|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNDR AUILDOR DELUARATION
<br />I hcrchy rnnD undcr pcMlty of Dcrjury llul , nnrcxcm lnm rhc Conrrucktrr t,i.ci* Luw ror
<br />'hc
<br />rollowing E son (SN7011.5
<br />Dusincs\ rnd ltolesion Codc): Any Cny.r O,unty shich rcquircs ! Frfrir b .un{ru.r. altc., iDptovc. d.mohh o. rcI'lt ony
<br />nrucrurc. prir r,' ir{ issusrcc. aho rcqutcs rhc appliclnr t{, strci pcrn io fiL1lilrcd srarcnrnr th.l rEor shc t lic.nrcd purso
<br />h rhc rmvnions oa rtu Conradtr\ Liccn*d L.w (ahnprcr 9, Commcncin! *irh Sccrion 7(fi) of Division I ofrh. Bu\in.$ and
<br />Prnlcssiotrs Codc) or rhd nc or shc is cxcmpr rhcrciro'n lnn rhc nlsh tor llrc allcscd dcnprn,n A.y vn nri.nofscti,.T0ll s ht 0try
<br />applicrnr fu a Fnnir sdbFck rhc rytli.rnr tu a.ivil pc alrr of nor fttrc rh fivc hundrcdd.llaml$50O)
<br />-1.
<br />$ ormr ol lhc fiotcny. ,tr my cu]oyec\ r ilh *rgc\ is lhcir qnc .annp. \rri,nr. wlll do rlr *.l't and fic (ndurc ii nrr
<br />irrctr(lud o!olltrcd ntr {,h (Sm 7l}44, Brsinc\\ nd Pnrt\si{in\ Cnl.: 'l lr C{ rr.ktr'\ l-i.crsc L[v docs nol 0rply lo rtr o*rcr ol
<br />rh. pbti-ay slt, hxilds.r i'nprorcs lhcmtr. rtrd sh. docssl.hwork himsc]l or hcrcll or rhnD8h hh o. hcr oen enPbyc.\.
<br />lrovtlcd rhrr \uch impmvemnktm nor i c'xl(l or ollirud fr srlc l( ho{Nrr. rhcbnildir!or irnp(*.nEnriss'ltwirhi",,nc tttr
<br />ofcotrl|]ldbn.lltr Owncr Buiklcr *illh!v. rtr hudcnol l['!in! rhd lf,or \hc dil nor buitl or iD!t,v. rhr pmpcny ior rhc l)urI.{.1
<br />_1. !sowncrofrh. nmp.ny. a'ncrclusivcly.onradi'rg wirh liccn$dc.nLa.ro^ro..nsrucrrh. lrojcd lsa 7(s4. Aninc\\
<br />,trd lhfssbn Cbd.: Thc Co.irmroi! Li.cnse Lnw doc\ trot rptly ro 0n o$ncr olnrop.n! who builds or inpiovcs rh$con.
<br />lnd *ho.onlncl\torsucnnnjecboirhBConrn.'o(tlianscdpu^udturhccunt((r'sLi.cnstjw)
<br />-l
<br />m cicnfl utulcr S6rio U & PC f$ rlri\ Rr{nl
<br />!!}atrEBs:laufENlarloN
<br />DECI.ANAIIAN
<br />I hcrch,rlliirnundcr n.idry.f Niury.tuol drfulhving.l.clnftrn s
<br />-lhavc
<br />anduillminrain a Ccniicarc ol Consnr ro Scltlnlurc fq *orkcn compcns,lio.rs ptuvidcd for bySccli :17(x)ollhc
<br />L2hor Codc. for lhc pslorm.rc. of lhc un* for whicn rhe Fn.il h nsued.
<br />I hrvcrnd $illnuinrrin NorkN cohtcd\rrn,n inlurxkr, r rcquncd hyS.rrn)n:17(X)(l rhc hborCodc.lorlhc pcrturmrNcof
<br />rlr *ork ntr whi.h rhtl.dnir iJ irsud Myworkd{ co lf,nsdi.n insunncc cdricrrlxlt licynu,nhcr n:
<br />\"., r^n.- Afhn^^- .V- l,.- t"ftrj-
<br />vJve-<o1<12-K-5 a 1 / rdi/1
<br />lcnify rhrr i'rrhc pcrfo utu.,,frh.workld*h'chrhi\r.rniriis{cd.IrhnllnorcnDloyurync^oDinrnynrnicr
<br />$ as h b.Lrnm subjd Io lhc workc6' .onuu{rl nr l{!s ol Colifonri( and lts'rc rlHr ii I \hoold b.to . sub].cr to rhc
<br />s.rkds coNtrtrs{r ior |) ovisions ol Scctnnr :]r(x).l r hc ltr'tfl Codc, l dEll. r{nhsirlr .o rfly wirh rln,s lrovisions
<br />TVARNINC: lrrilure ro surc u.r*cs
<br />civil rnB\p ro .ne huod,cd rhousrnd
<br />Sccrion :1076ol rh.lrhorCode.inrcrc(
<br />covcri8c i( unLwlnl, rtrd \hrLl suhjc.r rn cN oycr to oimiml pcnrhis rnd
<br />-(XXr. in diiion b rhc .od of.. 1F-ns ion. dsnra8cs at lx,viicd l( lhc
<br />YI orl ls tYlY, r1,..-
<br />DECIAMIIIJN
<br />I hcEby arfirn udo Fnaly ol Frrury rhd I rn liNn,.n und.r !tuvision of Chaplcr 9 (commmin8 wilh Scrbn 7000) or Divhion l
<br />of 6. Busincs and Pmfcssions Codc. ajn hy liccn{ is in {ull ,oG !n elrftr
<br />c-q( ,/,,*,*"*,,;q4{307-
<br />L tx ea lL#" b\}:."-
<br />!ONSIBIJI:IIONIIND]NC-&AEIII
<br />I hcrct'y aiiirm undcr pcnalryol perjrry rhd rhs. isn con{rucrion lcnding s!.tuy for rhc pct,t',noNc otthc wotk for ohich rhk Frnri n
<br />nsucd (Scr. 109?, Civ. C.l.
<br />Lcndcls Ad&css:
<br />-
<br />AIILICANLIES,AAA.IIA!
<br />I hclEby dlnn undcr pcnolly of pcrjury onc ol lhc lollowin8 d(lararions:
<br />Dcmoliri.n Prnrns Ash.sos Nolification Fedcrtrl RcSulol ions (Tnt 40. Prn6)
<br />R.qun€d kncr of Noiincaliotr
<br />-l
<br />(.f,iiyrhll ihc ttdcrul rcguhrnrns rcglrdin8 0$cskx rcrB'vol !rc nor lppli.abl. t, rhis PnU-cl
<br />lcMifyrhrtIhav.dMrhisdptli.rrmn&xl*rcrh rhctrhvc informalion nc.nccl llgreloco'nplywirhrllCiryrtrdCounry
<br />rrdiir.cs md Srarc lf,$\ rclar
<br />'o
<br />buildins conntu.(t,.. 0fi1 turcby authornc rqncr.llrives of rhn C y and Counry ro ctrrn uno. rr*
<br />hr. nFnri,incn |n)plny ir
<br />,\ppliont or Aletrl Signont 1l
<br />Wrtu Cc.o
<br />*.., rf z>l rf
<br />Site-Work
<br />Underground
<br />Pole Bases
<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 Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rouqh
<br />Service lVeter I
<br />X /zcFINAL /h 4.k ?4,1)
<br />Notes, Remarks, Etc.
<br />ID/SIG.
|