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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.OWNER BU!LDER DELCARATION <br />I hcBby afinn lndcr !.nrhy of pcrj!ry rhd I d eic4r finm rhE C.nrdlm Licnsc L.* lor lhc follovin8 Eav,6 (Sct 70ll 5 <br />Busincs oxl Profcssion Codc) Any Ciry or Coxfiy which rquircs 0 Fmril lo con(rct. sllci inFovc. .hmlish or mlat nny <br />strudurc. prior k, ns hruM&, at$ rcqun.s $c.pplicotrr lor such pcflnir ro file a sis.ed srsrcmnt thal t!orshc b liccnsd puruul <br />lo lhc provisions oftlr Contra€lols l-iatrsed Lrw (ChuIlcr 9. Codtu(ing wnb scdion 7{Do of Divkion I oa rhe Bx\inc* &d <br />lrcltssions Codc) o, rhlr h. or she is ercn r rhcftrrom,Jxl rh. uris ror th. allcScd cxcmplion Anyrblalionots.dion]oll.5byany <br />trrtlicmr f.r d p.rnir subjcts rhc applicanl lo a civil pcuhy ol ml mrc thln livc hund,cd doll 3 ($5m1. <br />-1. <br />!s owrcr ol rhc Dmrf,nr- or nry c,nfkr)rrc wirh wrg.\ ^ rhcn $b conrFDs,l ion. will do lhc sork ud rhc dfldm ir nol <br />i'ndlkLrlorollrcdforsrlc(Se70,a4.Businc*rndPolcssiotrsConc'fhcCinmclolsl-iccnscl-awd.csnor+!lyroroowncrol <br />rlc tmIEny who huilds o. ingr)v$ rhcrcn. aid rho dms \eh k,* hin\.lfor hcrslfor rhn'u8h his or hcr o*n cnployc.s, <br />p'ovidcd rhrr sr.h innmvc,EnN trc rFr irlcnd.n or olIcR{ 16r elc ll hr*drr, rhc hitlins .r infx.\$Enr is sld wirhin om Fr <br />ofc.n!)klion- rtE o$ncr Brikhr sill hjw rrr htutr ot l,nrving rhd rh or shc dt trol triH or n'll,rew r,E rrDFiy rbr rhc ,urpo. ol <br />-1. <br />o\owierolrht phrdy. r'ncx.lusivclycotrt0.linawirh liccnscd cotrlrucloF h conn d rir Ptujc.' {scc. ?(}44. Bu:inc$ <br />ord PhLssbtr aodc rhc Conkaclols Liccnse Law docs nor lr,plylo u.wn.r or nruDcdy qho buildso! inrprcltt lhcrc.n. <br />ond *ho onrBls rbr slch pmrc.k $irhr Conrn ronr ) licc.{d lu.su,nlo rhc Co rudusLiccnst!s) <br />-l <br />rncxcDrtrufdcr Sccri{nr ,B &Pc hrrhisr.r{nr <br />-:,-*&uoaK[Es:l:out!:llAll0N <br />IUIIABAIION <br />irlrv.f n rlurtoncoirhct'll(rwir!d(lardnN <br />aitr!CcnificarcofConrnrroSclllnsurefor*orkc.onpcnsdion.ospmvidcdlorbySalionl7morrh. <br />oilhcwork r'or whichlhcFn.il h nu.d <br />linworkcs .onFNalion nNrlNc. ss rcqutcd hyScclion 1700ofrhc t.abor Codc. for lhc lcrJormmc of <br />rhnFrnrn h irscd. Mywolkqs conrcns.rion insu.r!.c cmicr rxl Fli.y nun$.i m <br />h rb. pcrronun.c ollhc work for whi.h lhit lcn n nsucJ. I shxll nor . lpk,y .try l]cron h {n, manner <br />rorhc trork.^ .on{cnsri{nr h*sol(rllf(nir. i ngNrhd ill sl.ould hcconEsuh]ccrt,rh( <br />vortds.ompcnslionpovtionsofS<ri.n1700.frhctlborCod..Idull.tonhwithsmPlywirhrhosprovl\io.s <br />waRNlUc: klurc ro wurc w.,kc^ cn,ry{nsatnn mvcmBc is unbwrul. and shnll suhtrr an cmploycr Io qihiMl pcMuica,nd <br />rNrl rinc\ uilo "rc hundrcd rhousond dollaF rll(]O.Or)). in lddnion ro rhc cos or coinp. n Flt ion. dlmBcs as lrcvided ror rhc <br />s.dion 1071!r rh. bhor c.dc. inkrcn md ann,ry\ rc\ <br />D.r.r N ApDltotl{\ LrcEurp:.rolrnacrar\ DE(IaBArlo! <br />I tcE6y ,Nlm unJq Ptmlry nr p.rury rhot I m L.cnqd undcr pmvhion olChapld 9(conmncirg whh s..'ion 70tr0) orDivi\ion l <br />or Ik tll\oc* Md Pmtc*i,n\ Cod.. ond mylk.n$ n rn tull lotoc ad cllccr\ <br />I icense Nuntcr: <br />(J!t1t-!(I9r-LftlrlI!;-,I!iffrl <br />I h.Eby alfim undcr l]€ulry of F jury $ar rrm is . mnsd.lio. LndinS lgcrcy for rhc rErfomtuc 6r ih. worL lor vhth thh Finil is <br />isskd (s(.3097. cir. c.). <br />ATILIIANLDECI,AA.&UON <br />I [nby anim uft].r pcnally ofpcriu,y.nc orrhc rolkrwin8 d.clmrions: <br />Dctrxn ion Pcnnni Asb.r.s Norifi.rrion Fcdcal Rquluri.ns (TirlcJ0. Plrlo <br />Rc!DnoJ l-crrcr of N.lifi c.riotr <br />lccnrI rh.rrh.ltdcrrlrcgnbri,)tr\ rcS ding ash.no\ rc'mrrl arr nor rPrlirlblcro rhir |r+d <br />-l <br />ccnilyrhrr lhrvc rc rhisdnpli.{i.n o}d srrcrhnrlhcdrlc inhnnorion kcoEcr.I agti ro.unpl, wirh rllCiryrnd Counry <br />ordinrtucannd Shrc trh eldine tohuildirsconsflcttotr. n hcrcbyaurhoriT.rcrr.scnhivcsofrhnCiryondCou.lrrocnrdrF'nrh. <br />u&,vc nEntioned tmpcny ir inspccri(ntuqirss <br />Appli..nt o. Aaenl SigEtrR: <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Lile Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq i Groundino / UFER 8-9.t6,/<k:z <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 />Ceilinqs (Hard & Sollit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />lvleter Release <br />Rouoh <br />Service lrileter rJ.a-lB '4/(za }-A..ffi#) <br />FINAL *la-tB ,3b-L 11Y <br />Notes, Remarks, Etc. 2tt57' 6La'5€*/_9 ar) <br />COMMENTS <br />>21 <br />lcn'lr''. \Ln1 <br />- <br />tt <br />--t--