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APPROVALS DATE ID/SIG.COMMENTS OIINER BUILI,ER I'ELCARATION
<br />I hcrchy ofirm lndcr pcuxy or Frlury lh{l I am cxcDrFl fmm thc Conl.aciira Lkcns. rjw for lhc folloains rdav,n (scc7oll.5
<br />Brsiocs and Pror.sion Colc): Any City or County which rcqun \ a trnnn (o .otrstDcl. lllcr. impnrc, dciolhh .t Rryn y
<br />strucrurc. rrior ro ns huonce. lho rcquiB rhc spplicsnr r.rruch lxrmir ro filc a siancd suFftnr rhd lEor sh. t liccnscd Punuanr
<br />b rhc povhions oflh. Conrractor'\ l-iccnsed tjq (Cha er 9, Com'ftminB uith Scclion Tlxxl olDivhk,n 3 olthc Businc$ lnd
<br />Pmltsions C.dc) o. rhar lt or sh. h .rc.Dr rhc!.frum d rh. bash lor lhc ollcscd .xonprhn an,violilionofsccridnT0,rlSby3ny
<br />applictr.! r(, & pc,nir subjcch thc opplicanl loacivilocnallrolnol 'norcrh,n nvc hundrcddolhtr (S5(()).
<br />-1,
<br />rs owncr ol lhc prcpcny, {n ny.iiphycc{ wnh wr!.s rs lhcir solc.omncndion. $illdo rhc work nnd rhc slrdurc is not
<br />inrcrGl or ollcrcd tu el. (sd.?(),r4. Busntrs and Piofc$io.s Codc: Ttc Conkadoi( Li.cne tjw docs nolqrPly b u osnfior
<br />rh.rn,|xdy whohuildsori"Drolcsrh.No,ard*hodm\schs(,khnnscllorhcscllorlhougthisorhcrownc lplorccs.
<br />p'ovidcd rhi such in\Tortmms ae nor ir .ndcrl .r offc&l ror $h. Il lm$.vcr. rhc huikline or in!rcvc'Bd h $G *irhin onc Fr
<br />ol.on{,leri{nr, rlE O$ner aoius villhav. rh. hordcn ofnmvinS thd hc or shc did nor hoiH or iryrtrt rhc ptulu} tu thc Pur1nrof
<br />-l-
<br />!roen rotrhc tdpdry,,Ncx.tusnclycotrr.clios with li.cnscd conr,rr{rs t' .onnfld rhc Pn,jet (Scc. ?0.1.1, Busifr\\
<br />Dnd h'fsshnCodc Thc Conrracrol \ l-icensc Ldw do.s nor rnpll b in owrc. of P()r.n y who h ilds or im8trcs rhcrmn.
<br />rnd $ho.ont.r.trdsu.hpmi.rkwirhaContac!trGrli.ctrscdrurrur nJrhcc(,nncntr'sL
<br />I a ck r undcr Sccl
<br />I lrr.hJ alllr uMcr p.mlrvoipcrjuryoncotrhc lalkiwi',8 d(hrnri(xs
<br />-lhalcandwillminhinrCcnrlKarcofConscnrroSclalnsurclor*orkoilarmp.nsrtirn.rsrmyidedforbySccrion:l70o.rrhcljbor Code. a{tr thc p€,r.rtuicc or rhc work for whi.h rh. ,)cm is issucd
<br />I Mlc and will nuinrain sorlcra comlriirr ion insrmmc. ,i rcqutcd hy Sar ion ]700 of rh. Lf,tb, Codc, lor thc Frlbrrotue of
<br />rhc work for whth lhh p.!mi is issucil MywDrk.n cump.ns,lionnNurmcccu cr ond r,licy nnn'hcr dc:
<br />Camr:-
<br />-l
<br />ccnilyrh0r inrnc pcrtonMncrorrh. qork ilr qhi.hrhisFrnil i\ isuc .lrhrllnor cmlhyrny p.non innny 'nr ncr
<br />$ ,\(, h.co r suhF.r r.rhc w.rkc6' conu.nslrbn las\ofcrLt,rnir dd r8m rlN ill $ould bc.om srhl.d rorh.
<br />wo rri corlPttrs,r n,n p('visions of Scdion l?m oi rhc I !txr. Cdlc. I shall. lodhNirh conr ywidirfu)\c,n,vhiotrs
<br />WARNINC failurc Io sur. workcs'
<br />.ivil lines ut ro o* hxndr.d rhousand
<br />Sccrio[.]076 olthc btrr Codc. i crcsl
<br />.onrrcns.liotr $vcmS. n u.hwfol. nnd \hrll subic.r $ cmnlorrr ro cnni'd Fuhics d
<br />d.llais (rlO0.OX)). ir r diri{in ro rlr
<br />'/
<br />!.2r!ulAr&tt
<br />I hcrcby aiiiirn undq Fnrlry oI pcrjrrr rh"r I an li..n$d xndur pmvisidr oiChl,,lcr
<br />of lhc Busin.s! atrd Pmf.$io.s Codc. und my licn\c k in tull forc nnd cffNr
<br />nci'!g wnh Sation 7000) oi I)ivisi('n.l
<br />glNsrSucuoN.L[NplN (iE&cr
<br />I hcrchyoffirflunder pcnohyofperj!rylh rhcrc itrrmn{tuclion lcndinsagcncy ld rhc Frformncc ofrhc rort ror which rhis lcrnil i\
<br />isro.d (S.. 1097, Civ. C.).
<br />AELICANLDEqIAUUg!
<br />I nddry,fi under Fctralryofpcrj!ryoic olrhe following d(lumlions:
<br />De'tulirion P*mik-Asb.$os Nolification Fcdcral Re8lhtio.s Onk 40, Pd6)
<br />_R.quidd l.x.r of Noiifsliotr
<br />l.cnilirh.t lhclcdcmlrcsul ions rcsardins rh€no!renx,v lrr. trol rPlli.ablc ro rhisrtr,jdr
<br />l.dlilylhnl I hrvc relllhnnntl tr,'r"l{r('r[ rl].nliri,lnrr iinrn I rErcc lo comrly wirh allCiryard Coutrry
<br />nrivqorrhn Cirymd Counry b cnh uFn rhcordinrmcs and Slare ljws rel,ring
<br />r&,vc trrtunnkrl pmlcny lor
<br />Applicrnl or Agenl Sittrrlu ;72a8
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Flelease
<br />Rough
<br />Service It/eter
<br />FINAL /0 -21- t9 J)/,1q 9"
<br />Notes, Remarks, Etc
<br />ELECTRICAL-INSPECTOR RECORD
<br />Liccnsc Ch$-Liccnsc Numt r:
<br />-
<br />06l. ('ontro(lor
<br />Lcndfl . Add,.s
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<br />Communications Cable
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