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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DELCARATIoN <br />I hcrchy rlirm undcr Fn{lty ol F.rru.y ihar I dn.rc,n lrcfl1 rhc G,nrscro^- Licens li* f(tr r}F follo*ing rca$n (Scc Toll 5 <br />tlusine* snd P(nision Coder Any City or Counly qhich tqxircs I lctmil ro cunirucr- !lts. i6lnrv.. d.nmlnh or tNr lnv <br />{ru.rurc. nriDrh n\ i\su.n... als rcquirsrhc lrPli.anr for such pctmir t, fik i si8rcd slsremni rh,t hcor shc h li'c's'i pur{anr <br />k' lh. lr'ovhions of rhc ConlBctnis Li.cnscd Lrw (ChoPrt! g cohncncin8 *irh sclion ?tmo ol Divhbtr I of rh' Susinc$ lnd <br />Pbrc$n,.\ codc) o!thar h..rshc is cxcnrpl lhscfn,tonndrh. h!* f.r rhc llLCcd crcnrflion AnvvnnriionotSc''i'n70ll5hvtnv <br />rypli.anr for apcmn \ohj*F rhc oPplicanr k, dcivilpcnlllyolnol tu)nrhrn livc hundrcd dollfi(Ss(xJ) <br />l. ar o$ncr ol lhc pmp.ny. or my cmtk,trcs wirh w,ecs $ rhcn $h conll.nQr ion- sill do rtE *() orxl rht ntrtw is nor <br />inrcn,lcd or .rcrcd ttr ;b l!a.7rx4, ausinc$ ond Profcs\i,ns c(xlc: Tnc Conrrlcrors Lkcn* ljN dk\ mt opdv lo sn own'r of <br />rhc ln,pcdy qh. hildsor iryn)€srh€@n.,nd whodm!rkheor* himsclforhcrclforrhouAhhisorhcro*n'mflovec\' <br />Irovid.d rh.r nroh impmvmnkm mt int cd oltcrcd lor lth lt lmvers. rht t{iHir8 or imlmtrEnr i\sld*iihinonc )t! <br />;f corlphrio . rh. o*rcr Buildcr will h,!. rhc hudcn ol ptolin! rhtrr h. or sh. dil rur t{ild or iqrave rhc pmtcnv nn rlt pu{'os f <br />l. *.wtrcrolthc Fn'ndy. ancx.lusivclycontacrntS wiih li.cnscd.onri.rn r' c.nsrtocr rh Pn'Jd (Scc 7(N4. Bu{ne$ <br />! i Frfc$hn Cod. ThcContrlctn s Licc.sc bwd.cs noi anplyro m.*nc. ol FJr.ny sho buildsor nnProv's rhcrcon' <br />rnd *ho otrlmcF fir skh lsicls wirh a Conra.t,(r) li.cn{cd Pur\o, ro rhc Conrrlctr's Ltctr\c Las) <br />_l ncxcnrpt undcrSdrior <br />D.l. : <br />I hcrchy illtD rndcr Irnrlry.flEriury oN ofrhc lnlk <br />Ihrr.misillf i"n rCcn licrrtnlCo \c rriS.lflo\u'clrr\ork.rfr.fDcn\rhon.r\ |nrv cJ tur hy Sccli{,n.l7lr) ofrhc <br />tih.r Cdc. for lhc pcltutune ofrhc w'* tor shhh rhc rdmil k hsucd. <br />t h.rc lndwill mii'nrin sotkcrr conFn{arion insuramc- as rcquh.d hySccrirn lTmorrhc t tor Codc, ror rh' !c omn'col <br />rhc wolk tor whth lhis pctn r is hsu.d Mywor*.n on{En\dion insumnc. caricr dld Plicv nunh.r ftl <br />l',,1i.)_ Nun,hrr:_ExIncs:_ <br />-lrcnLlr-rhdtirth.F-rfttr@n.colrhcqorklnrrhi.hrln\lcrnril <br />i\ t\u.d.I \hrlltrol ctrPk)yniy |{non inrny rnmr <br />*, ar h hcconr suhjcd t) ihc so c6' con{Lis r ion l.ws ol Crlifonrir. rnd l8N rhrr ii I sk'uld h.coN {h]'d to rhc <br />sorkcF .onrpcnuri{nr nvki.nr ofSLrrnnr:17(lr of rlN lihtr Cod.. l \hall. lnnhwirh comnly wirh rhot ln vhions <br />.nil fiir\ up h onc huDdrd rhor\rtul (lollrrs (!l(Xr'lrI)r. irr .i,in h ihc ..{ .l .onll[!(lrrrrr\ r. f'o\kl(11 1o. ih. <br />S..r(nr 1or6.l rlr Ixhin (inl! <br />Ih.rcht 11fiD utr{lor r^_ rlr! oT tcUtr'y rhxr I Iltctrsd nnrntrrr"l(hrflcr'r(.onnrf,n.in!*irhSc.ri 7(xx))orll'ri\i.n I <br />of rlt Ar{N$ rl ltoli\\i( \ C.dc. nftlnry irttr\c <br />l ( cr\'( x\ <br />CIJIIIBIJCITAMENDINGAAEBS <br />Ihcrcny trfti,mxndrr tctrrllyolr.rjuryrh.rlhse n !otr{rurri,n hndinslscnc} r.r rhc Pcrlornun.c orrhc*ork rffwhichrh P'rmir n <br />kn'.d rs.c 1o9? Cir C.r. <br />txndci\ ddrr$: <br />- <br />APPLICAN'I' DFCLAR,\T!(IN <br />l,rrhy timo'd.r p.nrhy of ncrjrry.nc nlrh. nnnr$insddclan irtrs: <br />Dcnxnnion Pcrn,ir\ str{os Noritir ion F.dctrlRcsukri.ns (l'irlc 40. Prn6r <br />Rcquiren I c(.r.1 N"rrlictrr.tr <br />-l cc ilirhrr rhc Ln.rrlrceuhr.n\ Ngnrdins x\h.no\r. x ilrrc nor JPrli.rblc rolhn pn+cr <br />l.c rlyrhd lhrkuJrlNtJitilicrr(,nxnd(rtrhrrrh.rtx <br />orthnxnr.\.trrl sr11.l r\...1 irr! r, htrillli" <br />Lh,\. tr,.fr .n.d I','Nnr_ tu, <br />,\pplirntrl r/\gcni Sixn l <br />)ve in{nmrion h cotrccr L8rc lo cotr!,ly wnh aI Cn, lnd couily <br />I thh C , snd Counry !o Fnrn u|l.n tll <br />/U\ D.I' <br />Site-Work <br />Underoround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Founlains <br />Sions (monument) <br />Lile Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduil) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />[\4eter Release <br />Rouqh <br />Service ltileter <br />FINAL Llzt ln d4r4/^1 <br />Notes, Remarks, Etc