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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUII,DER DE!,CARATION
<br />I hcrcny amrm und., Dcmltyo, ncrilry rhs( I r ercn{,r rronr rh. contacroF Liccn* l-r* for rhc,ollowine mv,n iscc.?(r.r,.:
<br />Businc\\ a'd Polesion Cdlc): Any City ur Cnunty qhich rcquircs u pcrnir ro mn\r .t. alr.r. nDprorc. dcmrli{h ur rF'n rn\
<br />sdcturc. nriorlo irs hsua.ce. aho,cqrircs rhc +plicam aq sochFrfrir iJ lllcasisncd (rlcmnl rhci h.or\hc h l,ccnscd funurnr
<br />ro rhe polhi{,ns or rhe Conterols Li.cnscd Lnw (Choprd 9. Commcncins wirh s..lion 70(D ol Division :l ofrhc Busincs rn.l
<br />Pturcsions codc)or lhlt hcorshc hcicm lncrclio rand lhc hasi\ li,.rh.allcgcd cxcnuion Anylioltrrionofs..lioiTo.ll.5hytrny
<br />rpplE.trltoral).rnrirsuhjcchrhc,ppli.snruu.ivillcnrlryoriornrordhinfivchundreddolltrB($5ff,
<br />L as owncr ollhc !&rcny. or mycmploycc\ sirh $0Brr.\ rhcir w'h .ony.n\arion. willdo lhe work a.d rlt {tum i\ n'
<br />intcnd or ofcrcn nn ek (S( 7014. Bu{mss anil Pflrlcrsirns cod.: Tnc Conlraclois Licci* lr* dms m' .rdy ro m oNnq of
<br />the pRrpcny wh,t ilds or irlpmrcs lhcmn. ard *ho dG sEh wofi hiosclf or hc6.lf or thmu8h hh ar h.. own cdpk,yc.\.
<br />[ovi.lcd rhar ucn impokmik m 'br imfid.d or oficEd for slc ll hnwv.Y. rhc building or impn,Rtu b 5ll wirhin om )tu
<br />olmqhtion. thc Owmr guitq sillhle rh< l,trdc. of povins $d E or shc diJ d 6uill oi irirtro$ rhc pmptn, ror thc l)Urt eof
<br />-1.
<br />rso*ncrolrhcplopcny, afrexclusivcly.onti.rine wnh I.ctr*d .otrlrucron ro con(rucl rlf, lx,jcd (scc 7044.Irunncs
<br />nnd BDf$sinr Codc ThcConrracror's l.iccn\c L{w docr nor npplyb tnoqnd.ftroPcnywho huildsorimptuvc\ rh$con.
<br />rnd {hD.onrff(Iorsu.hprojersrithrContrrro(s)licrnrdpurlmrhrh.c.nadur'sLi.ctrckw).
<br />_l36cxcmtr oid$ S..r t'.'r-*aW4q
<br />I hcr.by ranrn u dcr pcnalry of psjury onc ol rl{ tullowiD8 d.cl.rll ions
<br />lhavcrxlwillminrrinaC.nifElt.olConsnrlnSelf-lnsurcli,rworkcB'coy.nurion,NtmvidcdforblSccrionlT0{lofrhc
<br />ljhor Gdq for rhc Frforlffcc otrhc work for shi.h rh. pcrnrir is is\ucd
<br />Ihavcandwillnrifl.inworkcrs cor.Dcn\ori.n insuarcc. !s requt.d hysc.ri.nlT(x}olrhc l-fior Codc. fd rhc lBLn n.cof
<br />rhc *.rr ror *hi.h
<br />'his
<br />p.irnil is issucd My workcn' conran\ar bn nNtun.. .mid dd Plicy numbcr ec'
<br />W RNINC: ljrilurc t' srcurc workcrs .o'npcnsdion cov.ngc is unlo*tu|. rtrd \hall subrc.r .n .nll)lotcr to aininal lttrilri.s rtd
<br />civil nncs !p n) u. hrndrcd lhousrtrd dollaB ($l(D.mo), in rl(nlirion ro rhc co{ dr.onlEnsrriotr. drmrgcs !s Pr.vi'lcd tur rhc
<br />Secin,tr 1076 olrhc Lxtrr Codc, inl.rcslotrd orlonry
<br />Dole: Appllonl
<br />,
<br />Dgctr.[AIlJ!
<br />I hcrc$y al6rn ud.r pcnalry o, pe,jxry rhnr l,n licn!.n undft rsrisnin ofChspl$!) (c.mB.cnrr wirh selion ?Un) o(Divi\io..l
<br />or rhc ausin.s ,nd Pmfc$ions Codc. tud my liccns is in rull fi,e ad cftNr
<br />Li.c.sc Chs:-Li.ctrsc Nun$cr:
<br />-Contmcior:
<br />CoNSTRUC I()N LIiNNING A(;F,N(]Y
<br />I hcrby trfirm undn Fnrky of pcriurr_ thil lhcrc h o consrNcli.n hndins r!6.y r.. rhc lnlonerncc ollhc work r.r shi.h lhn F nlil h
<br />i$ucd(Sn.-.1007.Cir C )
<br />AfILICANLDICLAMIII]N
<br />I h.td,y allm unler pcnalty of rE Jlry ot of lh. rdkrsinC ddl*01ions
<br />D.mlnioh Pcrnik.Asb.sos Norifi.lrion Ftdcral Rqllarions (Titlc 4), Pd6)
<br />Rcquncd rrrlc. ol Nolif!.arion
<br />I ccniiylhillhc ltdcral rcgulnri(,n\ rulmling rsh.{.src x,vnltrr. tr.r rlplic lc ro rhnln,jc.r
<br />|
<br />-lc.diry
<br />rhrr I lllk ftd rhis ippli..rion n {irc rhdr rhc Jsvc irkndi,r i\.otu.r lr8rL\ r,
<br />onli'rncc\ 3trd SrrrcLrtr\ rl.h! ro buiklir8con{n'cri{,n. lRl hcrrhyrurhrn.
<br />rborc nrnrtnKl pmp.ny for in\p..r
<br />,\p!li(int or,\A. l Six nlt'
<br />^;[/;;
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<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 (Conduil)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />l\4eter Release
<br />Rough
<br />FINAL ,-t\t] \(1 A/,/qfii,
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />Site-Work
<br />Service Ir/eter
<br />-Exrtes:--l.dn,fyrh{
<br />i'rrh. p.rformne of lhe w.rt lor whichrhk ncrmir is i\\rd,I shrll nor cnuloyanyPcnon inanynrnMcr
<br />b as ro b.sm su6jd lo rhc so,ks ompcn$rioi lass orCrlitunri& {nd ugce rhar iil \huld lrto.t subi.tr ro tir
<br />*ortc6 compcnsorion Folhion\ otScdnr l71D of rhc hb(, Codc.l shrll.lonhwnh comtly wirh rlx,* ttmvkions
<br />?O/c&
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