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ELECTRICAL-INSPECTOR RECORD
<br />APPHOVALS DATE ID/SIG.COMMENTS OWNEN BUILDEN DELCARATION
<br />I hcr.hy offirm undcr ncnally of pcriury rhd I !n dcmnl tmm rhc G,ntsdon Li..nsc ljw for rhc iollowins rcaen i Ss 70.r 15
<br />Bo{in.s ,nd Pofc*iod Cod.): Any Cily or Counly which rcqutcs n lcrnril lo connruct. olrer imtrolc. {lcfrrish ur Eran any
<br />srructuE. priu to ns i$uancc. also rcqutes rnc applicanr fo, such pcmir ro filc, sig d {at 'mnr rhd tror shc n liccnrd purulnr
<br />ro thc l,ovi\ions ol rhc conkr.lols Lienscd tjw (Ch,flcr 9. Commcncina oilh S.dn,n 7fixl .r Dilhion I ofrhc Busirrcs !.d
<br />Prcrc$iotrs Codc) or lhrt hco! shc t rxcmnr lh€Efromlnd lhc basn r{n rh. lllcg.d crcq'iiotr AnyvidolionoaSsli6nT0ll5by,o,
<br />amli.anr tua!€rmi slhjcclsthc applicnn' r.xcivilocillry.rno' nDrcih,n 6vc hutrdreddollm (SsuJ)
<br />l.,s oqncr.rrhc pmpedy. or n:ycnrpl.)t.s wirh s08cs rs Ihcir solc conDcnsrrioi. *illdo rh. wdk lid lhc srMm G ffn
<br />inEfrled or ofcrcd n, sk (SE.7OI4. gusinc$ and Pron$ions Codo Thc Conta.ttr s Lic.ns tiw docs nol lpply ro an o*ncr.r
<br />rhe JftF y who b{ikl\ or nr{orcs rtEmn. o wh. des trh wldr iimsclf or hcr*lf or rhnruEh hh or h$ ow, rmployccs-
<br />providcd rhsr such impmlcrcnh m nor inr.nd.d oi ollcrrl f.r elc. Il, howcv.i lhc ttrildinA or in[{orcmor is sH whhin n. ,t,tr
<br />or.orr{,lction. fic o*ncr Bri}:Lr Gll havc lnc hrdcn o{ I,nrinB rhIl lE or shc did er build or inpmv. th. pmF{y ttr th. p!ry,s of
<br />l. osorftrofrhc pmrcny. amcxclusivelycoflrrl.Iins with liccnscd conto.t,ft b ()n{ru.r lhc Ftuirt (Sec. ?044. Bu\ims\
<br />lnd PDfcssi,n Codc: 'l he Cont,cror's Liccdn tj* docs nor atply tu an orm. ofl)()lEny who build\ or in,ptuv.s rh.ron.
<br />lnd vl$ onrads lor such prerch wirh a ConrBcro(s) liccnscd IUEDnnr io rhc G,ntact s Liccns kv).
<br />-l
<br />!mcxcnrpr unrtr S$ln'n-
<br />Dulc O,.d
<br />IV(tRK FRS' CoI\I PENSA'I I(IN
<br />uiel^rrultN
<br />I hcr.hyrlfnmunJcr|[trrlryol p.rjuryoicorrltc k,lli'qhtdccl rali.i(
<br />-l
<br />hovcoduill nrinrainsC.nill.!r.orCod\c.r ros.lf ln\ur. for sorkcs' ompcns.rion. !\ pmvilcd lorbys.criotr:rTtDolrhi
<br />L,nor C'odc, lbr lnc pcrfolnENc ofthc qork lor *nich lhc I'c n r h issocd
<br />-,
<br />hrlc !trd will nuinuin xql.rr c.frpcn\rrn i'uuratr.c. as r.quncd byScciion l7(x)ol lhc liho. (hdc.ll, rh. l.rtonnin.. or
<br />rhc *ork fttr which lhhlr.rmii is nsled Myworkc cofiPcnqrn,n nr\u,trcccmicr trtu B,licy.umt'ct@
<br />_lccdif, ihrr i'1rhc l,cif.nnrNc ofrhc work li, which rhis pcrmir ir hsucd. I shallnor empk)t a.y Frv,n if rtry nunncr
<br />v' as lo bcotrE suhjet ro th. wolkc6 compcns ion laws oa CBliromia, nd a!rc. rhd irl shuld h*om su$jd krrhc
<br />workcrc' .onpcnqrn Dmvhions oiScdion lTfiJofrne Llhn clic.l rhrll. ronh*irh mmply wirh lhos p,o!ni.N
<br />WARNINC: F,ilurc n' $ctrrc workc^ .ontc s,ion corcragc is nn nl. rnd \l ll \uhicr rn.'
<br />civil fincs trp Io otrc hrndr.d rhouetrd dollar\ lSlrX).tXXr), irr .ddil
<br />s.dir)n rl)76.frh.l,l ('el. inr.'cd rMrr.n,cv \ li.\
<br />L
<br />I hcr.by rllirn undc, pcmlrrofpcrjuryrhrr I rn lien{J undcry lhrprs9(!Nm..i.EsithSccrhnTIXXDof l)ivirion:l
<br />ol rhc Businc$ nnd Pdtssins Codr, d .ry li.cnr is i. tull iorcc
<br />LiccnscCloss:-
<br />c 'recbl\
<br />cal.rlBueuar{.LEdDtNclcElcl
<br />I hcEby afinm unds pcnalty orFrjlrr rhar rhcrc n a onsltu.tion hndinP ag.my lor rhc Pc.f. Frcc orrhc so'k r.r*hi.h(hn p.nnir is
<br />i\u.d (Sc.. 1097, Civ C.).
<br />lrnd.as Addr.$
<br />AITLII;ANLIIECIAAAUON
<br />I hc[{y odinn unds pcnshy olpcrjry.n..rrhc rollowiiS dcclrr.rbns
<br />Dcnnliriotr Pcroiir$AstE(os Norifi.lrion rcdcal Rc8ul ions (Iirh r0. Prd6r
<br />Rcquircd Lcllcr of Noriiclriotr
<br />lccnily rh.r rhc lcdcrrlrcruhrnnN rg!, ll)pli.,blc trr thir F)jccl
<br />I c.nifyrhn Ihr!.,. rh\rnfli.rrtr)n iformdiotr n conccr I lsra t
<br />onliritrcc! rnd Srrrc l.rs\ mlrring h huildntg hy aurh.rDc r.trc*nldivcs of
<br />ahovc nrnt orcd pro,'cny nn ir
<br />]\Dpli(anl or,\tc.l Si8ntrturc €n ::'# "
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under SIab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit I
<br />Walls (Conduil)lbl6 ..t v*ffi
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rouqh
<br />Service lvleler )l
<br />FINAL 7,//0,//f "4 gA
<br />Notes, Bemarks, Etc
<br />Pole Bases
<br />damgcs !s providcd iot lhc
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