ,ile a sig.d {dcmnt rhd tf, or she Ls liccitd pxolnrt
<br />lo thc provnions ofltE Conlractr\ l-i.cnscd Lrw (Chatr.r 9, ConrmNine wilh Sccrion 7(Xx) of Divirio! ] orrhc Btrsirlc$ and
<br />PDresn,.s Codc) oi rhrr rr .r sh. is.rcn{r lhcrcfn'nand thc brsk lorthcllkscddcnpri,,o AnyviolalionofScclionT0.ll.5byan,
<br />arplicanl fo.. Fflnil subjccls lhc lpplicanrbrcivilp.nahyolnolmdrhnnhrchundtddollors(3500).
<br />l.,s owrcr.irhc pnrp.ny. or mycmployccs wirh wascs !s lhcn sob om!.orarion. willdo lhc *ork.rn thc (trtE is iol
<br />inrcnd.t or ollercd for slc (Sr.7044. Busincs and Pn,i€sn,ns Cdr.: Thc Conkaclors Liccns L{* d€! rer rpuly r. mowncr ol
<br />rh.ItuFdy who boildi or i,llrclrs rtEN.. ord wh. dG skh wo* hi,lsclfor luelf or rhrough his orhd own cnPloyccs.
<br />pnNidcd rhrr srch nnprc*nrmr iru fr, inr.nldt or oficrql for sL.ll h.rcv( th. t trildiq or in{,r.krnr issI]wirhi'r,,ft }td
<br />of.onrpkr ion. rtE Owner AuiBc. will huw dr blrd.i of pn,vins rhnr h. or shc did nor build or im['(,rc lhc pop.ny r. lE purlnt or
<br />l. a\owftrolrhc pm!.ny. incx.lusilclyconrrlins uirh li.cnsed contrcbE k,.onnru.r rlt lr(']cd (S( 7l]rj- Bu'i"r\\
<br />and Plrfc$i,i Codc: Thc Contactr's Liccnsc Lnw docr nor.pplyb r.owncrolnrcpc ywh(,htril oinnprovcslhcrcon.
<br />nil sho cotrir0d r tbr such pmJccrs wirh ! ftir.ncnnG) liccnscd Punur lo rhc conlru.tol s l,iccnrc I !* )
<br />_l lncxcnrpr uodcr Stuti.n .a &PC for lrrh rcNotr
<br />Drle:_ Ownor
<br />WORKFtLS' COMPENSATION
<br />DECI,ABAIIA!
<br />I ieEhy aflirm under pctulry of p.rlury oN ofrh. followinB dftldalioni
<br />-lh{!cod{ill.uinuindCcdincarcofCotrrn{loSclllnrurctorworkercomlrcrsarioo.rspdvidcdlorhyScclion3r0OollheLat or Codc for lhc pcrforrukc of rhc q.il for shkh lhc lEnnir k issucd
<br />t havc rnd Rillm.itrlrin wo.kcrr conucnsalio. inslrancc- rs requncd byS..rn,n]Tmofrhc Lr$.rConc. nn rhc frrni,n,'.. nr
<br />,.,,,-,. //6"
<br />Mrwnkcr( conD.n\rri{n, i'trurMcc.nnicr r nolicy trtrnrhcr arcl
<br />o t//l{
<br />-l
<br />ccnily rhal in thc pcrfofluncc otrhc *ork ttr qhi.h rhi\ p.nnir is is\ucd. I slull nor cmploy any tr^oi in tiy nDnm,
<br />s x ro txtonr \lbFcr r. rhc $orknC .onU.nsarion lowsofcahlbrni!. rnd agrcc lhd ifl \honld b..om suhj.tr lo rlE
<br />sorrcn .ofrpensrrionpmlnionsorSc.lion3Tmolthc hhrr Codc.l \hrll. nlnhsirhLunPl! wirhrhosc pn,visions
<br />WARNINC Foilurc Io su,€ krlcs oorc.sdion 6v.hst i\ unhwful. dnrl shall suhi.rr sn coDloyd r. ciniMl Fnalras and
<br />ci"rl fine. uD ro onc hundre<t thnu\!.d dclla\ rllrn,ooor, 'n addrnn t, rh. mi ni (omNn{tion. JrrurN a" nrcvdcd ln rhc
<br />,.,",. 7/z7l/ n*,*** f,"./,-*--
<br />IICE!,IELCONIBACIAB
<br />!ES,AAA.I&N
<br />I h.rcby urfirfl u.dcr pcM,ly ol lrrjury lhol I an liccned undcr pDvisnrn orCl$fld 9 (conamming Rirh SElion 7mO) orDivisi.n l
<br />or rh. Burik\s rnd Pmr.scions Cod.. .rt nry liccns n in tull lbrcc und crf(l.
<br />c[o tb o/L
<br />r'.**"- )(
<br />C(TNSTRUCTIoN LENDN(; AEl'N(]Y
<br />I hcrby,lo.nundci F.,lryoipcrjury lhll Ihdc n a oNlrudbn lendi'rszscicl roi rhc Pcrfoflmncc oitlr w.,k rbr *hich rhi\ Fnnn is
<br />tlucd (Sc. :1097-Civ. C )t ndcls Nrm:-
<br />ATTUCANLITECI.JTAIION
<br />I Myoiimundcr peialry.rpcrjnry on. olihc rollowin8 d..lamlions:
<br />D.nmlilion Pcr"its.AstEslos Norification Fcdcrll Re8uhrio.s llirk 40. Pd6)
<br />Rcquircd txltcr of Nolifrarion
<br />I cdify rhar rhc tcdcral rcBul ions rcgtrdirB .shnos rc Nval .rc nor lnrliGhl. b rhi\ PtuF.r
<br />-l.cnil_vrhrrl
<br />hNc rcrn rhi\npllicrrionrndndcrhrrrhcrh)lc n,fonnnltrtrr is..r..t I
<br />orliNtr..s trd Srarc t, wrrclrrifat, hri nrec.n!rucr dal h.dhy auihorizc rcprcs.nr
<br />rlr,vc r.iloid tm,[ny tur iictccrnrI)u
<br />aDDlicnhr or
<br />^r.nr
<br />silnnrum:)(.
<br />r,." ril..,-," rt).itrli: X fu^r,n
<br />rErc ro conuly wirh rll Ciry0.d Counry
<br />trcsnlrhnCiryunlC.unrrrocNsur{nrltr ._
<br />"",.,7/22,/tf
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough
<br />Service lvleter .tJ,"t/t i4cl
<br />FINAL /n/5/'t /M%/A aou
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Pole Bases
<br />Sub-Panels
<br />.-7-z z-'
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