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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.rby gffinn und.r p.nalry .t p.rjxry !ha! I m.xcnfl rbn $c Conlra.loN Licens LrB for rhc thllo*inB r8,n {Sdc 7011.5
<br />Busimrs snd Pft,re*ion CDdc) Any Ciry or Cou.ly vhEh mqutcs o pen.il to onnrucl. allcr, ihprot., dcd.lish or ftlui 3n,
<br />slDclurc, I,liorro irs hs!trmc. .ho rcqutcs rhc lppli.ant ,or such Fmir ro filc a rign.rl sar.mm rhd hc o. shc h ltlnsed ,tunurnt
<br />to rh. polisions ot rhc Contrrchls Liccnsd kw (Chaptcr 9. ConDcncing wirh S.crbn TOtn of Divkion I oftlrc Busincs !trd
<br />Pror'e$ionsCodc)orrhar lEorsh€ iscxchpr rfieElromaidrhc basi! ld rhc rllcgcd.rcnll)rion. Any vhlalhn of Scrion 70.1I 5 h, uy
<br />sppli.anr lor r p.nnir slbirrsrhc dptlic,nr k,,.ivilpc.alryormr !rcrcrhan fivc hundrcd dollan{$5m)
<br />l. as owmr of rhc tmlcny. or my cmplortcs wirh woScs as lhen sk enPc.s.lion, will do rh. wolk ,i lhc stnIlB i\ n,l
<br />inrcnd.d or olicrcd nr sk (Sa.7{x4. ausirc\s and Ptufcssi.ns Code: T}t Co.tacrors Licns Las docs ml 8!ply ro an .wncr of
<br />rhf pmpcdy who hrilds or in\rDB rh.rrn. .nl whl dfts skh *r* himself or heftcll or thmurh hn or h.r own.mpk yc.s.
<br />providcd rhd such impmwnEtrh sr r, inrcnd.\l or oltu ror slc ll howc\u. rhc boildiry or inFNvcm n sld wi6in nm rr
<br />or corphriotr rhc owkr BlikLr will haE Ihc hrdcn ol !mvin-! fid h. or dE dA ml hdild or h{dit rh. PsFny ror tlf, Fl.Ins of
<br />_l- asowmrofiic pmFny. !n.xclu\ivclycotrkrcrinc*irh ltcnsed c.nrmcroN ro connrud rh. nn+cl (S(.7044. Buri"cs
<br />and hnrc$k,n Codc: Thc C.nk.ror's Li.cnsc Law doc\ nol aptly ro r. osmr oipropcn, *lD builds oi inprov.s rhcr..i.
<br />.nd who .otrtmcrsiorsuchprclccls$irhsConlraclons)liccn$d pu^lanr t, rh. conr..kr's Ltcns lrq)
<br />I mcxcnrDr undcr Sccl
<br />Dnrq Owner:
<br />woRt(FRs.('oMPrNsATx)N
<br />IICLABAIII!!
<br />I hcrehy o,Inm undcr Dcnllryorpcriuryonc or lhc n,lhwina d(laralionrl
<br />l-rlltr Codc.li,rM ncrlhrnrncc ol lhc work ntr shich rhc Fnnir is i\\ucd
<br />workcrj .omnctrsrrtun ir r
<br />rir is issudl. My workcr'co
<br />m.c. 's rcqutcd hy Scrbn :17({) ol rhc l,Db.rC.d.. ior rhc PcrtornnnN of
<br />mlctrsaI[n iNurrEc caricr fll lolicy nr'nhcr c:
<br />94no'=1202
<br />l.cdrryrhdr inlhc pcrLlrtrkc ol lhc $o,k ld *hi.h lhntErnrir is is\u.d. I drll nor cilPloy rtry fcnon inrnY minNr
<br />$ n\ ro h&anx sublc.r hrhl worldi.omFi\ rtrn lr*\ofcdlif.rnii..rd.SBth illsh]ulJ trconr shJ.d t,rhl
<br />Norlc col\xlsrion pni!i\i,,n\ of SNrotr ]?m of rhc tihn Codc.l shrll.l'onh*irh conrply *irh rk){ provni{nr\
<br />WARNING: FanuE ro $curc wortcn' omp.nsorn n mvcfl8c is unlawtul. lnd \h,ll \uhtcr an cnploycr ro cnninal rmlrE\ lnd Icivil lii.\ ut t, oic hlndrcd rhousrnd
<br />srdtr loTri orrhl,-*-r .l", Ndc{
<br />".* /Q9
<br />d ofco'nFnrarion. d,m,8ci Ns nrovidcd for rhc
<br />DECI,AIAIION
<br />I h.Eb, aflirm undc, l)..rlryoipcriury lhar I.m lienscd undcr Fovision ofChapl€r s (comfting anh setion ?000) ofDivhion l
<br />of rncBBinessatul PofessioniCodc, dd nyliccnE n in tull foi.e,rrl.raftl
<br />oza 6az?s'.,v, s
<br />CONSIBIIqIQNIENDAG.AGENCI
<br />lhcrcby.ffiirnundcrpcnallyol,Erjuryrh0rlhqchacotrstruclionkndi4dE..yrorrhcpcrformnlcollhcporktn,hichUnpc.oirk
<br />i\sxcd (s* .10r?, civ c.).
<br />APPLICANT DECLANATION
<br />I rEn6y atrm udo p.nllly ol t'.rFry orc or lhc followi.B d(larations:
<br />Dcmlirion Pcrmirs Ar h.sroe Nor ifi. rl io. F.deral R.8uln( ions (Tirlc .l(). Pon6)
<br />R.quircd t tt.r of lloituat6n
<br />I cdify rhor rnc tudcrul rc-sular ions rcsedins astE(o! rcm,vrl m n r rp i.abk ro lhk prcJ€t.
<br />-lcenilyrharIh.vercadrhtaplrlicnrionrrl!r.rhdth.dt$!cinlomrio.is.orel.IBgrahoqiywnhrllcny.ndConnr,H:::ffi:jyr*
<br />-"-'"-"'"'"'""':"'::',"'':;Z;/Ap.m,ftn.m.,pdn,,, / tr*/ fll-z.zt-S
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unil
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
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<br />FINAL clztltR fV{xwi ?c)tl I UINotes, Remarks, Etc
<br />Pole Bases
<br />Sub-Panels
<br />Service lvleter
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